Clinical features of liver injury in patients with coronavirus disease 2019: An analysis of 201 cases

Objective To investigate the features of liver injury in patients with coronavirus disease 2019( COVID-19),and to provide a reference for clinical diagnosis and treatment. Methods Medical records were collected from 201 patients with COVID-19 who were admitted to Xiangyang Central Hospital from January 19 to March 5,2020,and these patients were divided into non-critical( mild/common type) group with 173 patients and critical( severe/critical type) group with 28 patients. The data on alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( TBil),direct bilirubin( DBil),and albumin( Alb) were collected. The t-test was used for comparison of normally distributed continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and the Wilcoxon rank-sum test was used for comparison of ranked data between groups. Results Among the 201 patients,37( 18. 4%) had liver injury,with 19 in the critical group and 18 in the non-critical group,and there was a significant difference in the incidence rate of liver injury between the two groups( 67. 9% vs 10. 4%,χ2= 52. 963,P < 0. 05). There were significant differences between the 19 patients with liver injury in the critical group and the 18 patients with liver injury in the non-critical group in the duration of abnormal ALT and/or AST( on admission and during hospitalization)( χ2= 11. 906,P < 0. 05) and the increase in ALT and/or AST( Z =-2. 869,P < 0. 05),and most patients had mild or moderate liver injury. Among the 201 patients,only one patient had elevated bilirubin( TBil < 2 × upper limit of normal,mainly indirect bilirubin) and had non-critical liver injury. The critical group had a significantly lower level of Alb than the non-critical group( t =-8. 002,P < 0. 05). Among the 201 patients,75 had a reduction in Alb,among whom 50( 50/201,24. 9%) had a reduction on admission and 25( 25/201,12. 4%) had a reduction during hospitalization,and there were significant differences in Alb( t =-4. 967,P < 0. 05) and hypoalbuminemia( χ2= 26. 645,P < 0. 05) between the two periods of time. Conclusion Liver injury is relatively common in patients with COVID-19,mainly mild or moderate liver injury. There is a low incidence rate of abnormal bilirubin and a high incidence rate of the reduction in Alb. There are significant differences in the incidence rate and severity of liver injury between the crucial and non-critical patients. Alb level can be used as one of the indicators to evaluate and predict the severity of COVID-19 patients.