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Study Finds Liver Injury to be Common Among COVID-19 Patients

A study of over 1,000 COVID-19 patients conducted by the Faculty of Medicine at the Chinese University of Hong Kong (CU Medicine) showed that around 20 percent of patients had liver injury and adverse clinical outcomes, prompting more cautious management of liver biochemistries.

As the current COVID-19 pandemic continues to develop, more information regarding the long- and short-term effects of the disease begin to surface, along with strategies to mitigate them. Studies worldwide have shown that the novel coronavirus may have lasting and damaging impacts on almost every organ, particularly the heart and lungs.

However, in view of the high prevalence of various chronic liver diseases in the Asia-Pacific region combined with the lack of data on the serial liver biochemistries of patients infected with human coronaviruses, a team of researchers from the Faculty of Medicine at The Chinese University of Hong Kong (CU Medicine) recently conducted a study to investigate the impact of liver injury on clinical outcomes in COVID-19 patients.

Upon analysing data from over 1,000 COVID-19 patients in Hong Kong, they found that liver injury in the form of hepatitis, cholestasis, or both, was observed in about 20 percent of patients. It was found that the level of liver enzyme alanine aminotransferase (ALT) or aspartate aminotransferase (AST) was elevated in 23 percent of the COVID-19 patients, which indicated liver damage. These findings were published in the world-renowned medical journal, Gut.

They assessed that the estimated risk of COVID-19 patients with liver injury experiencing adverse clinical outcomes such as intensive care unit (ICU) admission, use of invasive mechanical ventilation or death was almost eight times of other patients.

Professor Grace Wong Lai Hung, Professor in the Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics at CU Medicine, explained, “Liver injury is possibly caused by systemic inflammation and adverse drug reactions in severe COVID-19 patients who have been receiving different medical treatments. As the degree of liver injury could be impacted by coexisting chronic hepatitis in patients, a thorough review of medical history and detailed investigation for concomitant liver diseases are crucial to improve patient outcomes.”

The first author of the study, Dr Terry Yip Cheuk Fung, a post-doctoral fellow of the Department of Medicine and Therapeutics at CU Medicine added, “Although the exact impact of the novel virus on the liver has not been well elucidated so far, our findings proved that the chance of patients with liver injury having adverse clinical outcomes is obviously higher than that of others. This shows that liver injury is prognostically significant in COVID-19 patients.”

The authors recommended that cautious use of appropriate medications with least hepatotoxicity as well as vigilant monitoring of liver biochemistries be carried out in order to minimise liver injury in COVID-19 patients.

In addition, CU Medicine’s researchers led a group of experts from Mainland China, Japan, Singapore and Australia to issue a position statement in June this year on the management of COVID-19 patients with liver derangement, which was published recently in another international medical journal, The Lancet Gastroenterology & Hepatology. Clinical scenarios covered in the statement included the precautions for the use of pharmacological treatment for COVID-19 in patients with liver derangement, for example that liver tests should be conducted twice weekly in patients on potentially hepatotoxic medication, those with pre-existent liver diseases, and more frequently in any patients with abnormal liver function.

The statement also proposed the assessment and management of patients with hepatitis B or hepatitis, non-alcoholic fatty liver disease, liver cirrhosis, and liver transplantation during the pandemic.

Professor Vincent Wong Wai Sun, Director of the Cheng Suen Man Shook Centre for Hepatitis Research and Head of the Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics at CU Medicine, stated, “It is common to encounter patients with COVID-19 who have abnormal liver function. As the causes of liver impairment in COVID-19 patients and the liver toxicity of the new antiviral drugs are to be studied, experts in our group joined hands to give recommendations for the clinical management of patients with liver derangement, with the hope of providing the most appropriate care at this critical time. We strongly believe that these recommendations will be beneficial to the healthcare professionals in the Asia-Pacific region as well as around the world.” [APBN]