Evaluation of liver alterations in patients with post-acute covid-19 syndrome-a pilot study

ABSTRACT

Introduction: Patients suffering from the novel coronavirus disease 2019 (COVID-19) could experience several extrapulmonary involvements, including liver injury. As the COVID-19 infection continues, and more and more people get infected, we must consider the long-term consequences of this disease since several studies reported persisting symptoms after the infection [1]. Aims & Methods: This study aims to evaluate the presence of liver injury in patients with post-acute COVID-19 syndrome using a liver elastography (LE) study. 70 subjects recovering from COVID-19, and attending the hospital's specialized outpatient clinic for persisting symptoms (fatigue, shortness of breath, chest discomfort, palpitations, reduced exercise capacity) at 3 to 12 weeks after the acute illness were included in this study. All patients had a basal COVID-19 assessment (clinical exam, laboratory findings, thoracic computer-tomography), and subsequently, a clinical evaluation, laboratory tests and LE study. LE study included liver fibrosis, steatosis and viscosity evaluation in the same session using the Aixplorer MACH 30 system ShearWave Elastography (2D-SWE.PLUS), Sound Speed Plane-wave UltraSound (SSp.PLUS), Attenuation Plane-wave UltraSound (Att.PLUS), and Viscosity Plane-wave UltraSound (Vi.PLUS). Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) (FibroScan) were performed in the same session. Patients treated with antiviral therapy known to induce liver injury, patients with known liver disease and with contraindications for liver elastography, were excluded. Results: 70 subjects (mean age 43.5±10.3 y, 41% males) with confirmed COVID-19 infection were included. According to the presence and severity of the pulmonary injury assessed on TCT at the initial evaluation, study subjects were divided into 2 subgroups (with and without pulmonary involvement). LS mean values by TE, Vi PLUS (PaS) and CAP (db/m) values were significantly higher in subjects with pulmonary injury (n= 35) compared to those without (5.27±1.58 vs. 4.36±1.54 kPa, p=0.017;1.77±0.28 vs. 1.62±0.24 PaS, p=0.018;300.51±79.88 vs. 262.60±61.83 db/m, p=0.029), while no differences were found between LS by 2D-SWE PLUS and Att. PLUS values (5.27±0.99 vs.4.89±0.82 kPa, p=0.084;0.47±0.11 vs. 0.44±0.10 dB/cm/mHz, p=0.236). According to the time elapsed from the COVID-19 diagnosis until liver elastography evaluation, subjects were divided into two subgroups with assessments performed in the first 8 weeks-38 patients and within 9 to 12 weeks-32 subjects. LS mean values by TE and Vi PLUS values were significantly higher in subjects evaluated in weeks 9-12 after diagnosis, compared with those evaluated earlier (5.23±2.01 vs. 4.47±1.09 kPa, p=0.048 for TE and 1.78±0.30 vs. 1.60±0.19 PaS, p=0.008 for Vi PLUS, respectively), while no differences were found between LS by 2D-SWE PLUS (5.19±0.88 vs. 4.92±0.93, p=0.26). Conclusion: In patients with post-acute COVID-19 syndrome, persisting symptoms could be explained by residual lesions, whose severity is greater in more severe COVID-19 forms. These patients may be at risk of developing liver fibrosis and should be investigated in this regard in the first 12 weeks after the onset of the infection.