Patients with COVID-19 usually have increased liver enzyme levels, which is correlated to poorer outcomes during hospitalization including increased risk of ICU admission, intubation, and mortality. While evaluating patients, it is essential to contemplate causes of liver injury unrelated to COVID-19. Although treatment for COVID-19 may elevate liver enzyme levels, it is not contraindicated in patients with baseline abnormal liver tests. Therefore, it is advisable to monitor liver enzymes regularly in all hospitalized patients with COVID-19. Patients with pre-existing liver disease such as cirrhosis and those who have received a liver transplant may be an increased risk of severe COVID-19 outcomes.

Heightened liver enzyme levels can be found in 14% to 76% of patients with COVID-19. It has been observed in a recent meta-analysis of 107 studies involving 20,874 COVID-19–positive patients, the pooled incidence of elevated liver enzymes on presentation was 23.1%.

The hepatocellular pattern of liver injury was more frequently seen, which was mild and transient in most patients. Another retrospective study of 2,273 patients with COVID-19 showed 45% had mild liver injury, which was defined as a levels of alanine aminotransferase (ALT) above the upper limit of normal (ULN) and below 2 times ULN. Liver injury was moderate (ALT between 2-5 times ULN) in 21% of cases and severe (above 5 times ULN) in 6.4% of cases. 

Source: El Ouali S, Romero-Marrero C, Regueiro M. Hepatic manifestations of COVID-19. Cleveland Clinic Journal of Medicine. August 2020. Available at: https://www.ccjm.org/content/early/2020/08/25/ccjm.87a.ccc061 Accessed on: 09-06-2021.