Liver Dysfunction and Its Association with the Risk of Death in COVID-19 Patients:A Prospective Cohort Study

Background and Aims:Coronavirus disease 2019(COVID-19)is a new respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2(commonly known as SARS-CoV-2)with multiple organ injuries.The aim of this study was to analyze COVID-19-associated liver dysfunction(LD),its association with the risk of death and prognosis after discharge.Methods:Three-hundred and fifty-five COVID-19 patients were recruited.Clinical data were collected from electronic medical records.LD was evaluated and its prognosis was tracked.The association between LD and the risk of death was analyzed.Results:Of the 355 COVID-19 patients,211 had mild disease,88 had severe disease,and 51 had critically ill disease.On admission,223(62.8%)patients presented with hypoproteinemia,151(42.5%)with cholestasis,and 101(28.5%)with hepatocellular injury.As expected,LD was more common in critically ill patients.By multivariate logistic regression,male sex,older age and lymphopenia were three important independent risk factors predicting LD among COVID-19 patients.Risk of death analysis showed that the fatality rate was higher in patients with hypoproteinemia than in those without hypoproteinemia(relative risk=9.471,p<0.01).Moreover,the fatality rate was higher in patients with cholestasis than those without cholestasis(relative risk=2.182,p<0.05).Follow-up observation found that more than one hepatic functional index of two-third patients remained abnormal at 14 days after discharge.Conclusions:LD at early disease stage elevates the risk of death of COVID-19 patients.COVID-19-associated LD does not recover completely by 14 days after discharge.