Longitudinal progression of clinical variables associated with graded liver injury in COVID-19 patients

Justin Y. Lu, Harnadar Anand, Shalom Z. Frager, Wei Hou, Tim Q. Duong

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: Hospital-acquired liver injury is associated with worse outcomes in COVID-19. This study investigated the temporal progression of clinical variables of in-hospital liver injury in COVID-19 patients. Methods: COVID-19 patients (n = 1361) were divided into no, mild and severe liver injury (nLI, mLI and sLI) groups. Time courses of laboratory variables were time-locked to liver-injury onset defined by alanine aminotransferase level. Predictors of liver injury were identified using logistic regression. Results: The prevalence of mLI was 39.4% and sLI was 9.2%. Patients with escalated care had higher prevalence of sLI (23.2% vs. 5.0%, p < 0.05). sLI developed 9.4 days after hospitalization. sLI group used more invasive ventilation, anticoagulants, steroids, and dialysis (p < 0.05). sLI, but not mLI, had higher adjusted mortality odds ratio (= 1.37 [95% CI 1.10, 1.70], p = 0.005). Time courses of the clinical variables of the sLI group differed from those of the nLI and mLI group. In the sLI group, alanine aminotransferase, procalcitonin, ferritin, and lactate dehydrogenase showed similar temporal profiles, whereas white-blood-cell count, D-dimer, C-reactive protein, respiration and heart rate were elevated early on, and lymphocyte and SpO2 were lower early on. The top predictors of sLI were alanine aminotransferase, lactate dehydrogenase, respiration rate, ferritin, and lymphocyte, yielding an AUC of 0.98, 0.92, 0.88 and 0.84 at 0, − 1, − 2 and − 3 days prior to onset, respectively. Conclusions: This study identified key clinical variables predictive of liver injury in COVID-19, which may prove useful for management of liver injury. Late onset of sLI and more aggressive care are suggestive of treatment-related hepatotoxicity.

Original languageEnglish (US)
Pages (from-to)1018-1026
Number of pages9
JournalHepatology International
Issue number4
StatePublished - Aug 2021


  • Acute kidney injury
  • Aminotransferases
  • Aspartate aminotransferase
  • Cytokine storm
  • Liver dysfunction
  • Liver failure
  • Multi-organ failure
  • SARS-CoV-2

ASJC Scopus subject areas

  • Hepatology


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