ABSTRACT
Aim: To evaluate the prevalence of liver dysfunction and its correlation with severity and mortality in patients with Covid-19 infection. Materials and methods: Total 120 patients fulfilled the inclusion criteria were enrolled for the study after giving informed consent and were divided into two groups (moderate and severe Covid-19 infection). Patients were treated as per national guideline for Covid-19 infection as mentioned in flow chart above. Hemogram and Liver function test and inflammatory markers (C-reactive protein, Lactate dehydrogenase, D-dimer and ferritin) were performed on every alternate day of hospitalization. Patients were followed during whole hospitalization course and weekly for 1 month after discharge with these tests. Approval for the study was sought from Institutional Ethical committee. Results: The median levels of ALT, AST, ALP, GGT, LDH, TBIL, DBIL, and albumin were 20 U/L (IQR, 14–31), 20 U/L (IQR, 17–26), 75 U/L (IQR, 55–193), 21 U/L (IQR, 14–36), 198 U/L (IQR, 172–232), 8.4 umol/L (IQR, 6.5–11.3), 3.4 umol/L (IQR, 2.3–4.6), and 45 g/L (IQR, 41–47), respectively. Severe patients had significantly higher levels of ALT (26 vs 20 U/L, p=0.017), AST (31 vs 20 U/L, p < 0.001), GGT (30 vs 21 U/L, p < 0.001), LDH (334 vs 197 U/L, p < 0.001), TBIL (10.2 vs 8.3 umol/L, p=0.029), DBIL (4.9 vs 3.3 umol/L, p < 0.001), but significantly lower albumin (37 vs 45 g/L, p < 0.001) than non-severe patients. Abnormal AST (40% vs 7%, p < 0.001), LDH (90% vs 35%, p < 0.001), DBIL (20% vs 7%, p < 0.001), and albumin (50% vs 8%, p < 0.001) were commonly observed in severe patients, compared with non-severe patients. On multivariate analysis, age >60 years, male gender, BMI > 30 kg/m2, comorbidity, abnormal LDH and albumin on hospital admission, and abnormal peak hospitalization LDH and albumin were associated with progression to severe COVID-19 (OR > 1;p < 0.05). Conclusion: This large sample retrospective cohort study, we described the longitudinal changes of liver function parameters in patients with COVID-19. In addition, we con-firmed patients with abnormal liver function parameters were at increased risk of severe COVID-19 and death.
ABSTRACT
Patients with novel coronavirus disease 2019 (COVID-19) are at significantly increased risk for mortality and morbidity. Current management remains supportive care, ranging from symptomatic outpatient management to full-intensive care support, including intravenous fluids, invasive, and non-invasive oxygen supplementation. In patients with septic shock, treatment with antibiotics and vasopressors are recommended to keep mean arterial pressure (MAP) ≥ 65 mm Hg and lactate < 2 mmol/L. Because of the lack of effectiveness and possible adverse effects, routine corticosteroids should be avoided unless they are indicated for another reason (exacerbation of asthma or chronic obstructive pulmonary disease [COPD], and septic shock in whom fluids and vasopressors do not restore hemodynamic stability). There is currently no sufficient evidence of efficacy of hydroxychloroquine/chloroquine, remdesivir, and other antivirals in the treatment or prevention of COVID-19. Limited evidence shows that COVID-19 convalescent plasma can be used as a treatment of COVID-19 without the occurrence of severe adverse events. Drug regulatory agencies granted an emergency-use authorization of chloroquine/hydroxychloroquine and remdesivir to treat patients when a clinical trial is not available or participation is not feasible. Chloroquine and hydroxychloroquine are associated with QT interval prolongation and life-threatening cardiac arrhythmia in patients with pre-existing cardiovascular disease. Guidelines are issued for use of convalescent plasma in patients with serious or immediately life-threatening COVID-19. Data from several ongoing randomized controlled trials will provide further evidence regarding the safety and efficacy of these drugs for the treatment of COVID-19.