Researchers at the Yale Liver Center found that patients using covid-19 demonstrated with abnormal liver tests at much greater rates than indicated by earlier studies.1 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.
Past studies in China found that roughly 15% of patients with covid-19 had abnormal liver tests. The Yale study, which looked retrospectively at 1,827 covid-19 patients that had been hospitalized in the Yale New Haven Health program between March and April, revealed that the incidence of abnormal liver tests was much higher--between 41.6% and 83.4percent of patients, depending upon the specific test.

"We can speculate that US patients might have an elevated speed of additional risk factors like alcoholic or nonalcoholic fatty liver disease," he says.

Liver disease is widespread in the USA population. Michael Nathanson, MD, PhD, 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, states,"In the United Sstates, near one-third of people have fatty liver disease, and many million people have chronic hepatitis B or C."

Since the Yale researchers had access to patients' medical recordsthey were also able to check at their liver tests prior to being diagnosed with covid-19. Roughly one-quarter of patients in the study had abnormal liver tests before being admitted for the virus. But regardless of whether patients arrived into the hospital with existing liver issues or acquired them throughout their covid-19-related hospitalization, a strong association was detected between abnormal liver tests along with the harshness of these covid-19 instances, the investigators said.

Rather than the liver driving poorer outcomes in covid-19 sufferers, the organ is more likely"a bystander" influenced by the hyperinflammation connected with covid-19 and from the side effects of associated treatments, Nathanson says.

The research noted that a connection between drugs used to treat acute covid-19 and liver damage, most importantly the drug tocilizumab.

"We discovered a strong association between the use of covid-19 medications and abnormal liver tests," says Lim, but adds that they could not confidently tease out that the strange tests were due to"drug-induced liver harm" instead of the disease.

The researchers have additional clinical and lab-based studies underway to further comprehend covid-19's impact on liver pathology. Nathanson notes 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 study.

<strong>Reference</strong>

1. Hundt MA, Deng Y, Ciarleglio MM, Nathanson MH, Lim JK. Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network [published online ahead of print, 2020 Jul 29]. <em>Hepatology</em>. 2020;10.1002/hep.31487. doi<span style="color: #ff6600;">:<a style="color: #ff6600;" href="https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.31487">1002/hep.31487</a></span>