Liver: Function and dysfunction in COVID-19

Context: COVID-19 is known to cause extrapulmonary manifestations, including gastrointestinal and abnormal liver functions. Multiple mechanisms have been proposed to explain the pathobiology of liver damage: ACE2 receptor cholangiocytes mediated systemic inflammation, cytokine storm, hyperinflammation, and hypoxic changes. This was a cross-sectional study done in Department of General Medicine,JJM Medical College Davangere between July and September 2020 of patients falling under Category B and Category C.

Materials and Methods: The aim is to describe the clinical characteristics in patients of COVID-19 and investigate the gender difference with particular regard to liver impairment.Confirmation of COVID-19 positivity was based on RT-PCR for SARS-CoV-2 RNA. Laboratory investigations and clinical data was analyzed using SPSS Statistics 27.

Results: The final study population consisted of 116 patients. On performing the Mann Whitney U test, adjusted P values reveal a significant difference in ALT (P = 0.0348), total bilirubin (P = 0.0012) and direct bilirubin (P = 0.0024). The degree of hypoalbuminemia in males was significantly higher than in females (P = 0.0075). Other biochemical parameters, however, did not show significant difference amongst patients based on gender. Acute kidney injury was the most prevalent condition, present in 67.2% of the patients. Other co-morbidities were diabetes mellites, chronic liver disease, hypertension, hepatitis B and C, and hypothyroidism.

Conclusion: Ultrasonography of the abdomen is an essential investigation for all patients testing positive for COVID-19. Pre-existing disease may aggravate the viral hepatic injury, thereby worsening the clinical outcome. The profiles of liver toxicity of the drugs used in the treatment of COVID-19 also warrant watchful monitoring of liver function.