Background/Aim The coronavirus disease 2019 (COVID-19) had become a big threat worldwide. Liver injury is not uncommon in patients with COVID-19, and clarifying its characteristics is needed. This study aimed to identify factors associated with liver injury and to develop a new classification of predictive severity in patients with COVID-19. Methods Confirmed patients with COVID-19 (n = 60) were recruited retrospectively from Musashino Red Cross Hospital. The factors of liver injury especially on the elevation of liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) were analyzed. Grading was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results During a median hospitalization follow-up of 15 (4–41) days, 51 (85.0%) patients had COVID-19 pneumonia. In clinical courses, oxygenation was needed for 25 (41.6%) patients and intubation was needed for 9 (15.0%) patients. A total of 27 (45.0%) patients had gastrointestinal symptoms (GS), such as appetite loss, diarrhea, and nausea. A logistic regression analysis revealed that C-reactive protein (CRP) at baseline, oxygenation, intubation, and GS were significant factors of liver injury. Based on these results, patients were classified into three groups: group 1, no oxygenation pneumonia; group 2, pneumonia with oxygenation or GS; and group 3, intubation. We classified 25 (41.7%), 26 (43.3%), and 9 (15.0%) patients into mild, moderate, and severe groups, respectively. The peak of AST and ALT levels was significantly stratified with this criteria (mild [median AST, 28 IU/L; median ALT, 33 IU/L], moderate [median AST, 48 IU/L; median ALT, 47.5 IU/L], and severe [median AST, 109 IU/L; median ALT, 106 IU/L]; P <0.001 and P = 0.0114, respectively). Conclusion COVID-19-related liver injury was significantly stratified based on GS and severity of pneumonia.
【초록키워드】 COVID-19, coronavirus disease, Hospitalization, Pneumonia, severity, intubation, diarrhea, Characteristics, Patient, Aspartate aminotransferase, Liver injury, AST, Mild, Follow-up, moderate, patients, ALT, Injury, Oxygenation, criteria, liver enzyme, Predictive, C-reactive protein (CRP, alanine aminotransferase, Factor, Logistic regression analysis, Adverse, nausea, Common Terminology Criteria, courses, Gastrointestinal symptom, CTCAE, Result, analyzed, identify, develop, significantly, recruited, median, groups, stratified, baseline, Confirmed, patients with COVID-19, Red, 【제목키워드】 Pneumonia, severity, Injury, Gastrointestinal symptom, with COVID-19,