Clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan

BACKGROUND Coronavirus disease 2019(COVID-19) has become a worldwide pandemic. We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing the epidemiological, clinical, and laboratory data for 218 COVID-19 patients and identifying the risk factors for liver injury by multivariate analysis.AIM To investigate the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.METHODS The 218 patients included 94 males(43.1%), aged 22 to 94(50.1 ± 18.4) years. Elevated aspartate aminotransferase(AST) and alanine aminotransferase(ALT) were present in 42(53.2%) and 36(45.6%) cases, respectively, and 79(36.2%) patients had abnormally elevated transaminase levels at admission. Patients with liver injury were older than those with normal liver function by a median of 12 years, with a significantly higher frequency of males(68.4% vs 28.8%, P < 0.001) and more coexisting illnesses(48.1% vs 27.3%, P = 0.002). Significantly more patients had fever and shortness of breath(87.3% vs 69.8% and 29.1% vs 14.4%, respectively) in the liver injury group. Only 12(15.2%) patients had elevated total bilirubin. ALT and AST levels were mildly elevated [1-3 × upper limit of normal(ULN)] in 86.1% and 92.9% of cases, respectively. Only two(2.5%) patients had an ALT or AST level > 5 × ULN. Elevated γ-glutamyl transpeptidase was present in 45(57.0%) patients, and 86.7% of these had a γ-glutamyl-transpeptidase level < 135 U/L(3 × ULN). Serum alkaline phosphatase levels were almost normal in all patients. Patients with severe liver injury had a significantly higher frequency of abnormal transaminases than non-severe patients, but only one case had very high levels of aminotransferases.RESULTS Multivariate analysis revealed that male sex, high D-dimer level, and high neutrophil percentage were linked to a higher risk of liver injury. The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels in patients in Wuhan. Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.CONCLUSION Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.