Characteristics of Liver Functions in Patients With COVID-19 and Construction of a Prognostic Evaluation Decision Model Based on Liver Functions

A number of studies have suggested that coronavirus disease 2019 (COVID-19) can cause liver damage. However, clinical features and outcome of COVID-19 in patients with liver injury remain to be further investigated. In this study, the clinical data of 265 COVID-19 patients admitted to seven tertiary hospitals were collected. Based on a threshold for transaminase or total bilirubin levels at two times the normal upper limit, patients were divided into mild or moderate/severe liver injury groups. Among the 265 patients, 183 patients showed liver injury within 48 hours of admission. Aspartate aminotransferase levels were predominantly elevated in the liver injury group, but albumin levels were reduced. Moreover, fibrinogen and D-dimer were significantly increased. Furthermore, 68% of the patients with moderate/severe liver injury had one or more underlying diseases. Almost half of these patients developed acute respiratory distress syndrome (44%) and secondary infections (46%). These patients showed increased interleukin-6 and interleukin-10 levels and a decrease in PaO2 and the oxygenation index. In addition, levels of alanine aminotransferase, aspartate aminotransferase, and albumin were correlated with the oxygenation index, D-dimer and lymphocyte counts. Furthermore, a novel prognostic assessment model based on liver function was established, which accuracy reached 88% and was able to accurately assess the prognosis of COVID-19 patients.