Evaluation of Liver Damage in COVID-19 Patients Followed in The Intensive Care Unit

INTRODUCTION: In coronavirus disease 2019 (COVID-19), liver injury has been associated with the direct cytopathic effect on cholangiocytes, an uncontrolled immune response, sepsis, or drug-induced liver injury. This study aimed to evaluate liver damage in COVID-19 patients in the intensive care unit.
METHODS: Between January 1, 2021, and June 1, 2021, medications, mortality rates, length of stay in the intensive care unit, liver function tests, and acute phase reactants, during admission to the unit and on the 3rd, 7th, and 15th days of follow-up were analyzed retrospectively.
RESULTS: A total of 92 patients were included in the study. In a mean follow-up of 2 weeks, ALT levels increased by 62%, AST levels increased by 78.3%, GGT levels increased by 65.2%, ALP levels increased by 43.5%, and total bilirubin levels increased by 20.7% of the patients were observed. In repeated measurements of the patients, significant increases were observed in ALP (p=0.013), GGT (p=0.001), and bilirubin levels (p=0.012). Thirty-six patients resulted in mortality, and in patients who died, AST (p=0.02), day 15 AST (p=0.02), GGT (p=0.02), and ALP (p=0.009) values were observed to be significantly high. There was no relationship between CRP and IL-6 levels, transaminases, and cholestasis enzymes. When the patients who received and did not receive favipiravir treatment were compared, there was no difference other than the 3rd day AST (p=0.043) value.
DISCUSSION AND CONCLUSION: Increases in cholestasis enzymes were detected in the 15-day follow-up of patients admitted to the intensive care unit due to severe COVID-19. Furthermore, it was observed that the transaminase and cholestasis enzymes of the patients who ended in mortality were higher. In addition, liver enzymes were at similar levels between patients who received and did not receive favipiravir treatment.