Characteristics of liver injury in cases of COVID-19.

In novel coronavirus disease 2019 (COVID-19), liver injury was found at a high rate, and reports from outside Japan revealed that such injury was related to severity. We examined the characteristics of liver injury in 15 cases of COVID-19. Thirteen of these patients received antiviral therapy, such as favipiravir, remdesivir, and hydroxychloroquine. Liver injury was observed in eight cases at admission for COVID-19. The hepatic CT attenuation values at admission were significantly lower in nine patients who developed liver damage or showed its exacerbation during the treatment than in the remaining patients. Drug-induced liver injury due to antiviral drug was suspected in six cases. Liver injury due to COVID-19 may be related to low hepatic CT attenuation values and be modified by antiviral drugs.Copyright © 2021 The Japan Society of Hepatology.

Liver injury in patients with COVID-19 who received dexamethasone monotherapy

Introduction: Liver injury is frequently seen in coronavirus disease 2019 (COVID-19), and it has been reported to be associated with the severity of COVID-19. The direct action of the virus, cytokine storm, coagulation abnormalities, drug-induced, etc. are considered to be the causes of liver injury, and antiviral agents against COVID-19 and steroids used as anti-inflammatory agents have also been reported to contribute to the appearance of liver injury. In Japan, remdesivir, dexamethasone (Dex), baricitinib, etc. are used as therapeutic agents for COVID-19, but there is still not enough evidence about the frequency of liver injury as an adverse event. Aims & Methods: This study aimed to clarify the influence of Dex monotherapy for liver injury in COVID-19 with respiratory failure. We examined 171 patients with COVID-19 with liver injury in the respiratory failure groups and the nonrespiratory failure groups and investigated 41 patients with moderate COVID-19 with respiratory failure who received Dex monotherapy in the liver injury group and the nonliver injury group at the time before treatment. Result(s): The respiratory failure group had 64% more liver damage than the non-respiratory failure group, was older, had more men, and had significantly more complications of lifestyle-related diseases such as hypertension and diabetes. Obesity was more common in the liver injury group prior to Dex monotherapy, and the liver CT value was significantly lower than in the non-liver injury group. Liver injury worsened in 41% of patients after Dex monotherapy, but there was no significant difference in the frequency before Dex monotherapy between the liver injury group and the non-liver injury group, and the degree of liver injury was mild in all cases, improving in 38% of the liver injury group. Conclusion(s): Dex monotherapy was a safe treatment for moderate COVID-19 with respiratory failure, which frequently resulted in liver injury.