tetano
Editor, Senior Moderator
Hepatol Commun
. 2020 Oct 16;10.1002/hep4.1631.
doi: 10.1002/hep4.1631. Online ahead of print.
Liver Injury in Hospitalized Patients with COVID-19 Correlates with Hyper Inflammatory Response and Elevated IL-6
Ben L Da[SUP] 1 [/SUP], Tatyana Kushner[SUP] 1 [/SUP], Maan El Halabi[SUP] 2 [/SUP], Pavan Paka[SUP] 2 [/SUP], Mian Khalid[SUP] 3 [/SUP], Angad Uberoi[SUP] 2 [/SUP], Brian T Lee[SUP] 1 [/SUP], Ponni V Perumalswami[SUP] 1 [/SUP], Stephanie M Rutledge[SUP] 4 [/SUP], Thomas D Schiano[SUP] 1 [/SUP], Scott Friedman[SUP] 1 [/SUP], Behnam Saberi[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Liver injury is commonly seen in coronavirus disease 2019 (COVID-19). However, the mechanism behind liver injury, particularly in severe and critical COVID-19 patients, remains unclear and the clinical course is poorly described.
Methods: We conducted a single-center, retrospective cohort study of consecutive hospitalized severe and critically ill COVID-19 patients with or without liver injury who underwent immunologic testing (IL-6, IL-8, TNF-α, and IL-1?). Liver injury was defined as peak aminotransferases ≥3x ULN (40 U/L) or ≥120 U/L. Patients with liver injury were compared to those who had normal aminotransferases throughout the hospital course.
Results: 176 patients were studied; 109 with liver injury and 67 controls. Patients with liver injury were more likely to be male (71.6% vs 37.3%; p < 0.001). Peak inflammatory markers and IL-6 were higher in the liver injury group: CRP: 247 vs 168 mg/L, p < 0.001; LDH: 706 vs 421 U/L, ferritin: 2,973 vs 751 ng/mL, p < 0.001, IL-6: 121.0 vs 71.8, p < 0.001. There was no difference in the levels of IL-8, TNF-α, and IL-1?. The liver injury group had a longer length of stay and more severe COVID-19 despite having less diabetes and chronic kidney disease.
Discussion: An exaggerated hyper inflammatory response (cytokine storm) characterized by significantly elevated CRP, LDH, ferritin, and IL-6 levels and increasing severity of COVID-19 appears to be associated with the occurrence of liver injury in patients with severe/ critical COVID-19.
Keywords: covid‐19; viral hepatitis; cytokine storm; inflammation; interleukin‐6.
. 2020 Oct 16;10.1002/hep4.1631.
doi: 10.1002/hep4.1631. Online ahead of print.
Liver Injury in Hospitalized Patients with COVID-19 Correlates with Hyper Inflammatory Response and Elevated IL-6
Ben L Da[SUP] 1 [/SUP], Tatyana Kushner[SUP] 1 [/SUP], Maan El Halabi[SUP] 2 [/SUP], Pavan Paka[SUP] 2 [/SUP], Mian Khalid[SUP] 3 [/SUP], Angad Uberoi[SUP] 2 [/SUP], Brian T Lee[SUP] 1 [/SUP], Ponni V Perumalswami[SUP] 1 [/SUP], Stephanie M Rutledge[SUP] 4 [/SUP], Thomas D Schiano[SUP] 1 [/SUP], Scott Friedman[SUP] 1 [/SUP], Behnam Saberi[SUP] 1 [/SUP]
Affiliations
- PMID: 33230491
- PMCID: PMC7675519
- DOI: 10.1002/hep4.1631
Abstract
Background: Liver injury is commonly seen in coronavirus disease 2019 (COVID-19). However, the mechanism behind liver injury, particularly in severe and critical COVID-19 patients, remains unclear and the clinical course is poorly described.
Methods: We conducted a single-center, retrospective cohort study of consecutive hospitalized severe and critically ill COVID-19 patients with or without liver injury who underwent immunologic testing (IL-6, IL-8, TNF-α, and IL-1?). Liver injury was defined as peak aminotransferases ≥3x ULN (40 U/L) or ≥120 U/L. Patients with liver injury were compared to those who had normal aminotransferases throughout the hospital course.
Results: 176 patients were studied; 109 with liver injury and 67 controls. Patients with liver injury were more likely to be male (71.6% vs 37.3%; p < 0.001). Peak inflammatory markers and IL-6 were higher in the liver injury group: CRP: 247 vs 168 mg/L, p < 0.001; LDH: 706 vs 421 U/L, ferritin: 2,973 vs 751 ng/mL, p < 0.001, IL-6: 121.0 vs 71.8, p < 0.001. There was no difference in the levels of IL-8, TNF-α, and IL-1?. The liver injury group had a longer length of stay and more severe COVID-19 despite having less diabetes and chronic kidney disease.
Discussion: An exaggerated hyper inflammatory response (cytokine storm) characterized by significantly elevated CRP, LDH, ferritin, and IL-6 levels and increasing severity of COVID-19 appears to be associated with the occurrence of liver injury in patients with severe/ critical COVID-19.
Keywords: covid‐19; viral hepatitis; cytokine storm; inflammation; interleukin‐6.