The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections

• Published in: Journal of clinical medicine 2023-05, Vol.12 (9), p.3335
• Main Authors: Ritter, Einat, Shusterman, Eden, Prozan, Lior, Kehat, Orli, Weiss Meilik, Ahuva, Shibolet, Oren, Ablin, Jacob Nadav
• Format: Article
• Language: English
• Subjects: Body temperature; Clinical medicine; Clinical outcomes; Comorbidity; Coronaviruses; COVID-19; Enzymes; Hepatitis; Hospitalization; Infections; Laboratories; Liver; Mortality; Pandemics; Patients; Regression analysis; Respiratory syncytial virus; Severe acute respiratory syndrome coronavirus 2; Swine flu; Viral infections; Viruses; Vital signs
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12093335

liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. we aimed to compare patterns of abnormal liver function tests in patients suffering from COVID-19 infection and seasonal respiratory viruses: respiratory syncytial virus (RSV) and influenza (A and B). a retrospective cohort study was performed including 4140 patients admitted to a tertiary medical center between 2010-2020. Liver test abnormalities were classified as hepatocellular, cholestatic or mixed type. Clinical outcomes were defined as 30-day mortality and mechanical ventilation. liver function abnormalities were mild to moderate in most patients, and mainly cholestatic. Hepatocellular injury was far less frequent but had a strong association with adverse clinical outcome in RSV, COVID-19 and influenza (odds ratio 5.29 (CI 1.2-22), 3.45 (CI 1.7-7), 3.1 (CI 1.7-6), respectively) COVID-19 and influenza patients whose liver functions did not improve or alternatively worsened after 48 h had a significantly higher risk of death or ventilation. liver function test abnormalities are frequent among patients with COVID-19 and seasonal respiratory viruses, and are associated with poor clinical outcome. The late liver tests' peak had a twofold risk for adverse outcome. Though cholestatic injury was more common, hepatocellular injury had the greatest prognostic significance 48 h after admission. Our study may provide a viral specific auxiliary prognostic tool for clinicians facing patients with a respiratory virus.