Liver Injury in Hospitalized Patients with COVID‐19 Correlates with Hyper Inflammatory Response and Elevated IL‐6

• Published in: Hepatology Communications 2020
• Main Authors: Da, Ben L, Kushner, Tatyana, Maan El Halabi, Paka, Pavan, Mian Khalid, Uberoi, Angad, Lee, Brian T, Perumalswami, Ponni V, Rutledge, Stephanie M, Schiano, Thomas D, Friedman, Scott, Saberi, Behnam
• Format: Web Resource
• Language: English
• DOI: 10.1002/hep4.1631

Background Liver injury is commonly seen in coronavirus disease 2019 (COVID‐19). However, the mechanism behind liver injury, particularly in severe and critical COVID‐19 patients, remains unclear and the clinical course is poorly described. Methods We conducted a single‐center, retrospective cohort study of consecutive hospitalized severe and critically ill COVID‐19 patients with or without liver injury who underwent immunologic testing (IL‐6, IL‐8, TNF‐α, and IL‐1ß). Liver injury was defined as peak aminotransferases ≥3x ULN (40 U/L) or ≥120 U/L. Patients with liver injury were compared to those who had normal aminotransferases throughout the hospital course. Results 176 patients were studied; 109 with liver injury and 67 controls. Patients with liver injury were more likely to be male (71.6% vs 37.3%; p < 0.001). Peak inflammatory markers and IL‐6 were higher in the liver injury group: CRP: 247 vs 168 mg/L, p < 0.001; LDH: 706 vs 421 U/L, ferritin: 2,973 vs 751 ng/mL, p < 0.001, IL‐6: 121.0 vs 71.8, p < 0.001. There was no difference in the levels of IL‐8, TNF‐α, and IL‐1ß. The liver injury group had a longer length of stay and more severe COVID‐19 despite having less diabetes and chronic kidney disease. Discussion An exaggerated hyper inflammatory response (cytokine storm) characterized by significantly elevated CRP, LDH, ferritin, and IL‐6 levels and increasing severity of COVID‐19 appears to be associated with the occurrence of liver injury in patients with severe/ critical COVID‐19.