Abnormal liver function in patients hospitalized with COVID-19 in Latvia

Abnormal liver function (LF) is one of the processes registered during acute SARS-CoV-2 infection. This study aimed at investigating liver function in patients with COVID-19 on admission to the hospital. A retrospective study has been conducted within the framework of the National Research Program VPP-COVID-2020/1-0023. COVID-19 patients hospitalized in Riga East Clinical University hospital (March-November 2020) were included. Abnormal LF was defined as ALt>40 U/l, ASt>40 U/l, GGt>45 U/l, or total bilirubin (TBIL) >21 µmol/l. Liver injury was defined at the level of ALT three times greater than 40 U/l. Autopsies were performed on thirty patients who died. Liver samples of nine patients without severe comorbidities were analyzed. Among the 184 patients 68 (37%) had abnormal LF and 6 (3%) had the liver injury. Abnormal LF and liver injury were found in 13% and 17% of mild, 63% and 33% of moderate and in 24% and 50% of severe COVID-19 patients. Age, gender, presence of hypertension, coronary heart disease, diabetes, leucocytes, erythrocytes, platelets, and TBIL on admission had no significant differences in LF groups. Chronic liver diseases were previously diagnosed in 2% of patients with normal LF, 4% of patients with abnormal LF, and 50% of patients with liver injury. All liver samples showed fibrosis. Macrovesicular steatosis was observed in 78%, centrilobular necrosis in 22% (1-rare areas, 1-several areas in the field of vision), inflammation with predominantly lymphocytic infiltration in 89% (2-mild and 1-moderate inflammation in the portal fields, 5-mild inflammation in the portal fields and lobularly) of cases. The abnormal liver function is observed in one-third of patients hospitalizes with COVID-19. LF abnormality and liver injury are related to the COVID-19 severity. Investigation on admission allows hypothesizing that the abnormal function is a result of direct SARS-CoV-2 effect on the liver. Chronic liver diseases may interact with COVID-19 severity.