key: cord-1005645-cee8i0r6
authors: Liu, Yanqing
title: Letter to the Editors: Additional Factors to Consider When Studying Liver Injury Indicators and Mortality in COVID‐19 Patients
date: 2020-07-03
journal: Hepatology
DOI: 10.1002/hep.31445
sha: cc3a73b0698656a1f0ac359947458e9591b12b10
doc_id: 1005645
cord_uid: cee8i0r6

In a recent issue of Hepatology, Lei et al.((1)) conducted a multicenter retrospective cohort study that included 5,771 adult patients with coronavirus disease 2019 (COVID‐19) pneumonia in Hubei Province. The purpose of the study was to evaluate the relationships between liver injury indicators (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and total bilirubin [TBIL]) and mortality in COVID‐19 patients. The authors considered the possibility that elevated liver injury indicators, particularly AST, are strongly associated with mortality risk. However, the association between liver injury indicators and mortality in COVID‐19 patients should be interpreted cautiously in light of the following issues.

This article is protected by copyright. All rights reserved In a recent issue of HEPATOLOGY, Lei et al. (1) [TBIL] ) and mortality in COVID-19 patients. The authors considered the possibility that elevated liver injury indicators, particularly AST, are strongly associated with mortality risk. However, the association between liver injury indicators and mortality in COVID-19 patients should be interpreted cautiously in light of the following issues.

HBV infection can cause severe liver damage, including elevated serum enzymes ALT and AST.

HBV infection also has a strong correlation with the development of cirrhosis and hepatocellular carcinoma (HCC). (2) Similar to HBV, hepatitis C virus (HCV) infection is on the rise and is also associated with the development of HCC. (3) However, whether patients have HBV and/ or HCV infection is not discussed in the article.

In addition, inspired by AASLD Expert Panel Consensus Statement, (4) lactate dehydrogenase (LDH) is an important indicator in liver injury. Several studies have reported that LDH might be a risk factor for the progression of patients infected with COVID-19. (5) However, I did not find any data about LDH in this paper. It is my recommendation that LDH should be considered as an independent and/or joint indicator to assess the relationships between liver injury indicators and mortality in COVID-19 patients.

Longitudinal association between markers of liver injury and mortality in COVID-19 in China

Hepatitis B viral load predicts survival of HCC patients undergoing systemic chemotherapy

Epidemiology of viral hepatitis and hepatocellular carcinoma

Clinical Best Practice Advice for Hepatology and Liver Transplant Providers During the COVID-19 Pandemic: AASLD Expert Panel Consensus Statement