tetano
Editor, Senior Moderator
JGH Open
. 2021 Jul 15;5(8):888-895.
doi: 10.1002/jgh3.12599. eCollection 2021 Aug.
Clinical features and mechanism of liver injury in patients with mild or moderate coronavirus disease 2019
Kuniyo Gomi[SUP] 1 [/SUP], Takayoshi Ito[SUP] 2 [/SUP], Fumihiro Yamaguchi[SUP] 3 [/SUP], Yoshito Kamio[SUP] 4 [/SUP], Yoshinori Sato[SUP] 5 [/SUP], Hiroyoshi Mori[SUP] 6 [/SUP], Kei Endo[SUP] 7 [/SUP], Takashi Abe[SUP] 3 [/SUP], Shunsuke Sakakura[SUP] 3 [/SUP], Kouji Kobayashi[SUP] 8 [/SUP], Ken Shimada[SUP] 8 [/SUP], Jun Noda[SUP] 9 [/SUP], Tarou Hibiki[SUP] 9 [/SUP], Shin Ohta[SUP] 10 [/SUP], Hironori Sagara[SUP] 10 [/SUP], Akihiko Tanaka[SUP] 10 [/SUP], Megumi Jinno[SUP] 10 [/SUP], Masataka Yamawaki[SUP] 11 [/SUP], Fumiya Nishimoto[SUP] 11 [/SUP], Kazuaki Inoue[SUP] 12 [/SUP], Masatsugu Nagahama[SUP] 1 [/SUP]
Affiliations
Abstract
Background and aim: We aimed to identify clinical features that suggest that coronavirus disease 2019 (COVID-19) should be a differential diagnosis in patients presenting with a chief complaint of fever and abnormal liver function.
Methods: We retrospectively studied the presence or absence of abnormal liver function in 216 patients diagnosed with mild-moderate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between February and September 2020.
Results: Abnormal liver function was observed in 51 patients with mild-moderate COVID-19. The median peak aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were 57.5, 75.5, and 332.5 U/L, respectively. The median number of days from symptom onset to peak AST, ALT, and LDH were 8.5, 9, and 8.5, respectively. The median peak LDH/AST ratio was 9.0. Low lymphocyte-to-white blood cell ratio and elevated LDH were found to be independent contributing factors for intensive care unit (ICU) admission on a multivariate analysis.
Conclusions: AST-predominant AST/ALT/LDH elevation peaking 8-9 days after symptom onset and not accompanied by elevated alkaline phosphatase or gamma-glutamyl transferase may be a useful clinical feature for differentiating COVID-19 from other diseases. Since the median LDH/AST ratio was 9.0, it seems that the abnormal liver function caused by SARS-CoV-2 is an indirect damage to liver cells due to elevated cytokine levels caused by liver-infiltrating lymphocytes. SARS-CoV-2 infection should be considered in patients presenting with a chief complaint of fever and liver injury; those with a high lymphocyte-to-white blood cell ratio or and a high LDH/AST ratio may be admitted to the ICU.
Keywords: coronavirus disease 2019; liver injury; liver‐infiltrating lymphocytes; severe acute respiratory syndrome coronavirus 2.
. 2021 Jul 15;5(8):888-895.
doi: 10.1002/jgh3.12599. eCollection 2021 Aug.
Clinical features and mechanism of liver injury in patients with mild or moderate coronavirus disease 2019
Kuniyo Gomi[SUP] 1 [/SUP], Takayoshi Ito[SUP] 2 [/SUP], Fumihiro Yamaguchi[SUP] 3 [/SUP], Yoshito Kamio[SUP] 4 [/SUP], Yoshinori Sato[SUP] 5 [/SUP], Hiroyoshi Mori[SUP] 6 [/SUP], Kei Endo[SUP] 7 [/SUP], Takashi Abe[SUP] 3 [/SUP], Shunsuke Sakakura[SUP] 3 [/SUP], Kouji Kobayashi[SUP] 8 [/SUP], Ken Shimada[SUP] 8 [/SUP], Jun Noda[SUP] 9 [/SUP], Tarou Hibiki[SUP] 9 [/SUP], Shin Ohta[SUP] 10 [/SUP], Hironori Sagara[SUP] 10 [/SUP], Akihiko Tanaka[SUP] 10 [/SUP], Megumi Jinno[SUP] 10 [/SUP], Masataka Yamawaki[SUP] 11 [/SUP], Fumiya Nishimoto[SUP] 11 [/SUP], Kazuaki Inoue[SUP] 12 [/SUP], Masatsugu Nagahama[SUP] 1 [/SUP]
Affiliations
- PMID: 34386596
- PMCID: PMC8341189
- DOI: 10.1002/jgh3.12599
Abstract
Background and aim: We aimed to identify clinical features that suggest that coronavirus disease 2019 (COVID-19) should be a differential diagnosis in patients presenting with a chief complaint of fever and abnormal liver function.
Methods: We retrospectively studied the presence or absence of abnormal liver function in 216 patients diagnosed with mild-moderate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between February and September 2020.
Results: Abnormal liver function was observed in 51 patients with mild-moderate COVID-19. The median peak aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were 57.5, 75.5, and 332.5 U/L, respectively. The median number of days from symptom onset to peak AST, ALT, and LDH were 8.5, 9, and 8.5, respectively. The median peak LDH/AST ratio was 9.0. Low lymphocyte-to-white blood cell ratio and elevated LDH were found to be independent contributing factors for intensive care unit (ICU) admission on a multivariate analysis.
Conclusions: AST-predominant AST/ALT/LDH elevation peaking 8-9 days after symptom onset and not accompanied by elevated alkaline phosphatase or gamma-glutamyl transferase may be a useful clinical feature for differentiating COVID-19 from other diseases. Since the median LDH/AST ratio was 9.0, it seems that the abnormal liver function caused by SARS-CoV-2 is an indirect damage to liver cells due to elevated cytokine levels caused by liver-infiltrating lymphocytes. SARS-CoV-2 infection should be considered in patients presenting with a chief complaint of fever and liver injury; those with a high lymphocyte-to-white blood cell ratio or and a high LDH/AST ratio may be admitted to the ICU.
Keywords: coronavirus disease 2019; liver injury; liver‐infiltrating lymphocytes; severe acute respiratory syndrome coronavirus 2.