key: cord-0920210-enf4kf9o
authors: Meunier, Lucy; Meszaros, Magdalena; Pageaux, Georges‐Philippe
title: Letter to the Editors: Statins and COVID‐19: Efficacy Still to Be Proven
date: 2020-08-07
journal: Hepatology
DOI: 10.1002/hep.31511
sha: 91b527e2720fdc1433eda58b423d1e3dd371032f
doc_id: 920210
cord_uid: enf4kf9o

We read with interest the article by Bloom et al reporting liver biochemistry–associated trends, etiologies, and outcomes in 60 patients with coronavirus disease 2019 (COVID‐19). The authors reported that 69% of the patients had abnormal liver function tests (LFTs) on admission and 93% during their hospital stay, with an aspartate aminotransferase (AST) predominance. These results are similar to our own experience of 234 patients admitted with COVID‐19 according to World Health Organization (WHO) diagnostic guidelines.

reported that 69% of the patients had abnormal liver function tests (LFTs) on admission and 93% during their hospital stay, with an aspartate aminotransferase (AST) predominance. These results are similar to our own experience of 234 patients admitted with COVID-19 according to World Health Organization (WHO) diagnostic guidelines. [2] In our study, 149 (63.7%) patients were male (mean age [SD], 67 (±14) years), 9 (3.8%) had chronic liver disease, and 64 (27.4%) had diabetes.

On admission, 66.6% of patients had abnormal LFTs, with an AST predominance. Median AST on admission was also significantly higher than median alanine aminotransferase (ALT) (45 vs. 37 IU/L; P < 0.005). Upon admission, AST was correlated with ALT (r = 0.7; P < 0.005), confirming true hepatic, but not severe, COVID-19-related liver injury. [2] Statins were proposed for their capacity to modulate immune response as in retrospective study by Zhang XJ et al in which patients with statins had better survival and lower biologic inflammatory parameters compared to patients without statins. [3] In our cohort, only 42 (18%) patients were on statins prior to admission compared to 40% in Bloom et al.'s study. Likewise, AST levels were not significantly different between patients who were and were not prescribed statins prior to admission. Among 114 patients with severe disease on admission, 26 (23%) were taking statins. Statin prescription prior to admission did not impact COVID-19 severity (P = 0.06). We agree with Bloom et al. that statin-related drug-induced liver injury is uncommon but that caution should be taken when prescribing remdesivir with statins because remdesivir interaction clinical trials have not been conducted. [4] Furthermore, remdesivir and statins are both cytochrome P450 3A4 (CYP3A4) substrates, which could favor adverse effects with concurrent administration and explain why more patients needed to stop statins in the remdesivir trial.

Many unanswered questions remain concerning the interactions between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the liver, the role of the proinflammatory state favoring cytokine release, [4] and the impact of ischemia, hepatotoxic drugs, and viral load on COVID-19 severity [5] .

Liver Biochemistries in Hospitalized Patients With COVID-19. Hepatol Baltim Md 2020

Abnormal liver tests in patients hospitalized with Coronavirus disease 2019: should we worry?

In-Hospital Use of Statins Is Associated with a Reduced Risk of Mortality among Individuals with COVID-19

Food & Drug Administration. Fact Sheet for Health Care Providers Emergency Use Authorization (EUA) of Remdesivir (GS-5734

Clinical Best Practice Advice for Hepatology and Liver Transplant Providers During the COVID-19

Pandemic: AASLD Expert Panel Consensus Statement