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.