Clinical characteristics and risk factors of liver injury in COVID-19: a retrospective cohort study from Wuhan, China

Hepatol Int. 2020 Sep;14(5):723-732. doi: 10.1007/s12072-020-10075-5. Epub 2020 Oct 7.


Background: Coronavirus disease 2019 (COVID-19) has rapidly become a major international public health concern. This study was designed to evaluate the clinical characteristics and risk factors of COVID-19-associated liver injury.

Methods: A fraction of 657 COVID-19 patients were retrospectively analyzed. Clinical and laboratory data were derived from electronic medical records and compared between patients with or without liver injury. Multivariate logistic regression method was used to analyze the risk factors for liver injury.

Results: Among 657 patients, 303 (46.1%) patients had liver injury with higher rate in severe/critically ill patients [148/257 (57.6%)] than those in moderate cases [155/400 (38.8%)]. The incidence of liver injury was much higher in male [192/303 (63.4%)] than female [111/303 (36.6%)], and in severe/critical patients [148/303 (48.8%)] with percutaneous oxygen saturation ≤ 93% [89/279 (31.9%)] or peak body temperature ≥ 38.5 °C [185/301 (61.5%)] on admission. Liver injury-related inflammations included increased white blood cells, neutrophils and decreased lymphocytes. More patients with liver injury than without had increased serum IL-2R, TNFα, ferritin, hsCRP, PCT, ESR, γ-GT, and LDH. Multivariate regression analysis revealed that increasing odds of liver injury were related to male, higher serum hsCRP (≥ 10 mg/L), and neutrophil-to-lymphocyte ratio (NLR) (≥ 5). Moreover, more deceased patients (14/82 (17%)) had significantly elevated serum TBIL than discharged patients [25/532 (4.7%)].

Conclusion: Liver injury is a common complication in COVID-19 patients. The potential risk factors of liver injury include male, hsCRP and NLR score. A close monitor of liver function should be warned in COVID-19 patients, especially in severe/critical individuals.

Keywords: Alanine aminotransferase; COVID-19; Clinical course; Cytokine storm; Hypersensitive C-reactive protein; Liver damage; Multivariate regression analysis; Neutrophil-to-lymphocyte ratio; Retrospective cohort study; Total bilirubin.

MeSH terms

  • Betacoronavirus / isolation & purification
  • China / epidemiology
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / mortality
  • Coronavirus Infections* / physiopathology
  • Coronavirus Infections* / therapy
  • Critical Illness / epidemiology
  • Critical Illness / therapy
  • Cytokines / blood*
  • Female
  • Hepatic Insufficiency* / blood
  • Hepatic Insufficiency* / epidemiology
  • Hepatic Insufficiency* / virology
  • Humans
  • Incidence
  • Leukocyte Count / methods*
  • Liver Function Tests* / methods
  • Liver Function Tests* / statistics & numerical data
  • Male
  • Middle Aged
  • Pandemics*
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / mortality
  • Pneumonia, Viral* / physiopathology
  • Pneumonia, Viral* / therapy
  • Retrospective Studies
  • Risk Factors
  • Sex Factors


  • Cytokines

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2