Discussion
In the present retrospective cohort study, we observed a high LBAI prevalence of up to 57.7% and a high mortality of 22.3% in patients hospitalized with relatively severe COVID-19. Some key demographics, clinical features, and lab parameters, e.g., age ≥ 65 years, female, comorbidities, the severity of disease, depleted lymphocyte count, abnormal D-dimer and elevated serum ferritin levels were found to be significantly associated with liver injury. On-admission liver function is a reliable predictor of subsequent liver injury. Patients with liver injury had up to four times the risk of mortality. AST and TBIL are factors most strongly related to prognosis and therefore could aid in prognosis monitoring. The use of antibiotics and IVN were associated with liver injury and therefore should be used with caution among COIVD-19 patients. Hepatoprotective drugs tended to favor survival, and their uses deserve recommendations for patients with abnormal liver function.
In some recent studies, elevated levels of ALT and AST were reported in patients with COVID-19, with rates ranging from 14% to 53%4-7. The prevalence of liver injury in the present study was higher, partly due to the high proportion of severe and critical COVID-19. Previous studies found that liver injury was common in critically ill patients with COVID-194, 6. Several indices of liver function, including ALT, AST, and TBIL, were significantly elevated in severe COVID-19 cases compared with mild cases1. These results were coincident with ours. Besides this, we found some key demographics, e.g., age 65 years or above, female, and comorbidities were significant indicators of liver injury. These demographic characteristics and comorbidities are wind vanes for liver injury and are cue signals which are helpful for intensive care and individualized tailored surveillance.