Strong link found between abnormal liver tests and poor COVID-19
outcomes

Date:
August 7, 2020
Source:
Yale University
Summary:
Researchers found that patients with COVID-19 presented with
abnormal liver tests at much higher rates than suggested by earlier
studies. They also discovered that higher levels of liver enzymes
-- proteins released when the liver is damaged -- were associated
with poorer outcomes for these patients, including ICU admission,
mechanical ventilation, and death.



FULL STORY ========================================================================== Researchers at the Yale Liver Center found that patients with COVID-19 presented with abnormal liver tests at much higher rates than suggested by earlier studies. They also discovered that higher levels of liver enzymes
- - proteins released when the liver is damaged -- were associated with
poorer outcomes for these patients, including ICU admission, mechanical ventilation, and death.


==========================================================================
The study appeared online on July 29 in Hepatology.

Previous studies in China found that approximately 15% of patients
with COVID- 19 had abnormal liver tests. The Yale study, which looked retrospectively at 1,827 COVID-19 patients who were hospitalized in
the Yale New Haven Health system between March and April, found that
the incidence of abnormal liver tests was much higher -- between 41.6%
and 83.4% of patients, depending on the specific test.

In all, the Yale researchers examined five liver tests, looking at
factors such as elevations in aspartate aminotransferase (AST) and alanine transaminase (ALT), which indicate liver cell inflammation; an increase
in bilirubin, which indicates liver dysfunction; and increased levels of alkaline phosphatase (ALP), which may indicate inflammation of bile ducts.

Although the researchers do not know why the incidence of abnormal
liver tests was so much higher than in previous studies from China,
senior author Dr.

Joseph Lim, professor of medicine and director of the Yale Viral
Hepatitis Program, said other health differences between the Chinese
and U.S. populations could account for it.

"We can speculate that U.S. patients may have an increased rate of other
risk factors such as alcoholic or non-alcoholic fatty liver disease,"
he said.



========================================================================== Liver disease is widespread in the U.S. population. Dr. Michael Nathanson,
the Gladys Phillips Crofoot Professor of Medicine (digestive diseases), professor of cell biology, director of the Yale Liver Center, and
a co-author of the study, said: "In the U.S., close to one-third of
people have fatty liver disease, and several million people have chronic hepatitis B or C." Because the Yale researchers had access to patients'
health records, they were also able to look at their liver tests prior
to being diagnosed with COVID-19.

Approximately one-quarter of patients in the study had abnormal liver
tests prior to being admitted for the virus. But regardless of whether
patients came to the hospital with existing liver problems or developed
them during their COVID-19-related hospitalization, a strong association
was observed between abnormal liver tests and the severity of the COVID-19 cases, the researchers said.

Rather than the liver itself driving poorer outcomes in COVID-19 patients,
the organ is more likely "a bystander" affected by the hyperinflammation associated with COVID-19 and by the side effects of related treatments, Nathanson said.

The study noted a relationship between drugs used to treat severe COVID-19
and liver damage, most significantly the drug tocilizumab.

"We observed a strong association between the use of COVID-19 medications
and abnormal liver tests," said Lim, but added that they could not
confidently tease out that the abnormal tests were due to "drug-induced
liver injury" as opposed to the disease.

The researchers have additional clinical and lab-based studies underway to further understand COVID-19's impact on liver pathology. Nathanson noted
that as one of only four National Institutes of Health-sponsored liver
centers in the country, the Yale Liver Center is uniquely positioned to
advance this research.

Additional Yale researchers involved in the study include lead author and internal medicine resident Dr. Melanie Hundt; biostatistician Yanhong
Deng, co- director of analytics at the Yale Center for Analytical
Sciences; and Maria Ciarleglio, associate professor at the Yale School
of Public Health.


========================================================================== Story Source: Materials provided by Yale_University. Original written
by Brita Belli. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Melanie A. Hundt, Yanhong Deng, Maria M. Ciarleglio, Michael H.

Nathanson, Joseph K. Lim. Abnormal Liver Tests in COVID‐19:
A Retrospective Observational Cohort Study of 1827 Patients in a
Major U.S.

Hospital Network. Hepatology, 2020; DOI: 10.1002/hep.31487 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200807131912.htm

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