Features of liver injury related to COVID-19

ABSTRACT

Objective — to study the character of liver function tests' changes in patients with COVID — 19, assess the rate of their onset, their clinical and laboratory manifestations and degree of COVID-19 effects on the liver function with the purpose to implement treatment and preventive measures. Materials and methods. The study included 120 medical records of inpatients with COVID-19, hospitalized in the departments of Clinical Hospital № 8, reprofiled to the infectious wards in the period between November 2020 and April 2021. The most patients were aged 60—69 years (41.7 %) and older than 70 years (25.0 %), the minor portion was younger than 40 years (1.7 %);women prevailed (65.0 %). Results. The increased hepatic transaminases levels were revealed in 52 % of patients, and total bilirubin (especially indirect) was raised in 15 %. Higher transaminases levels, severe course of coronaviral disease and unfavorable prognosis were more common in male patients. Frequency of SARS-CoV-2 — associated liver injury with minimal grade of activity of liver transaminases prevailed in women older than 60 years and men aged 50 to 69 years. COVID¬19-associated hepatitis with moderate activity was observed in women aged 50—69 years and men of working age (40—49 years) and elderly (> 70 years) patients, high degree of transaminases' activity against COVID¬19 background was registered only in men aged 40—59 years with moderate to severe COVID¬19 course. Lethal outcomes due to severe pulmonary injury were registered in 19 patients with severe COVID¬19 course;they also had liver dysfunction. From them, 11 had diagnosed liver steatosis before COVID-19. The most part of deсeased due to COVID-19 were older than 60 years and had a history of comorbidities (type 2 diabetes mellitus, hypertension, coronary heart disease, non-alcoholic fatty liver disease, liver cirrhosis and 2—3 grade obesity). Conclusions. Hepatic impairment occurred in 52 % of inpatients with COVID-19. All patients with moderate course of coronaviral disease demonstrated positive dynamics of transaminases and bilirubin levels and favorable prognosis after hospitalization due to COVID-19. Most of them hadn't had liver injuries before coronaviral disease and six patients had been diagnosed with liver diseases before COVID-19. No cases of fatal liver failure were registered. After in-hospital treatment, the transaminases levels were lower in patients, who hadn't had history of liver diseases before COVID-19 and received hepatoprotective drugs. Treatment with glutathione and ursodeoxycholic acid was confirmed as the most effective therapy in patients with coronaviral disease. © Сучасна гастроентерологія, 2022.