Impact of COVID-19 on liver function: results from an internal medicine unit in Northern Italy
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Impact of COVID‑19 on liver function: results from an internal medicine unit in Northern Italy Marco Vincenzo Lenti1 · Federica Borrelli de Andreis1 · Ivan Pellegrino1 · Catherine Klersy2 · Stefania Merli1 · Emanuela Miceli1 · Nicola Aronico1 · Caterina Mengoli1 · Michele Di Stefano1 · Sara Cococcia1 · Giovanni Santacroce1 · Simone Soriano1 · Federica Melazzini1 · Mariangela Delliponti1 · Fausto Baldanti3 · Antonio Triarico4 · Gino Roberto Corazza1 · Massimo Pinzani5 · Antonio Di Sabatino1,6 on behalf of the Internal Medicine Covid-19 Team Received: 27 May 2020 / Accepted: 27 June 2020 © The Author(s) 2020
Abstract Little is known regarding coronavirus disease 2019 (COVID-19) clinical spectrum in non-Asian populations. We herein describe the impact of COVID-19 on liver function in 100 COVID-19 consecutive patients (median age 70 years, range 25–97; 79 males) who were admitted to our internal medicine unit in March 2020. We retrospectively assessed liver function tests, taking into account demographic characteristics and clinical outcome. A patient was considered as having liver injury when alanine aminotransferase (ALT) was > 50 mU/ml, gamma-glutamyl transpeptidase (GGT) > 50 mU/ml, or total bilirubin > 1.1 mg/dl. Spearman correlation coefficient for laboratory data and bivariable analysis for mortality and/or need for intensive care were assessed. A minority of patients (18.6%) were obese, and most patients were non- or moderate-drinkers (88.5%). Liver function tests were altered in 62.4% of patients, and improved during follow-up. None of the seven patients with known chronic liver disease had liver decompensation. Only one patient developed acute liver failure. In patients with altered liver function tests, PaO2/FiO2 50 mU/ml, and/or gamma-glutamyl transpeptidase (GGT) > 50 mU/ml, and total bilirubin > 1.1 mg/dl (this latter when associated with altered transaminases and with no other causes of increase). Other relevant laboratory liver tests included serum cholinesterase, alkaline phosphatase (ALP), serum albumin, international normalised ratio (INR), serum glucose, and urine ketones. Lactate dehydrogenase (LDH) was assessed as an unspecific marker of cytolysis, while c reactive protein (CRP) was included as unspecific inflammatory marker. Neutrophilto-lymphocyte ratio was included as a marker of stress used in critically ill patients [23]. Arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) was used for assessing the severity of respiratory failure. Diagnosis of COVID-19 was based on clinical grounds (flu-like symptoms, fever, tachypnoea, hypoxemia, presence of radiological interstitial pneumonia) and SARSCoV-2 detection through nasopharyngeal swab. More in depth, total nucleic acids (DNA/RNA) were extracted from samples (200 µl) using the Q IAsymphony ® instrument ® with QIAsymphony DSP Virus/Pathogen Midi Kit (Complex 400 protocol) following the manufacturer’s instructions (QIAGEN, Qiagen, Hilden, Germany). Specific realtime PCR targeting RNA-dependent RNA
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