A clinical profile of liver function tests in COVID-19 patients at tertiary care centre from north India

B. P Priyadarshi, Avdhesh Kumar, Vipul Singh, Sanjay Kumar Varma, Ravi Yadav, Pankaj Pandey, Sanjeev Tripathi


Background: The coronavirus is a large group of virus, which spread rapidly as an epidemic in china and was named initially as 2019 novel corona virus and subsequently named as Coronavirus disease 2019 (COVID-19) by World Health Organization (WHO). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a dramatic loss of human life globally and manifests a variety of clinical symptoms varying from fever, cough, headache, myalgias, nausea, vomiting to more severe pneumonia, ARDS, septic shock and multiorgan failure. SARS-CoV-2, primarily affect respiratory system but COVID-19 patients also have varying levels of liver injuries or liver dysfunction. This retrospective study was designed to analyze the clinical features, liver function and duration of hospital stay with confirmed cases of covid-19 in a tertiary care centre.

Methods: We conducted a cross-sectional study in the Isolation ward, Level -2 Covid Hospital, Government Medical College, Kannauj, Uttar Pradesh (India), from April to June 2021. A detailed history and examination was carried out as per the pre-designed proforma. The liver function test included alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin. Patients were considered with abnormal LFTs when any value of these tests was higher than upper limit of normal.

Results: One hundred and ten patients with covid-19 were enrolled during the study period. There were 74 males (67.2%) and 36 (32.7%) females.  The mean age of study population was 49.07±12.05 years. In present study, the mean value of serum bilirubin, SGPT, SGOT and ALP were 0.85±0.47 mg/dl, 74.6±66.9 IU/L, 48.45±36.86 IU/L and 229.25±69.79 IU/L, respectively. In present study, the abnormal liver function was seen in 67.2 % cases with COVID-19 patients. The mean duration of hospital stay among normal LFT and abnormal LFT patients group were 13.33±2.12 and 17.10±2.07 days, respectively.

Conclusions: The present study highlighted that abnormal liver function was observed in 67.2% cases with COVID-19 patients. Further research should focus on the cause of liver injury in covid 19 and on treatment and outcome.


Severe acute respiratory syndrome coronavirus, Liver injuries, Alanine transaminase, Aspartate aminotransferase, Alkaline phosphatase, Bilirubin

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Wit ED, Doremalen NV, Falzarano D, Munster VJ. SARS and MERS: Recent insights into emerging coronaviruses. Nat Rev Genet. 2016;14:523-34.

Bosch BJ, van der Zee R, de Haan CA, Rottier PJ. The coronavirus spike protein is a class I virus fusion protein: structural and functional characterization of the fusion core complex. J Virol. 2003;77:8801-11.

Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426:450-4.

Zhou P, Yang XL, Wang XG, Hu Ben, Zhang L, Zhang W, Si HR, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270-3.

Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, et al. Angiotensin-converting enzyme-2 (ACE2), SARS-CoV-2 and pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol. 2020;20:445-17.

Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020;24:91-8.

Chan JFW, To KKW, Tse H, Jin DY, Yuen KY. Interspecies transmission and emergence of novel viruses: lessons from bats and birds. Trends Microbiol. 2013;21:544-55.

Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z , et al. Characteristics of COVID-19 infection in Beijing. J Infect. 2020;80:401-6.

Parasher A. COVID-19: Current understanding of its pathophysiology, clinical presentation and treatment. Postgrad Med J. 2021;97:312-20.

Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. Washington State 2019-nCoV Case Investigation Team. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382:929-36.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.

Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20:425-34.

Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al . Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:606-12.

Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5:428-30.

Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40:998-1004.

Cha MH, Regueiro M, Sandhu DS. Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review. World J Gastroenterol. 2020;26:2323-32.

Pirola CJ, Sookoian S. SARS-CoV-2 virus and liver expression of host receptors: Putative mechanisms of liver involvement in COVID-19. Liver Int. 2020;40:2038-40.

Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARSCoV-2 and other lineage B betacoronaviruses. Nat Microbiol. 2020;5:562-9.

Belouzard S, Chu VC, Whittaker GR. Activation of the SARS coronavirus spike protein via sequential proteolytic cleavage at two distinct sites. Journal PNAS. 2009;106:5871-6.

Millet JK, Whittaker GR. Host cell entry of Middle East respiratory syndrome coronavirus after two-step, furin-mediated activation of the spike protein. Journal PNAS. 2014;111:15214-9.

Ou X, Liu Y, Lei X, Li P, Mi D, Ren L, et al. Characterization of spike glycoprotein of SARS-CoV-2 on virus entry and its immune cross-reactivity with SARS-CoV. Journal PNAS. 2020;11:1620-26.

Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Journal PNAS. 2020;16:1810-16.

Zhou Y, Fu B, Zheng X, Wnag D, Zhao C, Qi Y, et al. Pathogenic T cells and inflammatory monocytes incite inflammatory storm in severe COVID-19 patients. Natl Sci Rev. 2020;nwaa041.

Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71:762-8.

Jain SK, Dudani A, Jaiswal N, Deopujari K, Dube S. Assessment of clinical profile and risk factors associated with adverse outcome in covid-19 patients at a tertiary care hospital in central India. J Assoc Physicians India. 2021;69:27-31.

Kaushik A, Wani SN, Baba MA, Aggarwal AK. Prevalence of Abnormal Liver Function Tests in COVID-19 Patients at a Tertiary Care Centre. JAPI. 2020;68:10-16.

Saini RK, Saini N, Ram S, Soni SL, Suri V, Malhotra P , et al. COVID-19 associated variations in liver function parameters: a retrospective study. Postgrad Med J. 2020;10:1-7.

Garrido M, Guedes TP, Silva JA, Falcao D, Novo I, Archer S et al. Impact of Liver Test Abnormalities and Chronic Liver Disease on the Clinical Outcomes of Patients Hospitalized with COVID-19. GE Port J Gastroenterol 2021;28:253-64.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-13.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized patients with 2019 Novel Coronavirus infected Pneumonia in Wuhan, China. JAMA. 2020;323:1061-69.

Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C. Clinical Features of COVID-19-Related Liver Functional Abnormality. Clin Gastroenterol Hepatol. 2020;18:1561-66.

Rao CM, Jena SK, Patnaik S, Singh N, Gupta S, Priyadarshini S, et al. Clinical Course and Outcome of Critically Ill Clinical COVID-19 Pneumonia or Severe Acute Respiratory Illness. JAPI. 2021;69:42-7.

Gupta N, Agrawal S, Ish P, Mishra S, Gaind R, Usha G, et al. Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India. Monaldi Archives for Chest Disease. 2020;90:193-6.

Saluja M, Pillai D, Jeliya S, Bauddh N, Chandel R. COVID 19- Clinical Profile, Radiological Presentation, Prognostic Predictors, Complications and Outcome: A Perspective from the Indian Subcontinent. JAPI; 2020:68:13-8.

Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2019;130:2620-9.

Qingxian Cai, Huang D, Yu H, Zhu Z, Xia Z, Su Y, et al. COVID-19: Abnormal liver function tests. Journal of Hepatol. 2020;73:566-74.

Gan Q, Gong B, Sun M, Cao Z, Zheng Y, Zhang Y, et al. A High Percentage of Patients Recovered From COVID-19 but Discharged With Abnormal Liver Function Tests. Frontiers in Physiology. 2021;12:2-14.