tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Apr 23;8(6)
fab205.
doi: 10.1093/ofid/ofab205. eCollection 2021 Jun.
SARS-CoV-2 Viral Persistence Based on Cycle Threshold Value and Liver Injury in Patients With COVID-19
Grace Lai-Hung Wong[SUP] 1 2 3 [/SUP], Terry Cheuk-Fung Yip[SUP] 1 2 3 [/SUP], Vincent Wai-Sun Wong[SUP] 1 2 3 [/SUP], Yee-Kit Tse[SUP] 1 2 3 [/SUP], David Shu-Cheong Hui[SUP] 1 2 4 [/SUP], Shui-Shan Lee[SUP] 4 [/SUP], Eng-Kiong Yeoh[SUP] 5 [/SUP], Henry Lik-Yuen Chan[SUP] 2 6 [/SUP], Grace Chung-Yan Lui[SUP] 1 2 4 [/SUP]
Affiliations
Abstract
Background: Liver injury in patients with coronavirus disease 2019 (COVID-19) is common and prognostic. Direct viral tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for angiotensin-converting enzyme 2 receptors in hepatocytes may be one of the mechanisms of liver injury. We aimed to determine the role of viral persistence of SARS-CoV-2, based on cycle threshold (Ct) value, in liver injury in COVID-19.
Methods: This was a territory-wide retrospective cohort study of all public hospitals in Hong Kong. Laboratory-confirmed COVID-19 was identified. Serial liver biochemistries and Ct values of SARS-CoV-2 RNA were analyzed.
Results: We identified 7622 COVID-19 patients (mean age, 47 years; 48.2% male) diagnosed from March 24 to January 1, 2021, who had serial liver biochemistries and Ct values. A total of 1363 (17.9%) COVID-19 patients had alanine transferase (ALT)/aspartate aminotransferase (AST) elevations with 2 temporal patterns-early (within first 14 days of symptom onset) and late (>14 days from symptom onset). COVID-19 patients with ALT/AST elevations had a lower Ct value at admission (23 vs 25; P < .001), day 5 (24 vs 26; P < .001), and day 20 (31 vs 32; P < .001) after admission, compared with those without ALT/AST elevations. COVID-19 patients with ALT/AST elevations had a longer duration from first positive to first negative reverse transcription polymerase chain reaction test for SARS-CoV-2 (13 vs 9 days; P < .001). ALT/AST elevation and presence of diabetes were independent risk factors of viral persistence.
Conclusions: Liver injury in COVID-19 is linked to a higher SARS-CoV-2 viral load during the early phase of infection, signifying a possible direct viral injury to the liver. Prolonged viral persistence of SARS-CoV-2 is associated with liver injury.
Keywords: COVID-19; SARS-CoV-2; cycle threshold value; liver injury; viral persistence.
. 2021 Apr 23;8(6)
fab205.doi: 10.1093/ofid/ofab205. eCollection 2021 Jun.
SARS-CoV-2 Viral Persistence Based on Cycle Threshold Value and Liver Injury in Patients With COVID-19
Grace Lai-Hung Wong[SUP] 1 2 3 [/SUP], Terry Cheuk-Fung Yip[SUP] 1 2 3 [/SUP], Vincent Wai-Sun Wong[SUP] 1 2 3 [/SUP], Yee-Kit Tse[SUP] 1 2 3 [/SUP], David Shu-Cheong Hui[SUP] 1 2 4 [/SUP], Shui-Shan Lee[SUP] 4 [/SUP], Eng-Kiong Yeoh[SUP] 5 [/SUP], Henry Lik-Yuen Chan[SUP] 2 6 [/SUP], Grace Chung-Yan Lui[SUP] 1 2 4 [/SUP]
Affiliations
- PMID: 34099979
- PMCID: PMC8135402
- DOI: 10.1093/ofid/ofab205
Abstract
Background: Liver injury in patients with coronavirus disease 2019 (COVID-19) is common and prognostic. Direct viral tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for angiotensin-converting enzyme 2 receptors in hepatocytes may be one of the mechanisms of liver injury. We aimed to determine the role of viral persistence of SARS-CoV-2, based on cycle threshold (Ct) value, in liver injury in COVID-19.
Methods: This was a territory-wide retrospective cohort study of all public hospitals in Hong Kong. Laboratory-confirmed COVID-19 was identified. Serial liver biochemistries and Ct values of SARS-CoV-2 RNA were analyzed.
Results: We identified 7622 COVID-19 patients (mean age, 47 years; 48.2% male) diagnosed from March 24 to January 1, 2021, who had serial liver biochemistries and Ct values. A total of 1363 (17.9%) COVID-19 patients had alanine transferase (ALT)/aspartate aminotransferase (AST) elevations with 2 temporal patterns-early (within first 14 days of symptom onset) and late (>14 days from symptom onset). COVID-19 patients with ALT/AST elevations had a lower Ct value at admission (23 vs 25; P < .001), day 5 (24 vs 26; P < .001), and day 20 (31 vs 32; P < .001) after admission, compared with those without ALT/AST elevations. COVID-19 patients with ALT/AST elevations had a longer duration from first positive to first negative reverse transcription polymerase chain reaction test for SARS-CoV-2 (13 vs 9 days; P < .001). ALT/AST elevation and presence of diabetes were independent risk factors of viral persistence.
Conclusions: Liver injury in COVID-19 is linked to a higher SARS-CoV-2 viral load during the early phase of infection, signifying a possible direct viral injury to the liver. Prolonged viral persistence of SARS-CoV-2 is associated with liver injury.
Keywords: COVID-19; SARS-CoV-2; cycle threshold value; liver injury; viral persistence.