Liver function abnormalities in during and after SARS-CoV-2 infection
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Reviewed by Nhi Le, B.A.
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Posted on September 14th, 2022
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Previous studies had reported that those infected with SARS-CoV-2 experience abnormal abnormal liver function tests (A-LFT). However, it is uncertain if the problem resolved itself after viral clearance or if hepatological function disruption is a hallmark of post-acute COVID-19 syndrome. A recent article published in the Journal of Viral Hepatitis had reported their finding on the matter.
The study retrospectively looked at the health data from 595 patients who had been admitted to the hospital due to COVID-19. The study found that 61.5% of the patients experience A-LFT; with the majority (38.3%) is grade 1. Grade 2 and 3 prevalence is similar, 11.8% and 10.4% respectively. Grade 4 A-LFT is the least common (1.0%). Abnormality in the liver function occurs mostly in the form of elevated ALT and AST level (99.2%); raised TBIL level is less common (6.8%). In terms of severity, 41.8% of them were diagnosed with severe COVID-19, 40.5% had a P/F ratio below 200, and 16.1% needed to be admitted to ICU. More of those with severe COVID-19 experience A-LFT (78.3%) than those with moderate infection (49.4%).
After the patients had been treated and discharged from the hospital, 153 of them were followed up for a median of 6.1 months. 10.3% of them passed away during the surveillance period and there is no difference in mortality rate between those with abnormal or normal liver function. Also, there is no association in A-LFT status between when the patients had been admitted or during the follow-up phase. However, it is mostly driven by other comorbidities such as fatty liver disease, hypertension, diabetes, and obesity.
The effect of SARS-CoV-2 infection on liver function has many explanations including hyperinflammatory response, effect from metabolizing medical treatments, and hypoxic injury due to reduced oxygen saturation level. In addition, hepatocytes and cholangiocytes express ACE2 and TMPRSS2 that the SARS-CoV-2 virus can use to enter and infect the cells. The direct cytopathic effect is further supported by the fact that the SAR-CoV-2 genome and viral particles can be detected inside hepatocytes.
The study retrospectively looked at the health data from 595 patients who had been admitted to the hospital due to COVID-19. The study found that 61.5% of the patients experience A-LFT; with the majority (38.3%) is grade 1. Grade 2 and 3 prevalence is similar, 11.8% and 10.4% respectively. Grade 4 A-LFT is the least common (1.0%). Abnormality in the liver function occurs mostly in the form of elevated ALT and AST level (99.2%); raised TBIL level is less common (6.8%). In terms of severity, 41.8% of them were diagnosed with severe COVID-19, 40.5% had a P/F ratio below 200, and 16.1% needed to be admitted to ICU. More of those with severe COVID-19 experience A-LFT (78.3%) than those with moderate infection (49.4%).
After the patients had been treated and discharged from the hospital, 153 of them were followed up for a median of 6.1 months. 10.3% of them passed away during the surveillance period and there is no difference in mortality rate between those with abnormal or normal liver function. Also, there is no association in A-LFT status between when the patients had been admitted or during the follow-up phase. However, it is mostly driven by other comorbidities such as fatty liver disease, hypertension, diabetes, and obesity.
The effect of SARS-CoV-2 infection on liver function has many explanations including hyperinflammatory response, effect from metabolizing medical treatments, and hypoxic injury due to reduced oxygen saturation level. In addition, hepatocytes and cholangiocytes express ACE2 and TMPRSS2 that the SARS-CoV-2 virus can use to enter and infect the cells. The direct cytopathic effect is further supported by the fact that the SAR-CoV-2 genome and viral particles can be detected inside hepatocytes.