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Hepatology
Liver stiffness by transient elastography accompanies illness severity in COVID-19
  1. Maria Effenberger1,
  2. Christoph Grander1,
  3. Gernot Fritsche2,
  4. Rosa Bellmann-Weiler2,
  5. Frank Hartig1,
  6. Sophie Wildner2,
  7. Stefanie Seiwald2,
  8. Timon Erik Adolph1,
  9. Heinz Zoller1,
  10. Gunter Weiss2,
  11. Herbert Tilg1
  1. 1 Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
  2. 2 Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
  1. Correspondence to Professor Herbert Tilg; herbert.tilg{at}i-med.ac.at

Abstract

Objective Severe liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with COVID-19.

Design We investigated 32 patients with COVID-19 admitted to the University Hospital of Innsbruck in a prospective cross-sectional study. We performed laboratory testing, liver and spleen sonography and elastography to measure organ stiffness.

Results 12 patients (38%) showed elevated aminotransferases and gamma-glutamyltransferase levels. LS was positively correlated with elevated aminotransferase levels in patients with COVID-19 compared with those without elevated enzymes. Even mild liver damage raised LS significantly in COVID-19 as it was in patients with gastrointestinal symptoms. Furthermore, higher LS measurements were significantly associated with illness severity like pneumonia, need for mechanical ventilation, and even death.

Conclusion Transient elastography is a useful and non-invasive tool to assess onset and severity of acute liver injury in patients with COVID-19 patients. Increased LS seems to be predictive for a more severe and complicated course of disease.

  • acute hepatitis
  • liver
  • liver function test
  • hepatitis
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjgast-2020-000445

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    Footnotes

    • Contributors ME and HT designed the project and wrote the paper. CG and HZ verified the analytical methods and analysed the data. CG and FH performed ultrasound diagnostic and transient elastography. GW, GF, SS, SW and RB-W contributed to patient recruitment. All authors provided critical feedback and contributed to data analysis and manuscript preparation.

    • Funding The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: this work is supported by the excellence initiative VASCage (Centre for Promoting Vascular Health in the Ageing Community), an R&D K-Centre (COMET program – Competence Centers for Excellent Technologies) funded by the Austrian Ministry for Transport, Innovation and Technology, the Austrian Ministry for Digital and Economic Affairs and the federal states Tyrol, Salzburg and Vienna. TEA was supported by the Austrian Science Fund (FWF): FP33070-B.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the institutional ethics commission with an amendment to AN2017-0016 369/4.21 and written informed consent was obtained from all patients.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.