Changing features of liver injury in COVID-19 patients: Impacts of Infection with the SARS-CoV-2 Delta (B.1.617.2) variants

ABSTRACT

Objectives: In many studies, abnormal liver function test has been reported in more than half of the COVID-19 patients. However, it is not known for the liver involvement of the virus according to the strain. We investigated the features of liver injury in the COVID-19 patients with the SARS-CoV-2 Delta (B.1.617.2) variants. Materials and Methods: We performed a retrospective study that included 375 patients between 1 February 2020 and 31 November 2020 (pre-Delta period (PDP) group) and 125 patients between 1 August 2021 and 31 August 2021 (Delta period (DP) group) hospitalized for COVID-19 at National Medical Center in Korea. Initial liver injury was defined as ALT or AST levels ≥ 3 9 upper limit of normal (ULN), or ALP or total bilirubin ≥ 2 9 ULN within 3 days from admission. Severe COVID-19 was defined as respiration rate ≥ 30, oxygen saturation ≤ 93%, or oxygen requirement with pneumonia. Results: Of 500 patients with COVID-19, 301 (60.2%) had abnormal liver test and 43 (8.6%) had liver injury within 3 days. The patients with abnormal liver test were similar in both groups. (58.4%vs60.8% P = 0.635). On the other hand, the DP group had a significantly higher proportion of liver injury than the PDP group (15.2% [n = 19]vs.6.4%[n = 24], P = 0.002). The DP group (Odds ratio (OR), 2.539;95% confidence interval (CI), 1.211-5.325;P = 0.014), patients with pneumonia involvement over 50% of lung field at admission (OR, 4.982;95% CI, 1.966-12.625;P = 0.001), younger patients (OR,0.963;95%CI,0.940-0.988;P = 0.003), lower creatinine at admission (OR,0.132;95%CI,0.028-0.631;P = 0.011), higher CRP at admission (OR,1.009;95%CI,1.003-1.015;P = 0.002) were independently associated with liver injury. During hospitalization, 164 patients had severe COVID-19. The DP group and initial liver injury were high odds of progressing to severe COVID-19 (OR 2.867;95%CI 1.244-6.608, and OR 3.229;95% CI 1.131-9.219, respectively). Conclusion: Initial liver injury is more common in COVID-19 patients with Delta variants. Also, Delta variants is associated with poor clinical outcomes. Therefore, careful monitoring in COVID-19 patients with Delta variants is needed.