Joshua Y. Kwon, MD, Dawn Francis, MD; Mayo Clinic, Jacksonville, FL
Introduction: Recent studies have suggested that COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-20), can cause abnormal liver function tests (LFT) in affected patients both with and without pre-existing liver disease. Here we describe a series of patient cases involving abnormal LFTs in patients with confirmed COVID-19 infections in both the inpatient and outpatient setting at the Mayo Clinic in Florida.
Methods: 4 cases of COVID-19 infection with concomitant abnormal LFTs were identified. Only 1 of the 4 patients required hospital admission while three other patients were managed on an outpatient basis. 1 patient was managed completely outpatient, 2 patients required an emergency department visit, and the last patient was hospitalized and admitted to the ICU. ¾ patients had no pre-existing liver conditions, while 1 patient had findings suggestive of nonalcoholic fatty liver disease (NAFLD) on imaging with no prior diagnosis. Only 2 out of 4 patients had gastrointestinal symptoms including nausea, abdominal pain, and diarrhea. All patients recovered from COVID-19 with no major sequelae and their LFTs returned to baseline levels with no major intervention. 2 out of 4 patients were given hydroxychloroquine as part of their treatment. The average max aspartate transaminase (AST) and alanine transaminase (ALT) among all patients were 206±58.7 and 313±155, respectively. No significant pattern was seen between elevations of AST vs ALT. Notably, all patients had abnormal AST and ALT, but only 1 patient had elevated ALP. Bilirubin was not affected in all patients. Discussion: In the literature, there have been reports of abnormal liver function tests associated with SARS-CoV2. In many of these reports, only a small subset of patients had pre-existing liver conditions (< 10%). This suggests that there are unknown variables involved in COVID-19 infection that leads to liver injury. Severe illness leading to shock, hypoxia, or inflammation can all affect the liver, independently of the SARS-CoV-2 virus. Only one patient in the series was hospitalized, and all patients recovered from their disease over the course of 2 weeks. Other possible mechanisms include direct damage of liver cells by the virus or treatment associated drug hepatoxicity. Further studies are needed to evaluate the association between liver injury and the SARS-CoV-2 virus.
Disclosures: Joshua Kwon indicated no relevant financial relationships. Dawn Francis indicated no relevant financial relationships.