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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2021

Open Access 01-12-2021 | Acute Respiratory Distress-Syndrome | Research

Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?

Authors: Kevin Roedl, Dominik Jarczak, Andreas Drolz, Dominic Wichmann, Olaf Boenisch, Geraldine de Heer, Christoph Burdelski, Daniel Frings, Barbara Sensen, Axel Nierhaus, Marc Lütgehetmann, Stefan Kluge, Valentin Fuhrmann

Published in: Annals of Intensive Care | Issue 1/2021

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Abstract

Background

SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19.

Methods

Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN).

Results

72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01].

Conclusion

One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.
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Metadata
Title
Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?
Authors
Kevin Roedl
Dominik Jarczak
Andreas Drolz
Dominic Wichmann
Olaf Boenisch
Geraldine de Heer
Christoph Burdelski
Daniel Frings
Barbara Sensen
Axel Nierhaus
Marc Lütgehetmann
Stefan Kluge
Valentin Fuhrmann
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-021-00835-3

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