Compromised liver function in patients with a new coronavirus infection COVID-19

Clinicians have noted an increase in the level of hepatic transaminase in patients with the new coronavirus infection COVID-19 a number of times, and an unambiguous answer to the question of what caused this change in laboratory indices has not been received yet. The course of COVID-19 is often complicated by the development of haemophagocytic syndrome, and preventive anti-inflammatory therapy is required for its treatment, which is represented by biologic drugs (interleukin-6 inhibitors or JAK-kinase blockers) and glucocorticosteroids. It has been noted that the level of ALT and AST increases against the background of biological therapy.

The objective of the present study was to analyze the possible effect of biological therapy on the functional state of the liver.

Material and methods. The study randomly included 38 patients diagnosed with ICD-10 U07.1 (18 women and 20 men). Inclusion criteria were control of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin at least three times during the period of hospitalization, as well as an increase in these indicators above the reference values. This study was carried out while prescribing preventive anti-inflammatory therapy.

Results. The median (Me ± SD) age of the patients was 57 ± 14.67. Mann–Whitney U-test showed no significant difference in the activity of liver enzymes and total bilirubin upon admission to the infectious diseases hospital (p> 0.05). A statistically significant difference in indicators evaluation at admission and at discharge was determined using the Wilcoxon test for ALT levels in the group receiving biologic drugs (p = 0.004). In other cases, there was no statistically significant difference (p > 0.05). When analyzing the level of enzymes for the entire period of hospitalization with the use of Friedman criterion, the level of changes in hepatic transaminases in the group with the use of biologic drugs turned out to be equal for ALT p = 0.001. When assessing changes over the entire period of hospitalization by the de Ritis coefficient, the p-value was also significant (0.001) in this group.

Conclusion. This study shows the necessity to control the level of hepatic transaminase, especially when prescribing biological therapy for haemophagocytic syndrome.

1. Baklaushev V.P., Kulemzin S.V., Gorchakov A.A., Jusubalieva G.M., Lesnjak V.N., Sotnikova A.G. COVID-19. Jetiologija, patogenez, diagnostika i lechenie. Klinicheskaja praktika. 2020;11(1):7–20. (in Russian)]. DOI: 10.17816/clinpract26339

2. Kamkin E.G. Temporary guidelines. prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Versija 9. 2020 (in Russian)

3. Aboba ker A., Raba A.A., Alzwi A. Extrapulmonary and atypical clinical presentations of COVID‐19. J. Med. Virol. 2020;92:2458– 2464. DOI: 10.1002/jmv.26157

4. Lu-Lu Zhai, Feng Xiang, Wei Wang, Lun Wu, Lin Ye, Li-Chao Yao, Zhi-Gang Tang. Atypical presentations of coronavirus disease 2019 in a patient with acute obstructive suppurative cholangitis. Clinics and Research in Hepatology and Gastroenterology. 2020:135–140. DOI: 10.1016/j.clinre.2020.05.003

5. Paliogiannis P., Zinellu A. Bilirubin levels in patients with mild and severe Covid‐19: A pooled analysis. Liver International. 2020:1787– 1788. DOI: 10.1111/liv.14477

6. Zhang C., S hi L., Wang F.S. Liver injury in COVID-19: management and challenges. The lancet Gastroenterology & hepatology. 2020;5(5):428–430. DOI: 10.1016/S2468-1253(20)30057-1

7. Maev I.V., Shpektor A.V., Vasil'eva E.Ju., Manchurov V.N., Andreev D.N. New coronavirus infection COVID-19: extrapulmonary manifestations. Terapevticheskij arhiv. 2020;8:4–11. (in Russian)]. DOI: 10.26442/00403660.2020.08.000767

8. Drapkina O.M., Maev I.V., Bakulin I.G., Nikonov E.L., Chulanov V.P., Belousova E.A. et al. Temporary guidelines: «Diseases of the digestive system in the context of a new coronavirus pandemic (COVID-19)». Profilakticheskaja medicina. 2020;23(3):2120–2152. (In Russian)]. DOI: 10.17116/profmed202023032120

9. Sonzogni A., Previtali G., Seghezzi M., Grazia Alessio M., Gianatti A., Licini L., Morotti D., Zerbi P., Carsana L., Rossi R., Lauri E., Pellegrinelli A., Nebuloni M. Liver histopathology in severe COVID 19 respiratory failure is suggestive of vascular alterations. Liver International. 2020;40(9):2110–2116. DOI: 10.1111/liv.14601

10. Bangash M.N., Patel J., Parekh D. COVID-19 and the liver: little cause for concern. The Lancet Gastroenterology & Hepatology. 2020;5(6):529. DOI: 10.1016/S2468-1253(20)30084-4

11. Tihova G. We are planning a clinical trial. Question# 1: How to determine the required sample size? Regionarnaja anestezija i lechenie ostroj boli. 2014;8(3). (in Russian)

12. Severin S., Alejnikova T., Osipov E., Silaeva S. Biologicheskaja himija. 2017. (in Russian).