Liver injury is increasingly being observed in patients with COVID-19, with an incidence ranging from 14-53%. A recent study by Ji et al evaluated the liver injury patterns and implication of non-alcoholic fatty liver diseases (NAFLD) on clinical outcomes in patients with COVID-19.

From January 20 till February 17, 2020, investigators assessed consecutive patients admitted to two designated COVID-19 Hospitals in China with confirmed COVID-19 and information on NAFLD status. Liver injury was defined as hepatocellular if the alanine aminotransferase (ALT) level was >30 IU/L for males and >19 IU/L for females; ductular if alkaline phosphatase (ALP) was >the upper limit of normal (ULN) along with gamma-glutamyltransferase (GGT) >ULN; mixed if both hepatocellular and ductular enzymes were raised >ULN. NAFLD was defined by a hepatic steatosis index (HSI = 8 × [ALT/AST] + BMI [+ 2 if type 2 diabetes yes, + 2 if female]) of >36 points and/or by abdominal ultrasound examination. The ALT/AST value for HSI was obtained either at complete recovery on discharge or from records of the patients before and within 12 months of the diagnosis of COVID-19. The patients were followed until discharged with recovery or disease progression.

Two hundred and two consecutive patients were involved in this study. Liver injury was observed in 50% patients on admission and 75.2% during hospitalization. Nearly all liver injury was assessed as mild with hepatocellular pattern. Only 2.6% (4/152) had ductular or mixed pattern. About 33.2% had persistent abnormal liver function from admission to last follow-up. Progressive disease was evident in 19.3% while stable disease was noted in 80.7% patients. Patients with progressive disease were noted to be older, have higher BMI, and a higher percentage of comorbidity and NAFLD. According to the univariate and multivariate logistic regression analysis, male sex (odds ratio [OR] 3.1; 95% CI 1.1–9.4), age >60 years (OR 4.8; 95% CI 1.5–16.2), higher BMI (OR 1.3; 95% CI 1.0–1.8), underlying comorbidity (OR 6.3; 95% CI 2.3–18.8) and NAFLD (OR 6.4; 95% CI 1.5 - 31.2), had a link with COVID-19 progression.

There was higher risk of disease progression (6.6% [5/126] vs. 44.7% [34/76]), higher odds of abnormal liver function from admission to discharge (70% [53/76] vs. 11.1% [14/126]) and longer viral shedding time (17.5 ± 5.2 days vs. 12.1 ± 4.4 days) in NAFLD patients in comparison with patients without NAFLD.

Source: Ji D, Qin E, Xu J, et al. Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study. Journal of Hepatology April 8, 2020.