A recently published article in The Lancet throws light on possible liver impairment in COVID-19 patients. Here we cover, key points from the article- the challenges in cases of liver injuries and management strategies.
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The researchers assessed liver damage and causes for it, from data reported by seven, large case studies that examined clinical features observed in COVID-19 patients. Below are the main higlights.
Patients with severe COVID-19 appear to have higher liver dysfunction rates
About 2 to 11% of patients with COVID-19 had liver comorbidities and 14 to 53% cases reported abnormal levels of alanine aminotransferase and aspartate aminotransferase (AST) as the disease progressed. More number of patients with severe COVID-19 had abnormal liver aminotransferase levels than patients with severe COVID-19.
Prevalence of liver injury is higher in severe cases in comparison to milder cases of COVID-19
- An increase in AST was reported in 62% of the 13 ICU patients as compared to 25% of 28 patients, who did not need ICU admission.
- Diagnosis of COVID-19 conducted by a CT scan, before the onset of symptoms, showed lower incidences of AST abnormality as compared to those patients, who had their diagnosis done after the onset of symptoms.
Viral infection in liver cells could cause liver damage in COVID-19 patients
- About 2 to 10% of COVID-19 patients had diarrhoea and SARS-CoV-2 RNA was detected in stool and blood samples.
- Pathological findings of patients with SARS showed the virus was present in the liver tissue, however, viral inclusions were not observed.
Varied causes of liver impairment that seem plausible
- Drug hepatotoxicity could be a reason for the variation observed in different studies.
- Immune-mediated inflammation in critically ill COVID-19 patients could also be a factor.
- Immune dysfunction and abnormal cytokine levels could be linked to disease severity and mortality.
- Patients with an already compromised systemic immunity could be more susceptible to the infection.
The Lancet article encourages further research on liver injuries in COVID-19 patients and the possible treatment for the infection. To read about the cases in detail and other under-review information published in the original article, click here.