International Journal of Advanced Research in Medicine
2022, Vol. 4, Issue 1, Part C
Hepatic dysfunction in COVID-19: A useful prognostic marker of severe disease?
Author(s): Dr. Chandra Shekhar N and Dr. Diwakar TN
Abstract:Background: COVID-19 has disrupted many countries worldwide; its high mortality and spread has overwhelmed the healthcare systems. Hence it has become important to identify reliable predictors of disease severity and morbidity which would streamline healthcare resources into improving efficiency of management and thus improving the clinical burden and overall outcome. An increase in LFT parameters has showed an association with severity of the disease and ICU admissions seen by various studies. But none of the studies reviewed the LFT parameters with respect to the outcome. So, this can be done by monitoring LFT parameters and drawing a comparison.
Aim: To correlate serum liver function parameters levels in COVID-19 patients, admitted in an Indian setting, with clinical outcome.
Methods: A single-center, observational cross-sectional study was conducted in COVID-19 positive patients admitted from April1st, 2021 to May 1st, 2021. The diagnosis was confirmed by Real-Time Polymerase Chain Reaction (RT-PCR). Liver function test parameters were compared to clinical outcomes and checked for statistical association.
Results: A total of 157 COVID-19 patients were studied. Mann-Whitney test was used to find the medians of Total Bilirubin (TB) was 1.65 in the population that succumbed to death and 0.3 for the group that got discharged (p<0.05). Direct Bilirubin (DB) also showed a significant increase in non survivors 2.4 vs 0.2 (p<0.05). Total protein and albumin showed a decrease in levels in the patients that succumbed, median values of TP and Albumin in the non survivors and survivors are 6 and 3.1 and 6.8 and 3.8 respectively (p=0.005 and p=0.001). All enzyme levels were higher in the group that succumbed to death. The median Alkaline Phosphatase (ALP) 273 vs 84 in non-survivor group as compared to the group that got discharged (p<0.05). The aspartate aminotransferase (AST) and alanine aminotransferase (ALT) median levels were 144 and 123.5 in non-survivor group and 27 and 23 in the survivor group respectively. (p<0.05 for both)
Conclusion: Our study showed an association with increased liver enzyme levels, TB and DB and decreased total protein levels and albumin levels with adverse clinical outcomes. This important association would require additional studies to bring in new criteria and guidelines that would substantiate this finding as this could serve as a cost-effective triaging tool to assess patients according to need foreseeing the prognosis.