Clinical Features and Liver Injury in Patients with COVID-19 in the Japanese Population.

Objective Liver injury is a notable complication of coronavirus disease 2019 (COVID-19). This study aimed to clarify the clinical features and liver injury in Japanese patients with COVID-19. Methods We conducted a multicenter retrospective cohort study. All consecutive patients with COVID-19 who visited or were admitted to our hospital before May 12, 2020, were enrolled. Their demographics, symptoms, laboratory findings, comorbidities, concomitant drugs, treatment, and clinical course were reviewed. We defined liver injury as alanine aminotransferase (ALT) or gamma-glutamyl transferase (GGT) levels over the upper limit of normal. Results Twenty-two patients with COVID-19 (median age, 47 years old; men/women, 13/9) were enrolled. Two patients had underlying liver diseases, and two were diagnosed as having COVID-19 without any symptoms. Elevated ALT and GGT levels were found in 12 and 12 patients, respectively, and liver injury was observed in 15 patients (68.2%). Compared with the patients without liver injury, those with liver injury had a significantly higher fever during the clinical course (median, 37.5°C vs. 38.8°C, p=0.006). A significant correlation was found between the highest serum liver values and the highest body temperature in each patient. Among the 22 patients, 4 required artificial respiratory support, and 2 died thereafter. Liver injury was not associated with the severity or mortality of COVID-19. Conclusion Elevated levels of liver enzymes in the Japanese patients with COVID-19 were associated with the highest body temperature during the clinical course but not with the severity or mortality of COVID-19.

[Rapid Diagnosis of COVID-19 in A Patient without A Positive History of Contact Who Presented with Severe Hypoxia：Case Report]

We report the case of an 85-year-old woman who was transported to our hospital by ambulance with progressively worsening dyspnea and hypoxia. She had no history of contact with any patient with coronavirus disease 2019 (COVID-19). The peripheral arterial oxygen saturation level on a 10 L/min non-rebreather-type mask was as low as 80%. Chest auscultation revealed coarse crackles. After emergency intubation, it was surmised that the probability of heart failure was low because of the lack of pink, frothy sputum. Bacterial pneumonia was also considered to be unlikely, as the sputum was not purulent. Moreover, laboratory data revealed a normal white blood cell count (6,100/μL) and no elevation of the serum procalcitonin level (0.63 ng/mL), which were also consistent with the condition not likely to be a bacterial infection. Pulmonary thromboembolism was ruled out by the presence of coarse crackles on chest auscultation and normal blood pressure. Thereafter, the possibility of COVID-19 was considered and the patient was immediately isolated. Two days later, the polymerase chain reaction test for COVID-19 returned positive. There was no evidence of transmission of the virus to the healthcare personnel who had treated this patient, including the 6 with medium-risk exposure, during the 3-week period after the exposure. In the COVID-19 pandemic era, rapid differential diagnosis of hypoxia is essential to prevent further transmission of SARS-CoV-2 infection. Our case highlights the importance of the sputum appearance/characteristics and laboratory data for rapidly ruling out diseases other than COVID-19.