Effects of COVID-19 on the liver: The experience of a single center

Table 1 Characteristics of the studied patients

Variables	Group 1 (with elevated liver enzymes)		Group 2 (with normal liver enzymes)		P value
		Number of tested		Number of tested
n/%	603/88.2	603	81/11.8	81
Male, n/%	356/59.0	356	28/34.6	28	< 0.0001
Female, n/%	247/41.0	247	53/65.4	53
Age, yr ± SD	50.7 ± 9.5	603	51.9 ± 12.4	81	0.5075
Hospitalization, d ± SD	9.7 ± 5.9	603	8.7 ± 6.5	81	0.2039
ALT, U/L, range	149 ± 115, 40-728	603	22 ± 9, 7-39	81	< 0.0001
AST, U/L, range	90 ± 77, 3-818	552	22 ± 7, 11-39	70	< 0.0001
GGT, U/L, range	114 ± 125, 8-820	550	22 ± 8, 7-35	72	< 0.0001
ALP, U/L, range	101 ± 128, 29-1183	93	77 ± 25, 45-131	10	0.128
Bilirubin, μmol/L, range	9.1 ± 5.5, 3-67.1	460	7.6 ± 3.2, 3.2-18.5	61	0.0028
SPA, %, range	96.1 ± 19.5, 5-176	500	98.6 ± 21.9, 39-154	64	0.3868
INR, range	1.04 ± 0.18, 0.83-3.87	506	1.03 ± 0.11, 0.86-1.6	68	0.4728

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; INR: International normalized ratio; SPA: Stago prothrombin assay.

Table 2 Coronavirus disease 2019 pneumonia severity indices of patients with elevated liver enzymes (group 1) versus normal liver enzymes (group 2)

	Group 1 (n = 603)		Group 2 (n = 81)		P value
		Number of tested		Number of tested
Moderate COVID, n/%	436/72.2	603	64/79.0	81	0.4341
Severe COVID, n/%	134/22.4		14/17.3
Critical COVID, n/%	33/5.4		3/3.7
O2 demand, n/%	188/31.2	603	21/25.9	81	0.3354
SpO2, %, range	94.4 ± 3.5, 68-100	594	95.3 ± 2.9, 84-99	76	0.0169
Respiratory rate, n/min, range	18.4 ± 3.2, 14-40	543	17.7 ± 2.4, 14-28	72	0.0291
Mortality, total, n/%	17/2.8	603	3/3.7	81	0.6573
CRP, mg/L, range	72.3 ± 68.9, 0.4-459.0	571	54.2 ± 56.1, 0.6-327.0	70	0.0151
IL-6, ng/L, range	50.3 ± 120.0, 3-2499	546	35.7 ± 38.9, 2-188	65	0.0402
LDH, U/L, range	357.9 ± 134.0, 167-979	435	299.0 ± 173.4, 134-1304	49	0.0254

COVID: Coronavirus disease; CRP: C-reactive protein; LDH: Lactate dehydrogenase; IL-6: Interleukine-6.

Table 3 Comparison of coronavirus disease 2019 pneumonia complications in patients with (group 1) and without (group 2) elevated liver enzymes

	Group 1	Group 2	P value
Bacterial complication, n/%	335/55.6	34/42.0	0.0213
Sepsis, n/%	14/2.3	4/4.9	0.1672
Respiratory failure, n/%	63/10.4	7/8.6	0.6146
Acid-alkaline imbalance, n/%	11/1.8	0	0.2204
Electrolyte imbalance, n/%	67/11.1	8/9.9	0.7385
Hyperkalemia, n/%	10/1.7	0	0.2426
Hypokalemia, n/%	40/6.6	7/8.6	0.5023
Hypernatremia, n/%	1/0.2	2/2.5	0.0032
Hyponatremia, n/%	13/2.2	0	0.1821
Blood volume decrease, n/%	15/2.5	3/3.7	0.5209
Blood clotting disorder, n/%	6/1.0	3/3.7	0.0446
Acute kidney failure, n/%	15/2.5	1/1.2	0.4836
Acute liver failure, n/%	5/0.8	0	0.3672
Antibiotic resistance, n/%	18/3.0	1/1.2	0.3681

Table 4 Prevalence of underlying diseases in patients with (group 1) and without (group 2) elevated liver enzymes

	Group 1	Group 2	P value
Hospitalization, d, n ± SD	9.7 ± 5.9	8.7 ± 6.5	0.2039
Primary hypertension, n/%	193/32.0	21/25.9	0.2638
Heart disease, n/%	32/5.3	6/7.4	0.4430
Lung disease, n/%	19/3.2	5/6.2	0.1652
Diabetes, n/%	50/8.3	9/11.1	0.4015
Obesity, n/%	14/2.3	3/3.7	0.4532
Hyperlipidemia, n/%	31/5.1	5/6.2	0.6962
Podagra, n/%	12/2.0	0	0.2002
Kidney disease, n/%	16/2.7	4/4.9	0.2518
Prostate disease, n/%	9/1.5	1/1.2	0.8546
Urinary tract disease, n/%	39/6.5	6/7.4	0.7487
Thyroiditis and goiter, n/%	21/3.5	4/4.9	0.5121
Gastrointestinal disease, n/%	32/5.3	3/3.7	0.5387
Liver disease, n/%	22/3.7	2/2.5	0.5865
Nervous and mental diseases, n/%	27/4.5	1/1.2	0.1666
Cancers, n/%	17/2.8	5/6.2	0.1098

Table 5 The association of the severity of coronavirus pneumonia with the demographic characteristics of patients and critical disease outcomes (data from univariate logistic regression analysis)

	OR	95% confidence interval	P value
Gender: male vs female	1.5989137	1.1317308-2.2732760	0.0083
Age	1.0260275	1.0116249-1.0409474	0.0004
Respiratory rate	1.1588882	1.0942282-1.2311821	< 0.0001
Acute respiratory failure	3.3114884	2.0001907-5.4967193	< 0.0001
O2 demand	3.9476028	2.7654860-5.6573094	< 0.0001
Sepsis	7.4825581	2.7778683-23.601933	0.0002
Acute kidney failure	6.2586207	2.2427771-20.097089	0.0008
Antibiotic resistance	3.8879310	1.5485304-10.193077	0.0041
Mortality	26.8383223	7.6407747-169.97850	< 0.0001

OR: Odds ratio.

Table 6 The association of the severity of coronavirus pneumonia with underlying diseases (data from univariate logistic regression analysis)

	OR	95% confidence interval	P value
Diabetes	2.3041738	1.3274753-3.9642971	0.0027
Heart disease	2.5760479	1.3198252-4.9960747	0.0050
Hyperlipidemia	2.2857140	1.1426635-4.5048434	0.0173

OR: Odds ratio.

Table 7 Independent factors associated with the severity of coronavirus disease 2019 (data from multivariate logistic regression analysis)

	OR	95% confidence interval	P value
Age	1.0227924	1.0032076-1.0431564	0.0234
Gender: male vs female	1.7233575	1.1114172-2.7017507	0.0161
Respiratory rate	1.1444804	1.0724480-1.2254639	< 0.0001
Respiration failure	2.1878906	1.1163265-4.2384266	0.0209
Sepsis	14.923604	1.6112025-359.53433	0.0352
Diabetes	3.2206335	1.5539799-6.6834759	0.0016
Hyperlipidemia	2.6652639	1.1327787-6.2794095	0.0238

OR: Odds ratio.

Table 8 Data from patients with acute liver failure

Gender	Age	Outcome	COVID severity	Respiratory failure, SpO2, respiratory rate	O2	Laboratory tests	COVID complications	Comorbidities
Male	84	Deceased	Critical	Yes, 83%, 18/min	No	ALT 107, ALP 117, GGT 107, LDH 743, Alb 29.3	Sepsis; Electrolytes imbalance; Hypokalemia; Acid-alkaline imbalance	Heart disease; Epilepsy
Male	55	Deceased	Critical	Yes, 91%, 34/min	Yes	CRP 111, IL-6 87, ALT 115, AST 344, ALP 40, LDH 448, Alb 28.1	Sepsis; Hypokalemia; Hyponatremia; Blood coagulation disorder	Primary hypertension; Obesity; Antibiotic resistance
Male	44	Recovered	Moderate	No, 94%, 16/min	No	CRP 98, IL-6 54, ALT 113, AST 193, ALP 73, GGT 355, LDH 399	Hypokalemia	Primary hypertension; Heart disease; Kidney disease
Male	42	Deceased	Critical	Yes, 80%, 30/min	Yes	CRP 459, IL-6 99, ALT 162, AST 183, ALP 1183, GGT 67, LDH 900, Alb 16.6	Acute kidney failure; Sepsis; Bacterial pneumonia complication; Hypokalemia; Blood coagulation disorder	Urinary tract infection; Anemia; Antibiotic resistance
Male	50	Deceased	Moderate	No, 98%, 22/min	No	CRP 221, IL-6 626, ALT 521, AST 53, ALP 296, GGT 559, LDH 546, Alb 16.5	Acute kidney failure; Sepsis; Blood coagulation disorder; Hypokalemia	Heart disease; Cancer (lymphoma)

COVID: Coronavirus disease; CRP: C-reactive protein; LDH: Lactate dehydrogenase; IL-6: Interleukine-6; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Alb: Albumin.

Table 9 Analysis of patients hospitalized with coronavirus disease 2019 depending on the outcome of the disease

	Deceased	Recovered	P value
Total number, n/%	20/2.9	664/97.1
Male/female ratio	17/3	367/297	0.0081
Age, yr ± SD	64.3±11.9	50.45	0.0004
With normal enzymes, n/%	3/15.0	78/11.7	0.6554
With elevated enzymes, n/%	17/85.0	586/88.3
Moderate COVID, n/%	2/10.0	498/75.0	< 0.0001
Severe COVID, n/%	5/25.0	143/21.5
Critical COVID, n/%	13/65.0	23/3.5
Respiratory failure, n/%	17/85.0	53/8.0	< 0.0001
Respiratory rate, n/min ± SD	22.3 ± 5.6	18.2 ± 2.9	0.0099
SpO2, % ± SD	88.7 ± 6.3	94.6 ± 3.2	0.0010
O2 demand, n/%	11/55.0	198/29.8	0.0158
Bacterial pneumonia complication, n/%	5/25.0	364/54.8	0.0084
Sepsis, n/%	13/65.0	5/0.8	< 0.0001
Acute liver failure, n/%	4/20.0	1/0.15	< 0.0001
Acute kidney failure, n/%	10/50.0	6/0.9	< 0.0001
Electrolytes imbalance, n/%	11/55.0	64/9.6	< 0.0001
Antibiotic resistance, n/%	7/35.0	12/1.8	< 0.0001
Urinary tract infections, n/%	5/25.0	40/6.0	0.0007
Primary hypertension, n/%	10/50.0	204/30.7	0.0669
Heart disease, n/%	10/50.0	28/4.2	< 0.0001

COVID: Coronavirus disease.