Clinical Outcome of Hospitalized COVID-19 Patients with Abnorma Liver Functions: A Prospective Cohort Study

Abstract

Background: COVID-19 is a viral illness caused by SARS-CoV2 coronavirus. The prognosis and outcome of the disease is mainly affected by the involvement of the respiratory system but involvement of other organ systems including liver have impact on patient morbidity and mortality. Several recent studies have suggested that patient with altered liver functions were associated with more severe disease with worse outcomes in comparison with patients with normal liver functions.

Objective: This study aim to assess the impact of altered liver functions on the clinical course of COVID-19.

Materials & Methods: This was a prospective cohort study conducted in the Dhaka medical college hospital, Dhaka during the period of August 2020 to July 2021. One hundred and seventy four patients were enrolled as the study subjects. After discharge from hospital, they were followed up by clinically and by ALT level (over phone or face to face interview at follow up clinic) at 1 month and 6 month to see abnormal ALT was due to COVID-19 infection or other cause. Among them eighty seven patients have abnormal LFT and eighty seven patients have normal LFT. They were matched for demographic characteristics. They were assessed clinically for severity of the disease and outcomes during hospitalization period.

Results: Raised ALT was the most common LFT abnormality (69%) among abnormal LFT group of study patients. Both COVID-19 severity and the use of glucocorticoids were independent risk factors for abnormal LFT in study populations. LFT abnormality in COVID-19 was transient and tended to resolve over time. ALT normalizations was gradual in severe to critical COVID-19 than mild to moderate illness. In almost all of the patients, ALT became normal at 6th months of follow up in both groups. Abnormal LFT in COVID-19 was associated with more severe disease (RR 1.31, 95% CI, 1.00- 1.72; p=0.047). Oxygen requirement was more in COVID-19 patients who had abnormal LFT than in patients with normal LFT (RR 1.47, 95% CI, 1.16-1.86; p=0.001). Regarding outcome in terms of death, mechanical ventilation and recovery, we didn’t find any significant difference between abnormal and normal LFT group.

Conclusion: Raised ALT was the most common LFT abnormality among abnormal LFT group. Pattern of LFT abnormality was predominantly hepatitic. Abnormal LFT was associated with more severe COVID-19. Oxygen requirement was more in abnormal LFT group. Regarding outcome in terms of death, mechanical ventilation and recovery, we didn’t find any significant difference between abnormal and normal LFT group.