Acute liver injury and its association with death risk of patients with COVID-19: a hospital-based prospective case-cohort study

Lin Fu; Jun Fei; Shen Xu; Hui-Xian Xiang; Ying Xiang; Zhu-Xia Tan; Meng-Die Li; Fang-Fang Liu; Ying Li; Ming-Feng Han; Xiu-Yong Li; Hui Zhao; De-Xiang Xu

Several studies found that elderly COVID-19 patients had more severe symptoms and signs than younger cases [18, 19] . The present study analyzed the influence of gender and age on SARS-CoV-2-induced ALI. We showed that the levels of serum total bilirubin, ALT, alkaline phosphatase and glutamyl transferase were higher in males than in females. By contrast, serum albumin level was lower in males than in females. Further analysis showed that total bilirubin, ALT, alkaline phosphatase and glutamyl transferase were higher in older patients than younger ones. By contrast, albumin and globulin were lower in older patients than younger ones. According to several clinical reports, COVID-19 patients with comorbidities had worse prognosis [14, 20] . Indeed, this study found that 40.8% COVID-19 patients were with diabetes, 35.2% with hypertension, and 4.5% with liver disease. To explore the influence of comorbidities on ALI, the present study analyzed hepatic functional indexes among different groups. Our results showed that alkaline phosphatase was slightly higher in COVID-19 patients with hypertension than those without hypertension. In addition, alkaline phosphatase and glutamyl transferase were slightly higher in patients with diabetes than those without diabetes.