An Evaluation of Liver Function Tests in SARS-CoV-2 infection in the backdrop of chronic kidney disease

INTRODUCTION

The SARS-CoV-2 pandemic has emerged as perhaps the most challenging global health problem of this century. The concomitant presence of co-morbidities like chronic kidney disease (CKD), diabetes, chronic heart disease etc. makes the task of patient management difficult.

AIMS AND OBJECTIVES

To assess the patterns of liver test abnormalities in patients of COVID-19 infection with and without CKD and evaluate the probable outcomes.

MATERIALs and METHODS

A cross-sectional retrospective observational study done on 600 patient samples (Group 1 COVID-19 without CKD, Group 2 COVID-19 with CKD and Group 3 non COVID-19 with CKD) which were processed for Liver function test (AST, ALT and ALP) and Renal function test (Urea and Creatinine) in the Department of Biochemistry, Dr. RML Hospital New Delhi.

RESULTS

AST and ALT levels were significantly higher (P < 0.05) in all COVID-19 positive patients - group 1 mean ± 2 SD, (63.63 ± 42.89 U/L & 50.25 ± 46.53 U/L respectively) and group 2 (90.59 ± 62.51 U/L & 72.09 ± 67.24 U/L respectively) as compared to Group 3 (25.24 ± 7.47 U/L & 24.93 ± 11.44 U/L respectively) and also a statistically significant elevation is seen in these two parameters (AST & ALT) in Group 2 as compared to Group 1 (P< 0.05). There was a negative significant correlation between eGFR and AST/ALT levels in Group 1 (p < 0.05). In Group 2, a weak positive correlation was seen with ALT (p < 0.01).

No significant correlation existed between eGFR and ALP in groups 1 and 2. In Group 3, eGFR’s showed strong correlations with AST and ALT levels (p < 0.01) and reduction in kidney function correlated well with increase in serum ALP levels, (p < 0.01).

CONCLUSIONS

This study most comprehensively describes that SARS-CoV-2 positive CKD patients show more elevations in serum aminotransferase levels as compared to their non-CKD counterparts, in contrast to non-COVID-19 CKD cases. Serum ALT values in SARS-CoV-2 patients show significant correlation with calculated eGFR values. Elevated ALP values in CKD patients may be used as an indicator of declining kidney function. However, more studies in this direction are needed.