Research Article

Evaluation of Biochemical Test Results in Patients with COVID-19 Infection

Marilena Stamouli
Naval and Veterans Hospital, Greece
Sofia Kougioumtzidou
Naval and Veterans Hospital, Greece
Antonia Mourtzikou
General Hospital Nikea Piraeus “Agios Panteleimon”, Greece
* Corresponding author
Antonia Korre
Athens University of Economics and Business, Greece
Georgia Kalliora
National and Kapodistrian University of Athens, Greece
Panagiotis Koumpouros
General Hospital Nikea Piraeus “Agios Panteleimon”, Greece
Maria Tsesmeli
Naval and Veterans Hospital, Greece
Vasiliki Mpourtsala
Naval and Veterans Hospital, Greece
Anastasios Skliris
Naval and Veterans Hospital, Greece
Christos Stergiou
Naval and Veterans Hospital, Greece
DOI icon 10.24018/ejbiomed.2022.1.1.5

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Submitted 2022-01-23
Published 2022-02-16

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Article Main Content

Background: The current pandemic outbreak of COVID-19 due to SARS-CoV-2 virus, affected the health care systems, health services and economy globally. Moreover, it significantly affected the health of the population worldwide. Mortality and morbidity rates are still increasing. According to WHO, as of September 2021 there have been 224180869 confirmed cases of COVID-19, including 4621173 deaths. USA, India, and Brazil are the three world's worst-hit countries. In Greece the mortality rate is at 3%.

Methods: Study population included 565 patients, who were admitted at the Emergency Department and the Pathology Department of Naval and Veterans Hospital, Athens, Greece, during a period of 3,5 months. Patients’ demographic characteristics, underlying diseases, travel history, symptoms, aetiology of admission and history of contact with confirmed cases were recorded. All patients included to the study were positive for SARS-CoV-2 and characterized as COVID-19 patients. All statistical analyses were conducted using MINITAB 17.

Results: Statistically significant differences in the results of albumin (marginal p-value), urea, creatinine, AST, ALT, and LDH between hospitalized and non-hospitalized patients were detected. Also, we observed statistically significant differences in the results of albumin, urea, creatinine, and ALT, between male and female patients. Moreover, patient age was statistically significant between male and female patients. The Logistic regression model of hospitalization show that statistically significant variables are ALT, LDH, age and gender.

Conclusions: The rapid spreading of the new COVID-19 pandemic due to SARS-CoV-2 increased the need for the measurement of biochemical tests and the evaluation of their correlation with patient hospitalization. Biochemical monitoring of COVID-19 patients is critical for assessing disease severity and progression as well as monitoring therapeutic intervention. Several common biochemical tests have been implicated in COVID-19 infection progression, providing important prognostic information. In the present study we evaluated the test results of albumin, urea, creatinine, AST, ALT, LDH and total bilirubin in patients with COVID-19 infection..

Keywords: biochemical tests, clinical outcomes, COVID-19 infection, hospitalization, liver function parameters, liver injury, SARS-CoV-2

References

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China. N Engl J Med. 2020 Feb 20;382(8):727-733. doi: 10.1056/NEJMoa2001017.
     Google Scholar
  2. WHO Director-General's opening remarks at the media briefing on COVID-19-11 March 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
     Google Scholar
  3. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 2020 Mar 13;7(1):11. doi:10.1186/s40779-020-00240-0.
     Google Scholar
  4. Mei H, Pond SK, Nekrutenko A. Stepwise Evolution and Exceptional Conservation of ORF1a/b Overlap in Coronaviruses. Molecular Biology and Evolution. 2021 December; 38(12):5678–5684. doi:10.1093/molbev/msab265.
     Google Scholar
  5. Sariol A, Perlman S. Lessons for COVID-19 Immunity from Other Coronavirus Infections. Immunity. 2020;53(2):248-263. doi:10.1016/j.immuni.2020.07.005.
     Google Scholar
  6. Malik YS, Sircar S, Bhat S, Sharun K, Dhama K, Dadar M, et al. Emerging novel coronavirus (2019-nCoV)-current scenario, evolutionary perspective based on genome analysis and recent developments. Vet Q. 2020 Dec;40(1):68-76. doi: 10.1080/01652176.2020.1727993.
     Google Scholar
  7. Hoffmann M, Kleine-Weber K, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020 Apr 16;181(2):271-280. doi: 10.1016/j.cell.2020.02.052.
     Google Scholar
  8. Chen WH, Strych U, Hotez PJ, and Bottazzi ME. The SARS-CoV-2 vaccine pipeline: An overview. Curr Trop Med Rep. 2020 Mar 3;1-4.doi: 10.1007/s40475-020-00201-6.
     Google Scholar
  9. McGrowder DA, Miller F, Cross MA, Anderson-Jackson L, Bryan S, Dilworth L. Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis. Diseases. 2021 Jul 1;9(3):50. doi:10.3390/diseases9030050.PMID: 34287285.
     Google Scholar
  10. Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020 May;40(5):998-1004. doi: 10.1111/liv.14435.
     Google Scholar
  11. Chai X., Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. BioRxiv. [Preprint] 2020. Available from: http://doi. org.: 10.1101/2020.02.03.931766. [Accessed 4th February 2020].
     Google Scholar
  12. Jothimani D, Venugopal R, Abedin MF, Kaliamoorthy I, Rela M. COVID-19 and the liver. J Hepatol. 2020;73(5):1231-1240. doi:10.1016/j.jhep.2020.06.006.
     Google Scholar
  13. Ridruejo E, Soza A. The liver in times of COVID-19: what hepatologists should know. Ann Hepatol. Jul-Aug 2020;19(4):353-358. doi: 10.1016/j.aohep.2020.05.001.
     Google Scholar
  14. Hwaiz R, Merza M, Hamad B, HamaSalih S, Mohammed M, Hama H. Evaluation of hepatic enzymes activities in COVID-19 patients. Int Immunopharmacol. 2021 Aug; 97: 107701. doi: 10.1016/j.intimp.2021.107701.
     Google Scholar
  15. Kumar-M P, Mishra S, Jha DK, Shukla J, Choudhury A, Mohindra R, Mandavdhare HS, Dutta U, Sharma V. Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis. Hepatol Int. 2020 Sep;14(5):711-722. doi: 10.1007/s12072-020-10071-9.
     Google Scholar
  16. Zarei M, Bose D, Nouri-Vaskeh M, Tajiknia V, Zand R, Ghasemi M. Long-term side effects and lingering symptoms post COVID-19 recovery. Rev Med Virol. 2021 Sep 9:e2289. doi: 10.1002/rmv.2289.
     Google Scholar
  17. Idalsoaga F, Ayares G, Arab JP, Díaz LA. COVID-19 and Indirect Liver Injury: A Narrative Synthesis of the Evidence. J Clin Transl Hepatol. 2021 Oct 28;9(5):760-768. doi: 10.14218/JCTH.2020.00140.
     Google Scholar
  18. Xia T, Zhang W, Xu Y, Wang B, Yuan Z, Wu N, et al. Early kidney injury predicts disease progression in patients with COVID-19: a cohort study. BMC Infect Dis. 2021; 21(1012). Available from: https://doi.org/10.1186/s12879-021-06576-9.
     Google Scholar
  19. Bajwa H, Riaz Y, Ammar M, Farooq S, and Yousaf A. (2020). The Dilemma of Renal Involvement in COVID-19: A Systematic Review. Cureus. 2020 Jun 15;12(6):e8632. doi: 10.7759/cureus.8632.
     Google Scholar
  20. Martinez-Rojas MA, Vega-Vega O, and Bobadilla NA. Is the kidney a target of SARS-CoV-2? Am J Physiol Renal Physiol. 2020 Jun 1; 318(6): F1454–F1462. doi: 10.1152/ajprenal.00160.2020.
     Google Scholar
  21. https://www.who.int/publications-detail/laboratory-biosafety-guidance-related-to-coronavirus-disease-2019.
     Google Scholar
  22. Xu W, Huang C, Fei L, Li Q, and Chen L. Dynamic Changes in Liver Function Tests and Their Correlation with Illness Severity and Mortality in Patients with COVID-19: A Retrospective Cohort Study. Clin Interv Aging. 2021; 16: 675–685. doi: 10.2147/CIA.S303629.
     Google Scholar
  23. Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020 Feb;91:264-266. doi: 10.1016/j.ijid.2020.01.009.
     Google Scholar
  24. Lippi G, Sanchis-Gomar F, Henr BM. Coronavirus disease 2019 (COVID-19): the portrait of a perfect storm. Ann Transl Med. 2020 Apr;8(7):497. doi: 10.21037/atm.2020.03.157.
     Google Scholar
  25. Del Zompo F, De Siena M, Ianiro G, Gasbarrini A, Pompili M, Ponziani FR. Prevalence of liver injury and correlation with clinical outcomes in patients with COVID-19: systematic review with meta-analysis. Eur Rev Med Pharmacol Sci. 2020 Dec;24(24):13072-13088. doi: 10.26355/eurrev_202012_24215.
     Google Scholar
  26. Wang Q, Zhao H, Liu LG, Wang YB, Zhang T, Li MH, Xu YL, Gao GJ, Xiong HF, Fan Y, Cao Y, Ding R, Wang JJ, Cheng C, Xie W. Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients. Mil Med Res. 2020 Jun 7;7(1):28. doi: 10.1186/s40779-020-00256-6.
     Google Scholar
  27. Huang H, Chen S, Li H, Zhou XL, Dai Y, Wu J, Zhang J, Shao L, Yan R, Wang M, Wang J, Tu Y, Ge M. The association between markers of liver injury and clinical outcomes in patients with COVID-19 in Wuhan. Aliment Pharmacol Ther. 2020 Sep;52(6):1051-1059. doi: 10.1111/apt.15962.
     Google Scholar
  28. Hundt MA, Deng Y, Ciarleglio MM, Nathanson MH, Lim JK. Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network. Hepatology. 2020 Oct;72(4):1169-1176. doi: 10.1002/hep.31487.
     Google Scholar
  29. Zeng QL, Yu ZJ, Ji F, Li GM, Zhang GF, Xu JH, Lin WB, Zhang GQ, Li GT, Cui GL, Wang FS. Dynamic changes in liver function parameters in patients with coronavirus disease 2019: a multicentre, retrospective study. BMC Infect Dis. 2021 Aug 16;21(1):818. doi: 10.1186/s12879-021-06572-z.
     Google Scholar
  30. Huang J, Cheng A, Kumar R, Fang Y, Chen G, Zhu Y, et al. Hypoalbuminemia predicts the outcome of Covid-19 independent of age and co-morbidity. J Med Virol. 2020 Oct;92(10):2152–2158. doi:10.1002/jmv.26003.
     Google Scholar
  31. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020 May;5(5):428-430. doi: 10.1016/S2468-1253(20)30057-1.
     Google Scholar
  32. Feng G, Zheng KI, Yan Q-Q, Rios RS, Targher G, Byrne CD, et al. COVID-19 and liver dysfunction: current insights and emergent therapeutic strategies. J Clin Transl Hepatol. 2020 Mar 28;8(1):18-24. doi: 10.14218/JCTH.2020.00018.
     Google Scholar
  33. Portincasa P, Krawczyk M, Machill A, Lammert F, Ciaula AD. Hepatic consequences of COVID-19 infection. Lapping or biting? Eur J Intern Med. 2020 Jul;77:18-24. doi: 10.1016/j.ejim.2020.05.035.
     Google Scholar
  34. Clark R, Waters B, and Stanfi AG. Elevated liver function tests in COVID-19: Causes, clinical evidence, and potential treatments. Nurse Pract. 2021 Jan; 46(1): 21–26. doi: 10.1097/01.NPR.0000722316.63824.f9.
     Google Scholar
  35. Xiang H-X, Fei J, Xiang Y, Xu Z, Zheng L, LiX-Y, et al. Renal dysfunction and prognosis of COVID-19 patients: a hospital-based retrospective cohort study. BMC Infectious Diseases. 2021 Feb; 21:158. Available from: https://doi.org/10.1186/s12879-021-05861-x.
     Google Scholar
  36. Kim S-G, Sung HH. Status of Kidney Function in Hospitalised COVID-19 Patients in the Southern Gyeonggi Province, South Korea. Korean J Clin Lab Sci. 2021Sept 30;53(3):208-216. Available from: https://doi.org/10.15324/kjcls.2021.53.3.208.
     Google Scholar


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