Liver Function Tests; a Marker of Severity in COVID-19 Patients

Research Article

Austin Hepatol. 2020; 5(1): 1013.

Liver Function Tests; a Marker of Severity in COVID-19 Patientss

Ahmed M1*, Umar M2, Sufyan A1, Zeb S3, Ahmad H1, Shahid R4, Aziz Q5, Akram MO6, Khan MM7 and Ahmed H1

1MBBS, Rawalpindi Medical University, Rawalpindi, Pakistan

2Vice Chancellor, Chief of Gastroenterology and Hepatology Division, Rawalpindi Medical University, Rawalpindi, Pakistan

3Department of Medical Education, Rawalpindi Medical University, Rawalpindi, Pakistan

4Department of Medical Education, Rawalpindi Medical University, Rawalpindi, Pakistan

5Consultant Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan

6Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan

7Department of Infectious Diseases, Rawalpindi Medical University, Rawalpindi, Pakistan

*Corresponding author: Muhammad Ahmed, MBBS, Rawalpindi Medical University, Rawalpindi, Pakistan

Received: May 25, 2020; Accepted: June 16, 2020; Published: June 23, 2020


Background: The corona virus disease 2019 (COVID-19) begun as an outbreak in China in December 2019 and soon became a pandemic. The disease was previously unknown to humanity, hence its clinical aspects key to adequate assessment and management are yet evolving. An understanding to these is essential to ensure optimal patient directed care amid high burden of disease. Clinicopathological factors as Liver Function Tests might be a cornerstone in predicting the severity of disease.

Objectives: To assess for changes in Liver Function Tests in COVID-19 patients and its association with disease severity.

Methods: PCR confirmed COVID-19 patients with Liver Function Tests on presentation were enrolled at Allied Hospitals of Rawalpindi, Pakistan. Demographic data and Liver Function Tests were entered and analyzed. Descriptive statistics were applied and statistical tests were run to check for association with disease severity.

Results: Patients with higher age and comorbidities are more likely to develop severe disease. Liver Function Tests are more likely to be deranged in severe patients with AST levels significantly associated with disease severity.

Conclusion: Deranged Liver Function tests particularly AST levels may act as a marker of predicting severe COVID-19.

Keywords: COVID-19; SARS COV 2; Severity; Liver Function Tests; AST; Pakistan; Rawalpindi


The corona virus disease 2019 (COVID-19) began as an outbreak in December 2019 in Wuhan, China [1]. The disease reported outside of China on January 13, 2020 [2]. Severe Acute Respiratory Syndrome Corona virus 2 (SARS-COV-2) being highly contagious turned out to be a worldwide threat and declared Pandemic by WHO on March 11, 2020 [3]. Apart from having high infectivity, the disease also carries a significant mortality varying from 4.1% in USA to 14.6% in Belgium [4,5,6]. Europe and America are carrying a high disease burden and consequently having its adverse economic and health sector effects [7]. This puts the third world countries that are relatively spared so far into a risk of developing an even worse potential crisis.

The corona viruses are known to humanity for quite a few decades [8,9,10]. There have been outbreaks previously reported as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) [11,12,13,14]. However, SARSCOV- 2 is a strain completely new to mankind. Its epidemiological and clinicopathological aspects are rapidly evolving with each passing day. The initial patterns of disease were understood from case reports and a few small scale studies [15,16,17,18]. New trends are being established in the light of further studies and systematic reviews [19,20]. A considerable portion of patients who develop the disease are either asymptomatic or develop mild to moderate symptoms. These patients mainly require isolation and other precautionary measures so as to contain the spread. Indoor hospitalized care is not a necessity for most of these as they are clinically stable and no specialized monitoring or intervention has been proven to any benefit [21].

COVID-19 may be severe in around 30 % of patients calling for an observation in a health facility, with a fraction potential candidate for intensive care [22,23]. Under increasingly overwhelming COVID-19 burden on health care system ensuring patient focused quality of care based on disease severity is of utmost importance. Hence clinicopathological factors predictive of severity of disease would be a cornerstone in prioritizing resources effectively. The present study is designed to assess for accuracy of Liver Function Tests in defining the severity of COVID-19 and possible need for intensive care.


To assess various risk factors determining severity of COVID-19, to investigate changes in Liver Function Tests and to assess its association with Severity of disease.

Materials and Methods

This was a cross sectional study conducted on patients quarantined at public sector hospitals affiliated with Rawalpindi Medical University, Rawalpindi from March 24 to April 20, 2020 after ethical approval from Institutional Research Forum, Rawalpindi Medical University. Patients were enrolled in this study via non probability consecutive sampling technique.