Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients

Background: Recent studies reported that patients with coronavirus disease-2019(COVID-19) might have liver injury. However, few data on the combined analysis and change patterns of alanine aminotransferase(ALT), aspartate aminotransferase(AST) and total bilirubin(TBil) have been shown.Methods: This is a single-center retrospective study. A total of 105 adult patients hospitalized for confirmed COVID-19 in Beijing Ditan Hospital between January 12, and March 17, 2020 were included, and divided into mild group(n=79) and severe group(n=26). We compared liver functional test results between the two groups. Category of ALT change during the disease course was also examined.Results: 56.2%(59/105) of the patients had unnormal ALT, AST, or total TBil throughout the course of the disease, but in 91.4%(96/105) cases the level of ALT, AST or TBil ≤3 fold of the upper limit of normal reference range(ULN). The overall distribution of ALT, AST, and TBil were all significantly difference between mild and severe group(P<0.05). The percentage of the patients with elevated both ALT and AST was 12.7%(10/79) in mild cases vs. 46.2%(12/26) in severe cases(P=0.001). 34.6%(9/26) severe group patients started to have abnormal ALT after admission, and 73.3%(77/105) of all patients had normal ALT before discharge.Conclusions: Elevated liver function index is very common in patients with COVID-19 infection, and the level were less than 3×ULN, but most are reversible. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group.