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

The influence of ALI on the prognosis of COVID-19 is unclear. The present study analyzed the impact of ALI on death risk of COVID-19 patients. Our results showed that the fatality rate was higher in COVID-19 patients with hypoproteinemia than those without hypoproteinemia. Moreover, the fatality rate was higher in COVID-19 patients with cholestasis than without cholestasis. Our results suggest that hypoproteinemia and cholestasis at the early stage elevate death risk of COVID-19 patients. It is especially interesting whether SARS-CoV-2-induced ALI recovers in a short time after discharge. In the present study, 150 COVID-19 patients were followed up and measured hepatic functions 14 days after discharge. Unexpectedly, no significant difference on the values of serum direct bilirubin, indirect bilirubin, TBA, alkaline phosphatase, glutamyl transferase and AST was observed when admission and 14 days after discharge. Although serum albumin level was rebounded on 14 days after discharge, 17% COVID-19 patients remained below normal range. Our results indicate that hepatic functional indexes of two-third COVID-19 patients remain abnormal 14 days after discharge. Therefore, further follow-up is required to further evaluate whether SARS-CoV-2 infection causes permanent liver injury.