Liver injury in COVID-19: clinical features and treatment management

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Abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread to many countries around the world. In addition to lung disease, severe cases also displayed varying degrees of liver injury. This article will describe the latest developments regarding coronavirus and the pathogenesis of liver injury, the prone population and clinical characteristics of these patients, as well as providing some suggestions for clinical treatment.

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

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Author and article information

Contributors

Shi Ouyang:

ORCID: http://orcid.org/0000-0003-0173-3276

ouyangshi@gzhmu.edu.cn

Journal

Journal ID (nlm-ta): Virol J

Journal ID (iso-abbrev): Virol J

Title: Virology Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1743-422X

Publication date (Electronic): 9 June 2021

Publication date PMC-release: 9 June 2021

Publication date Collection: 2021

Volume: 18

Electronic Location Identifier: 121

Affiliations

[1 ]GRID grid.410737.6, ISNI 0000 0000 8653 1072, Department of Traditional Chinese Medicine, , The Fifth Affiliated Hospital of Guangzhou Medical University, ; Guangzhou, 510150 China

[2 ]GRID grid.410737.6, ISNI 0000 0000 8653 1072, Department of Infection Disease, , The Fifth Affiliated Hospital of Guangzhou Medical University Guangzhou, ; Guangzhou, 510150 China

[3 ]GRID grid.440734.0, ISNI 0000 0001 0707 0296, School of Public Health, , North China University of Science and Technology, ; Tangshan, 063210 Hebei China

[4 ]GRID grid.417009.b, ISNI 0000 0004 1758 4591, Department of Clinical Laboratory Medicine, , The Third Affiliated Hospital of Guangzhou Medical University, ; Guangzhou, 510150 China

[5 ]GRID grid.410737.6, ISNI 0000 0000 8653 1072, Department of Clinical Laboratory Medicine, , The Fifth Affiliated Hospital of Guangzhou Medical University, ; Guangzhou, 510150 China

[6 ]GRID grid.413432.3, ISNI 0000 0004 1798 5993, Departments of Geriatrics and Oncology, , Guangzhou First People’s Hospital, ; Guangzhou, 510180 China

[7 ]GRID grid.79703.3a, ISNI 0000 0004 1764 3838, School of Medicine, , South China University of Technology, ; Guangzhou, Guangdong China

[8 ]GRID grid.411866.c, ISNI 0000 0000 8848 7685, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, ; Guangzhou, 510378 Guangdong China

[9 ]GRID grid.410737.6, ISNI 0000 0000 8653 1072, Department of Preventive Medicine, School of Public Health, , Guangzhou Medical University, ; Guangzhou, 510150 China

Author information

Shi Ouyang http://orcid.org/0000-0003-0173-3276

Article

Publisher ID: 1593

DOI: 10.1186/s12985-021-01593-1

PMC ID: 8188532

PubMed ID: 34108015

SO-VID: 494e4c59-d0c8-4c88-9c02-d4d5ba4dcd5a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 December 2020

Date accepted : 2 June 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81803884

Award Recipient : Shi Ouyang

Funded by: Scientific Research Project of Guangdong Provincial Bureau of Traditional Chinese Medicine

Award ID: 20191215

Award Recipient : Shi Ouyang

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ScienceOpen disciplines: Microbiology & Virology

Keywords: covid-19,sars-cov2,liver injury

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ScienceOpen disciplines: Microbiology & Virology

Keywords: covid-19, sars-cov2, liver injury

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Liver injury in COVID-19: clinical features and treatment management

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Novel Coronavirus Disease COVID-19

Most cited references 40

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

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Cited by 47

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