Liver injury in coronavirus infected patients: the experience of a COVID-19 dedicated hospital in lombardia, italy

ABSTRACT

Background: In December 2019, a new contagious disease, named COVID-19 and caused by a novel coronavirus (SARSCov- 2), emerged in Wuhan City, China, and is now spreading across international borders Although the disease mainly causes respiratory symptoms, it can also cause impairmentof other organs Interestingly, in many cohorts of patients infected with SARS-Cov-2 it has been noted a more or less significant increase of transaminases, however the real impact of such alteration on liver function is currently unknown This study aimed at evaluating the impact of COVID-19 on the liver function and the clinical outcome of these patients Methods: In this monocentric retrospective study, patients admitted at the ASST-Papa Giovanni XXIII-Bergamo with diagnosis of COVID-19 between 1stMarch and 30thApril 2020 were enrolled A significant increase of hepatic cytolysis was defined as ALT ≥5xULN. Impairment of liver function was defined as association of ALT ≥5xULN with bilirubin ≥1.5 mg/dL and/or INR ≥ 1.7. Results: One thousand two hundred sixty three patients with confirmed SARS-Cov-2 infection were enrolled (mean age 66 years, 76% males). A significant increase of ALT was present in 47 (4%) of patients and among these 8 (17%) and 3 (6%) presented bilirubin ≥1.5 mg/dL and/or INR ≥ 1 7, respectively Eleven/forty seven patients (23%) died after a median of 5 (1-21) days since COVID-19 diagnosis, with 30-day-mortality rate of 19%, nobody for liver-related causes Age and creatinin were the only independent predictors of mortality. Moreover, mortality rate was no significantly increased in patients with ALT ≥5xULNcompared to patients with ALT <5xULN (p=0 94) Conclusion: Infection for SARSCov- 2 may result in increase of transaminases however it is not associated with significant impairment of liver function and increase of mortality.