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Liver impairment in COVID-19 patients: a retrospective analysis of 115 cases from a single center in Wuhan city, China

Our take —

Markers of liver dysfunction in COVID-19 patients were elevated slightly, but not to a clinically significant degree. Liver dysfunction was not more pronounced than in a control group with community-acquired pneumonia, and did not predict COVID-19 severity. The small sample size and single location limit generalizability.

Study design

Case-Control

Study population and setting

Cases were comprised of all 115 health care workers and family members (>14 years old without hepatitis B infection) with confirmed SARS-CoV-2 infection who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from 1/18/20 to 2/22/20. Controls were 119 patients with community-acquired pneumonia from the same hospital.

Summary of Main Findings

Serum markers of liver dysfunction and inflammation were not significantly elevated in COVID-19 patients relative to community-acquired pneumonia patients. Only the neutrophil-to-lymphocyte ratio was a predictor of COVID-19 severity.

Study Strengths

Patients were tested for a wide array of liver function indices. The presence of a control group improves the validity of the analysis.

Limitations

The sample size is small and comes from a single hospital. There were few (n=31) severe cases of COVID-19. The comparison groups may differ by much more than just disease etiology – healthcare workers and their families represent a different population than the broader patient population. Because the sensitivity of the SAR-CoV-2 diagnostic testing is, as yet, unclear, COVID-19 patients may have been incorrectly classified as having non-COVID pneumonia, thus biasing the results.

Value added

This is one of the first studies to focus specifically on liver dysfunction as a manifestation of COVID-19.