The impact of COVID 19 on admissions with a severe acute liver injury

ABSTRACT

Background: The most common causes for an acute liver injury (ALI) in patients admitted to hospital has evolved over the past several decades. This can be attributed to largely by advancements in the treatments of viral hepatitis, alongside increasing co-morbidities in an ageing population. Our study aimed to assess the most common causes for an ALI (defined by ALT >700 IU/mL) in patients admitted to the acute assessment unit (AAU) over a 12 month period where COVID 19 was declared a global pandemic, and accounted for a rising proportion of hospital admissions. Methods: A search was performed between April 2020 and April 2021 of all patients admitted to the AAU with an ALT of >700 IU/mL. A review of patients electronic notes was undertaken to obtain information on the reason for admission, patient demographics and comorbidity, evidence of synthetic liver dysfunction and cause of ALI. Results: A total of 61 patients were admitted with a severe ALI over this 12 month period. There were an equal number of male (n=30) and female patients (n=31). The mean age was 58.7 years, range 23-99 years. The most common cause for an ALI was an ischaemic hepatitis (31.1%, n=19). Other causes for an ALI included;pancreatobiliary causes (21.3%, n= 13), drug induced liver injury (DILI) (18%, n= 11) which included acetaminophen overdose (n=4) and other drugs (n=7), COVID 19 infection (9.8% , n=6) and acute viral hepatitis (4.9%, n=3). The table below illustrates the difference in mean age and laboratory parameters between patients who experienced each type of liver injury. Inpatient mortality rates were highest in the patients with an ALI secondary to COVID 19 (66.7%, n=4) followed by those with an ischaemic hepatitis (36.8%, n=7). There were no reported inpatient deaths in patients with an ALI secondary to pancreatobiliary, drug induced or viral hepatitis. Conclusion: COVID 19 has been widely reported to cause acute rises in the serum transaminases, however this study demonstrates that the insult can occur in comparable degree to the other leading causes of ALI such as acetaminophen overdose and ischaemic hepatitis. These patients were older, with a higher mean ALT and creatinine. They were also found to have a higher degree of cardiovascular comorbidity which was in keeping with the risk factors associated with hospitalisation in COVID 19 infection. The higher mortality rates in these patients suggests a severe ALI as a marker of poor prognosis in patients admitted with COVID 19 infection.