Acute hepatitis and liver injury in hospitalized patients with COVID‑19 infection

Georgakopoulou,Vasiliki Epameinondas; Bali,Triada; Adamantou,Magdalini; Asimakopoulou,Stavroula; Makrodimitri,Sotiria; Samara,Stamatia; Triantafyllou,Maria; Voutsinas,Pantazis M.; Eliadi,Irene; Karamanakos,Georgios; Basoulis,Dimitrios; Chatzipanagiotou,Odysseas; Adamopoulou,Eleni; Alevizou,Antonia; Athanasiadis,Menelaos; Spandidos,Demetrios A.; Papalexis,Petros; Tarantinos,Kyriakos; Sipsas,Nikolaos V.; Samarkos,Michael; Cholongitas,Evangelos

doi:10.3892/etm.2022.11627

Acute hepatitis and liver injury in hospitalized patients with COVID‑19 infection

Authors:
- Vasiliki Epameinondas Georgakopoulou
- Triada Bali
- Magdalini Adamantou
- Stavroula Asimakopoulou
- Sotiria Makrodimitri
- Stamatia Samara
- Maria Triantafyllou
- Pantazis M. Voutsinas
- Irene Eliadi
- Georgios Karamanakos
- Dimitrios Basoulis
- Odysseas Chatzipanagiotou
- Eleni Adamopoulou
- Antonia Alevizou
- Menelaos Athanasiadis
- Demetrios A. Spandidos
- Petros Papalexis
- Kyriakos Tarantinos
- Nikolaos V. Sipsas
- Michael Samarkos
- Evangelos Cholongitas
View Affiliations

Affiliations: Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece, Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece, 1st Pulmonology Department Sismanogleio Hospital, 15126, Athens, Greece
Published online on: September 26, 2022 https://doi.org/10.3892/etm.2022.11627
Article Number: 691
Copyright: © Georgakopoulou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Coronavirus disease 2019 (COVID‑19) is a systemic illness with an increased host inflammatory response that affects multiple extra‑pulmonary organs, including the gastrointestinal tract. Abnormalities in liver biochemistry have been observed in a significant proportion of patients with COVID‑19 upon admission, and this proportion increases with hospitalization. These abnormalities are typically manifested as elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, with less frequently detected elevations in the levels of cholestatic enzymes. Elevated aminotransaminase levels have been linked to an increased risk of mortality and complications, indicating the severity of COVID‑19 infection. The present study evaluated the prevalence and the baseline factors associated with the development of acute hepatitis (ΑΗ), liver injury (LI) and associated patterns, as well as the presence of abnormalities in the levels of aminotransferases at discharge in the same cohort. For this purpose, 1,304 patients with confirmed COVID‑19 infection were enrolled in the study. According to the results obtained, AST levels at baseline were the only independent factor for AH during hospital stay, while AST, alkaline phosphatase and ferritin levels were independent baseline factors for the development of LI. The patients with hepatocellular, compared to those with cholestatic LI, exhibited similar survival rates, as well as similarities in the development of acute kidney injury and the need for oxygen via high‑flow nasal cannula and/or mechanical ventilation. In addition, age and ALT were independent risk factors for persistent abnormal values of AST and ALT at discharge.

View Figures

View References

1	Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, et al: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 395:497–506. 2020.PubMed/NCBI View Article : Google Scholar
2	Bhurwal A, Minacapelli CD, Orosz E, Gupta K, Tait C, Dalal I, Zhang C, Zhao E and Rustgi VK: COVID-19 status quo: Emphasis on gastrointestinal and liver manifestations. World J Gastroenterol. 27:7969–7981. 2021.PubMed/NCBI View Article : Google Scholar
3	Georgakopoulou VE, Gkoufa A, Damaskos C, Papalexis P, Pierrakou A, Makrodimitri S, Sypsa G, Apostolou A, Asimakopoulou S, Chlapoutakis S, et al: COVID-19-associated acute appendicitis in adults. A report of five cases and a review of the literature. Exp Ther Med. 24(482)2022.PubMed/NCBI View Article : Google Scholar
4	Weber S, Hellmuth JC, Scherer C, Muenchhoff M, Mayerle J and Gerbes AL: Liver function test abnormalities at hospital admission are associated with severe course of SARS-CoV-2 infection: A prospective cohort study. Gut. 70:1925–1932. 2021.PubMed/NCBI View Article : Google Scholar
5	Cholongitas E, Bali T, Georgakopoulou VE, Giannakodimos A, Gyftopoulos A, Georgilaki V, Gerogiannis D, Basoulis D, Eliadi I, Karamanakos G, et al: Prevalence of abnormal liver biochemistry and its impact on COVID-19 patients' outcomes: A single-center Greek study. Ann Gastroenterol. 35:290–296. 2022.PubMed/NCBI View Article : Google Scholar
6	Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, Li Z, Zhou G, Gou J, Qu J, et al: COVID-19: Abnormal liver function tests. J Hepatol. 73:566–574. 2020.PubMed/NCBI View Article : Google Scholar
7	Sobotka LA, Esteban J, Volk ML, Elmunzer BJ and Rockey DC: North American Alliance for the Study of Digestive Manifestation of COVID-19*. Acute liver injury in patients hospitalized with COVID-19. Dig Dis Sci. 67:4204–4214. 2022.PubMed/NCBI View Article : Google Scholar
8	Ekpanyapong S, Bunchorntavakul C and Reddy KR: COVID-19 and the liver: Lessons learnt from the EAST and the WEST, a year later. J Viral Hepat. 29:4–20. 2022.PubMed/NCBI View Article : Google Scholar
9	Bernstein D, Roth N, Kim A, Epstein M, Hirschwerk D, Kvasnovsky CL and Satapathy SK: Presentation, patterns and predictive value of baseline liver tests on outcomes in COVID-19 patients without chronic liver disease. World J Gastroenterol. 27:7350–7361. 2021.PubMed/NCBI View Article : Google Scholar
10	Gurala D, Al Moussawi H, Philipose J and Abergel JR: Acute liver failure in a COVID-19 patient without any preexisting liver disease. Cureus. 12(e10045)2020.PubMed/NCBI View Article : Google Scholar
11	Gan Q, Gong B, Sun M, Cao Z, Zheng Y, Zhang Y, Wen P, Shen Y, Hong L, Hou T, et al: A high percentage of patients recovered from COVID-19 but discharged with abnormal liver function tests. Front Physiol. 12(642922)2021.PubMed/NCBI View Article : Google Scholar
12	Robles-Diaz M, Lucena MI, Kaplowitz N, Stephens C, Medina-Cáliz I, González-Jimenez A, Ulzurrun E, Gonzalez AF, Fernandez MC, Romero-Gómez M, et al: Use of Hy's law and a new composite algorithm to predict acute liver failure in patients with drug-induced liver injury. Gastroenterology. 147:109–118. 2014.PubMed/NCBI View Article : Google Scholar
13	Hanley JA and McNeil BJ: A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 148:839–843. 1983.PubMed/NCBI View Article : Google Scholar
14	Pellegrini JR Jr, Sabbula B, Russe-Russe JR, Munshi RF, Meshoyrer D, Sajid N, Gutierrez A, Munnangi S, Szydziak E and Akella J: A retrospective analysis of COVID-19-infected patients with acute hepatitis who develop acute liver failure in a safety net hospital. BMJ Open Gastroenterol. 8(e000738)2021.PubMed/NCBI View Article : Google Scholar
15	Melquist S, Estepp K, Aleksandrovich Y, Lee A, Beiseker A, Hamedani FS and Bassett J: COVID-19 presenting as fulminant hepatic failure: A case report. Medicine (Baltimore). 99(e22818)2020.PubMed/NCBI View Article : Google Scholar
16	Chew M, Tang Z, Radcliffe C, Caruana D, Doilicho N, Ciarleglio MM, Deng Y and Garcia-Tsao G: Significant liver injury during hospitalization for COVID-19 is not associated with liver insufficiency or death. Clin Gastroenterol Hepatol. 19:2182–2191. 2021.PubMed/NCBI View Article : Google Scholar
17	Paštrovic F, Lucijanic M, Atic A, Stojic J, Barisic Jaman M, Tjesic Drinkovic I, Zelenika M, Milosevic M, Medic B, Loncar J, et al: Prevalence and prognostic impact of deranged liver blood tests in COVID-19: Experience from the regional COVID-19 center over the cohort of 3812 hospitalized patients. J Clin Med. 10(4222)2021.PubMed/NCBI View Article : Google Scholar
18	Krishnan A, Prichett L, Tao X, Alqahtani SA, Hamilton JP, Mezey E, Strauss AT, Kim A, Potter JJ, Chen PH and Woreta TA: Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients. World J Gastroenterol. 28:570–587. 2022.PubMed/NCBI View Article : Google Scholar
19	Medetalibeyoglu A, Catma Y, Senkal N, Ormeci A, Cavus B, Kose M, Bayramlar OF, Yildiz G, Akyuz F, Kaymakoglu S and Tukek T: The effect of liver test abnormalities on the prognosis of COVID-19. Ann Hepatol. 19:614–621. 2020.PubMed/NCBI View Article : Google Scholar