Pattern and Risk Factors of Liver Injury among Hospitalized Covid-19 Patients: The Experience of a Greek Referral Hospital

Background: Although the new coronavirus (SARS-COV-2) affects predominantly the respiratory system, concomitant liver manifestations are common among COVID-19 patients. Aim: To investigate the prevalence and pattern of liver impairment (hepatocellular, cholestatic, mixed) and identify risk factors potentially associated with the liver injury in hospitalized patients with Covid-19. Materials and Methods: This retrospective study enrolled consecutive patients with Covid-19 who had evidence of liver injury on admission and/or during hospitalization in a tertiary hospital. Patient demographic, clinical and laboratory data were captured from the hospital's electronic data monitoring system. Univariate and multivariate logistic regression analysis were applied to identify risk factors for liver injury. Results: Overall, of the 113 hospitalized Covid-19 patients, 73 (64.6%) patients had evidence of liver injury. Admission to Intensive Care Unit and length of in-hospital stay were identified as independent risk factors for liver injury by multivariate analysis (p = 0.014 and p = 0.001, respectively). 35 patients (47.9%) had hepatocellular and 18 patients (24.7%) had cholestatic liver injury. Admission to Intensive Care Unit was statistically significantly associated with hepatocellular injury (p = 0.006). Conclusions: Liver injury is common in hospitalized Covid-19 patients. Hepatocellular-type injury is more common and is associated with a more severe course of disease.