The current study is aimed at evaluating the pattern of liver impairment in patients with Covid-19. In addition, the study determined the acceptable and practical diagnostic criteria of Covid-19 Induced Hepatitis (CIH) along with probable causes of liver damage and appraisal of recently published data about the impairment of liver function in these patients.

The authors reviewed literature of newly published data and study in PubMed cited journals and other international publisher journals, which mainly included liver derangement in COVID-19. Statistical analysis of submitted data were evaluated using SPSS. 

The outcome of the study showed that 60% of patients with SARS could have abnormal liver functions. Almost 14–53% of patients with Covid-19 (7/114, 6.14%) have prominently abnormal Aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Impairment in liver enzymes in severe Covid-19 pneumonia was remarkably higher than patients with mild disease, with mean average (37.87±32.17 vs 21.22± 12.67;38.87 ± 22.55 vs 24.39± 9.79). Moreover, patients with community acquired pneumonia (CAP) had noticeably less impaired liver synthetic function (32/114, 28.07%) in contrast to Covid-19 pneumonia (60/115, 52.17%), suggested with high INR. Biopsy of 114 deceased with Covid-19 and liver impairment showed mild sinusoidal dilatation with lymphocyte infiltration. Fatality among Covid-19 and chronic liver disease with Child T-P score A was 23.9%, and Child T-P score B 43.3% with 63.0% fatality among patients with Child T-P score C, Moon AL. Acute liver failure in Covid-19 was seen only in 2 cases, including one adult, and infant who had recent liver transplant.

Thus, Covid-19 Induced Hepatitis (CIH) is a novel clinical syndrome and is defined as a benign new transient hepatitis in a SARS-CoV-2 patients. It is characterized by gradual onset, elevated AST and ALT, dilated sinusoids with lymphocytic infiltration of liver parenchyma, non-obstructive jaundice, stable underlying liver disease and no radiological new hepatobiliary changes. 

Source: Gadour E, Hassan Z, Shrwani K. P31 Covid-19 induced hepatitis (CIH), definition and diagnostic criteria of a poorly understood new clinical syndrome. Gut 2020;69:A22.