PLoS One . Liver injury with COVID-19 based on gastrointestinal symptoms and pneumonia severity

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PLoS One


. 2020 Nov 4;15(11):e0241663.
doi: 10.1371/journal.pone.0241663. eCollection 2020.
Liver injury with COVID-19 based on gastrointestinal symptoms and pneumonia severity


Shun Kaneko ¹ , Masayuki Kurosaki ¹ , Kaoru Nagata ² , Reiko Taki ³ , Ken Ueda ² , Satoko Hanada ³ , Koji Takayama ³ , Shinichiro Suzaki ⁴ , Naoshige Harada ⁴ , Toru Sugiyama ⁵ , Masayuki Nagasawa ⁶ , Namiki Izumi ¹



Affiliations

• PMID: 33147270
• DOI: 10.1371/journal.pone.0241663

Abstract

Background/aim: The coronavirus disease 2019 (COVID-19) had become a big threat worldwide. Liver injury is not uncommon in patients with COVID-19, and clarifying its characteristics is needed. This study aimed to identify factors associated with liver injury and to develop a new classification of predictive severity in patients with COVID-19.
Methods: Confirmed patients with COVID-19 (n = 60) were recruited retrospectively from Musashino Red Cross Hospital. The factors of liver injury especially on the elevation of liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) were analyzed. Grading was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Results: During a median hospitalization follow-up of 15 (4-41) days, 51 (85.0%) patients had COVID-19 pneumonia. In clinical courses, oxygenation was needed for 25 (41.6%) patients and intubation was needed for 9 (15.0%) patients. A total of 27 (45.0%) patients had gastrointestinal symptoms (GS), such as appetite loss, diarrhea, and nausea. A logistic regression analysis revealed that C-reactive protein (CRP) at baseline, oxygenation, intubation, and GS were significant factors of liver injury. Based on these results, patients were classified into three groups: group 1, no oxygenation pneumonia; group 2, pneumonia with oxygenation or GS; and group 3, intubation. We classified 25 (41.7%), 26 (43.3%), and 9 (15.0%) patients into mild, moderate, and severe groups, respectively. The peak of AST and ALT levels was significantly stratified with this criteria (mild [median AST, 28 IU/L; median ALT, 33 IU/L], moderate [median AST, 48 IU/L; median ALT, 47.5 IU/L], and severe [median AST, 109 IU/L; median ALT, 106 IU/L]; P<0.001 and P = 0.0114, respectively).
Conclusion: COVID-19-related liver injury was significantly stratified based on GS and severity of pneumonia.