FREQUENCY OF HEPATIC FUNCTION ALTERATION IN MEXICAN PATIENTS WITH COVID-19 AND ITS ASSOCIATION WITH THE SEVERITY OF ACUTE RESPIRATORY DISTRESS SYNDROME: PRELIMINARY RESULTS

Introduction

COVID-19 is a disease caused by the SARS-CoV-2 virus; atypical pneumonia and sepsis are the most severe manifestations of the disease. There is evidence that the virus affects the liver in different ways. The mechanism of liver damage has not yet been clearly established.

Objectives

To determine the frequency of alterations in the LFT (liver function tests) and its association with the severity of the ARDS (accute respiratory distress syndrome) in patients with COVID-19 and to determine if obesity, DM2 (diabetes mellitus) and HBP (high blood pressure) are associated with the severity of the ARDS.

Material and methods

Descriptive, cross-sectional and observational study of 56 patients with dx of ARDS due to COVID-19; Main variables: glucose, LFT and procalcitonin. Secondary variables: age, BMI, DM2, HBP, the severity of ARDS and days of stay. The frequency of qualitative variables was calculated in percentages, measures of central tendency and dispersion were determined for quantitative variables and the association between the increase in the parameters of the LFT and the severity of ARDS by calculating the Spearman correlation coefficient and the Mann-Whitney U test, stratifying according to those who survived or died. The medians of the quantitative values ​​of the LFT between living and deceased were compared with the Mann W. U test for independent samples; due to the small sample size and the fact that the normality requirement was not met, statistically significant values ​​were considered with p <0.05.

Results

Of the 56 patients, 57% are women, all had tomographic data compatible with COVID-19. 41% presented moderate ARDS and 34% severe; 45% died. In the living, the frequency of DM2 and HBP was 22% in severe ARDS; An increase in AST (Aspartate aminotransferase) was found in 67% of admissions and in 100% there was an increase in its maximum peak. In mild ARDS, 33% of the living had increased GGT (gamma glutamyl transferase) at admission and 78% in severe ARDS. There was a statistically significant association between the increase in LDH (lactic dehydrogenase) at the maximum peak and the severity of ARDS (p = 0.047), the GGT at admission almost reached the statistically significant p value (p = 0.053), with a Spearman coefficient of 0.354 (p = 0.051). In the deceased, the frequency of DM2 in severe ARDS was 40%. 100% of those who died with severe ARDS had GGT and LDH increased values at their maximum peak. 100% with moderate ARDS and 90% of the severe ones had hypoalbuminemia upon admission, with a significant association with ARDS severity (p = 0.033). The LDH values at the maximum peak also showed a significant association with ARDS severity (p = 0.043) with a Spearman coefficient of 0.413 (p = 0.040).

Discussion

To date, this study is one of the few that has investigated the effects of the SARS-CoV-2 virus on liver function and its association with the severity of ARDS in Mexican population. Although our study has the weakness of having a small sample size, it has the strength of being carried out in a hospital that was converted into a COVID hospital, with which we will have access to data from a high number of patients, which will allow comparison alterations in liver function in living and deceased patients and relate it to the severity of ARDS.

Conclusions

Most of the patients had no history of DM2 or HBP; a large percentage had overweight / obesity and hyperglycemia on admission. There is a high frequency of patients who have alterations in LFT; however, with this sample, it was only possible to determine that the increase in LDH at the maximum peak during hospitalization and hypoalbuminemia on admission are associated with the severity of ARDS.

The authors declare that there is no conflict of interest.