The present retrospective study was performed to assess the role of liver sonography in patients with coronavirus disease 2019 (COVID-19) and elevated liver enzymes. The authors of the study included patients tested positive for SARS-CoV-2 in emergency ward between January 01 and April 24, 2020 and recorded their elevated liver enzymes were included (Cohort 1). The local radiology information system was screened for sonographies in COVID-19 patients at the intensive care unit in the same period (Cohort 2). They evaluated liver sonographies and histologic specimen and suspicious findings were recorded. Review of medical records were done for clinical data. An association between ultrasound findings and clinical data were evaluated with severity of liver enzyme elevation.

The outcome showed that126 patients were evaluated in Cohort 1, out of which 47 (37.3%) had increased liver enzymes. Severity of liver enzyme elevation was linked to mortality. Among these, eight patients (6.3%) had suspicious ultrasound findings, including signs of acute hepatitis, such as thickening of gall bladder wall, hepatomegaly, decreased echogenicity of liver parenchyma and vascular complications. While, Cohort 2 included 39 patients, among which 14 were also included in Cohort 1. Out of these, 19 patients (48.7%) had suspicious ultrasound findings, of which 13 patients had signs of acute hepatitis and six had vascular complications. Pathology was conducted in six patients and the most common findings were severe cholestasis and macrophage activation.

Thus, the study concluded that increased liver enzymes are not a cause of significant concern, if rise in enzymes are only mild to moderate in majority of hospitalized COVID-19 patients. Nevertheless, bedside sonography in severely ill patients acts as a important diagnostic tool in identifying different patterns of vascular, cholestatic or inflammatory complications in the liver, which are related to high mortality rates. Furthermore, macrophage activation as histopathologic link for a hyperinflammatory syndrome are reported to be the most common complication in COVID-19.

Source: Spogis J, Hagen F, Thaiss WM, Hoffmann T, Malek N, Nikolaou K, Berg CP, Singer S, Bösmüller H, Kreth F, Kaufmann S. Sonographic findings in coronavirus disease-19 associated liver damage. PLoS One. 2021 Feb 19;16(2):e0244781.