Dynamic liver function indexes monitoring and clinical characteristics in three types of COVID-19 patients

  1. Cheng Chen
  2. Jie Jiang
  3. Xiaoxiao Xu
  4. Yiyang Hu
  5. Yi Hu
  6. Yu Zhao

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Abstract

Background and Aims: The abnormal liver function and even liver failure related death were reported in the COVID-19 patients, but less of studies focus on the dynamic liver function changes. We analysed the liver function indexes of COVID-19 patients to explore the characteristics of liver function changes in patients with different severity. Methods: This study included 54 moderate, 50 severe, and 31 death nucleic acid-confirmed COVID-19 patients hospitalized at the central hospital of Wuhan, China. Epidemiological histories, clinical features, imaging materials, medications and especially major liver function laboratory tests were collected for analysis. Results: The clinical symptoms did not present any significant difference in the patients at admission, but the older male patients had pronounced mortality risk. The normal ratio of ALT, TB, and DBIL of moderate patients was 96.3%, 94.44%, and 98.15% separately at the first test, but 59.26% of patients showed declined ALB levels. The normal ratio of all liver function indexes declined after admission, but most abnormalities were mild (1-2 times of upper limit unit) and went back normal before discharge. In severe patients, the normal ratio of ALB dropped down to 30.61% at admission along with the dramatic impaired normal ratio of bilirubin at the second test. The severe patients liver function dysfunction was worse than the moderate patients but without a significant difference. The dead patients showed a significantly higher level of DBIL, AST, GGT and CRP than other groups patients in the final test, along with the hypoalbuminemia. What is worse, 16.13% of non-survivors were diagnosed with liver failure. No medication was found to be related to ALT, AST, and GGT abnormality in our study. Conclusion: In moderate and severe patients, liver dysfunction was mild. Patients widely presented lower level of ALB. The higher level of bilirubin, AST, and GGT was likely to indicate the worse outcome. Dynamic monitoring of liver function indexes could be considered and liver failure related death should be noticed and prevented in the early stage.

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    SciScore for 10.1101/2020.05.13.20099614: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Institutional Review Boards of Hubei Public Health Clinical Center, the Central Hospital of Wuhan, China.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    To the limitations of this study, the number of patients in each group in the present study is limited, and all data were collected from a single hospital, a large scale study in multi-centre, even in multi-country could be designed in the future. On the other hand, we did not systemically consider the whole disease situation basing on other related laboratory tests, that would be harder for us to take consideration of the liver injury to the whole disease progression in the patients. In conclusion, in our study, we separately and dynamically analyzed the liver function tests at three-time points of moderate, severe and dead COVID-19 patients. Liver dysfunction and damage truly happened in some COVID-19 patients and most liver derangement and damage happened and further developed after admission. Severe acute liver injury and failure presented in patients, which should be noticed and prevented in the early stage to help decreasing mortality. However, most hepatic abnormalities are mild and are more likely to be the subsequent consequences of systemic inflammatory dysfunction in COVID-19 patients, more attention should be paid to focus towards viral control and modulating systemic inflammation in COVDI-19 patients.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.05.13.20099614v2 on medRxiv
  3. Version published to 10.1101/2020.05.13.20099614v1 on medRxiv