Liver Function Tests Deteriorate with Increasing Severity of COVID19: A Single Center Large Retrospective Study of Indian Patients

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a respiratory system trophic disease. Liver involvement is emerging from recent data. Studies describing liver function test (LFT) abnormalities are sparse from our population. Aims: We studied LFT abnormalities in different categories of COVID-19 and its significance in relation to primary outcomes of in-hospital mortality. Methods: It was a retrospective study from a single center of a metropolitan city. All consecutive patients with proven COVID19 by reverse transcriptase-polymerase chain reaction from 23rd March 2020 till 31stOctober 2020 were enrolled. Of 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Results: Deranged LFTs were present in 681/1474 (46%) patients. Hepatocellular type of injury was most common (93%). Patients with deranged LFTs had more probability of developing severe disease (P<0.001) and mortality (P<0.001). Higher mean age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), chronic kidney disease (P<0.02) cirrhosis (P<0.001), lower oxygen saturation (SpO2) levels at admission (P<0.001), higher serum creatinine (P value<0.001), D-dimer levels (P<0.001) and positive radiological findings on Chest X-ray (P<0.001) were associated with deranged LFTs. Acute liver injury was seen in 65 (4.33%) cases on admission and 57(3.5%) cases during hospital stay. On admission, raised serum bilirubin, aspartate and alanine transaminases, international normalized ratio and low serum albumin were found to be significant. However, on multivariate analysis for predicting mortality, age, serum creatinine, and PaO2/FiO2 ratio only were found to be significant (P<0.001). Conclusion: In COVID-19, LFT abnormalities are common and multifactorial. As severity of disease progresses, derangement in LFT’s increase. However, it is not associated with in- hospital mortality.