Background: The information regarding the clinical course of COVID-19 patients with liver injury is very limited, especially in severe and critical patients. The objective of this study was to describe the characteristics and clinical course of patients admitted with severe and/or critical SARS-CoV-2 infection in liver function, as well as explore the risk factors that affect liver function in the enrolled COVID-19 patients.
Methods: Information on clinical characteristics of 63 severe and critical patients with confirmed COVID-19 were collected and analyzed.
Results: The incidence of abnormal aspartate aminotransferase, alanine aminotransferase, and total bilirubin in the critical group was obviously higher than in the severe group (81.48%, 81.49%, 62.67%, and 45.71%, 63.88%, 22.86%, respectively, p<0.05). The time for liver parameters to reach their peak or trough was approximately 2-3 weeks. No significant difference was observed in cycle threshold values of open reading frame 1ab and nucleocapsid protein gene on admission or at the peak among liver injury group, abnormal group and normal group (p>0.05). Patients with invasive ventilator, decreased percentage of neutrophil, lymphocyte and monocyte, and SOFA score ≥ 2 (p<0.05) were the independent factors associated with liver injury.
Conclusions: Abnormal liver tests are commonly observed in severe and critical patients with COVID-19. The time of 2-3 weeks after admission should be paid attention to patients with critical COVID-19 in case of the occurrence of liver injury. As independent risk factors for the occurrence of liver injury, regarding decreased ratio of neutrophils, lymphocytes and monocytes, the requirement of invasive ventilator, and SOFA score ≥2 , patients with these abnormal parameters should be of particular concerned during hospitalization.