Liver Biochemical Abnormalities and Their Association with Systemic Inflammatory and Severity Markers in Hospitalized COVID-19 Patients.

Abstract

Background:

Coronavirus disease 2019 (COVID-19) is a multisystem disorder frequently associated with hepatic biochemical abnormalities. However, data from sub-Saharan Africa remains limited. This study aimed to evaluate liver enzyme abnormalities and identify factors associated with hepatic cytolysis among hospitalized COVID-19 patients at the University Clinics of Kinshasa.

Methodology:

A retrospective, cross-sectional, analytical study was conducted among 273 patients with PCR-confirmed COVID-19 between 2020 and 2022. Patients with pre-existing liver disease, viral hepatitis, alcohol consumption, or incomplete records were excluded. Hepatic cytolysis was defined as AST and/or ALT levels greater than twice the upper limit of normal. Sociodemographic, clinical, and biological data were analyzed using univariate and multivariate logistic regression models to identify independent associations.

Results:

The mean age of patients was 58.6 ± 14.9 years, with a predominance of males (75.4%). Hepatic cytolysis was observed in 65.9% of patients, predominantly characterized by elevated AST levels. Significant correlations were identified between liver enzymes and markers of inflammation and disease severity, including CRP, LDH, and oxygen saturation. Multivariate analysis demonstrated that elevated CRP, LDH, triglycerides, uric acid, and troponin levels were independently associated with hepatic cytolysis.

Conclusion:

Liver biochemical abnormalities are common in hospitalized COVID-19 patients and are strongly associated with systemic inflammation, metabolic disturbances, and multiorgan involvement. These findings suggest that hepatic cytolysis reflects systemic disease severity rather than isolated liver injury. Routine liver function assessment at admission may support risk stratification and clinical monitoring.