Liver function tests often elevated in COVID-19

Last Updated: 2020-04-21

By Marilynn Larkin

NEW YORK (Reuters Health) - More than a third of SARS-CoV-2 patients in a single center in China had elevated liver function tests, researchers report. U.S. experts suggest the finding is unlikely to be worrisome.

Dr. Jilin Cheng of Fudan University in Shanghai and colleagues studied 148 consecutive patients with confirmed COVID-19 (about half men; mean age, 50) at the Shanghai Public Health Clinical Center from January 20 through January 31, 2020.

Abnormal liver function was defined as increased levels of alanine and aspartate aminotransferase, gamma glutamyltransferase, alkaline phosphatase, and total bilirubin.

As reported in Clinical Gastroenterology and Hepatology, 55 (37.2%) had abnormal liver function on admission, of whom 14.5% had high fever (compared with 4.3% of those with normal liver function).

By February 19, 92 of the patients had been discharged, and one had died who was critically ill on admission with complex underlying diseases.

Patients with abnormal liver function were more likely to be male, and had higher levels of procalcitonin and C-reactive protein. No statistical between-group difference was seen in drugs taken before hospitalization; however, a significantly higher proportion of patients with abnormal liver function had received lopinavir/ritonavir after admission (57.8% vs. 31.3%).

Patients with abnormal liver function had longer mean hospital stays (mean, about 15 days) than patients with normal liver function (mean, about 13 days).

Dr. Paul Thuluvath, Director of The Center for Liver and Hepatobiliary Diseases and Chief of the Division of Gastroenterology Liver at Mercy Medical Center in Baltimore, commented by email, "Enzyme abnormalities are seen in 20%-40% of patients with COVID-19 and usually it is mild. It is seen in more severe disease, but has no impact on survival," as shown in his team's review on the topic, published April 1 in the Journal of Clinical and Experimental Hepatology. (https://bit.ly/3cFBxtJ)

"This is a very small descriptive study," he told Reuters Health. "The group that received medications - proven to have no benefit - had a higher prevalence of elevated liver enzymes, but that could be related to more severe disease rather than the medicine. That is why we need controlled trials."

Dr. Will Bulsiewicz, a gastroenterologist at East Cooper Medical Center and Roper Mt. Pleasant Hospital in South Carolina, also commented by email to Reuters Health. Like Dr. Thuluvath, he noted said the liver abnormalities were mild. "There were no cases of liver failure reported," he noted, "so while abnormal liver function tests may be present, we do not yet have evidence to suggest that the virus is capable of inducing liver failure as a means to threaten life."

Further, he said, "the abnormal liver tests were more frequently seen among those with other indications of more severe COVID-19. They were more likely to have severe fever (>39C) and elevated inflammatory markers."

Regarding lopinavir/ritonavir and abnormal liver tests, he said, "This drug combination did not perform well in a randomized trial of 199 patients with severe COVID-19, as published in the New England Journal of Medicine. (https://bit.ly/3czYRsG) It seems unlikely that we will be turning to lopinavir/ritonavir to treat severe COVID-19 anytime soon, if ever at all.

"It's worth noting that we actually have a lot of experience with this drug combination in the treatment of HIV," he added. "In that setting, liver function abnormality is extremely rare, and even when someone has a damaged liver, there are no warnings to reduce or eliminate this drug," he concluded.

Dr. Cheng did not respond to requests for a comment.

SOURCE: https://bit.ly/2RUOKa7 Clinical Gastroenterology and Hepatology, online April 10, 2020.