COVID-19 and liver injury: hypoalbuminaemia and γGT should be observed at hospital admission

[...]we observed an association between elevated liver function tests (LFTs) and more severe COVID-19, a composite outcome which was defined as the need for intensive care unit (ICU) treatment and/or COVID-19-related death. Furthermore, when combining γGT or AST with hypoalbuminaemia at the time of admission, a drastic risk increase of severe COVID-19 was observed.2 These observations were confirmed by other groups.3 4 Moreover, we did not observe correlations between transaminases and inflammation parameters such as C reactive protein or interleukin 6, which is in contradiction to the studies quoted by Dufour et al.5–7 These differences may be due to differences in design since the correlations between liver injury and systemic inflammation were observed in cohorts for whom liver injury was defined using peak transaminases any time throughout hospitalisation5 or LFT elevations at non-defined stages of hospitalisation.6 This is of importance since exaggerated immune responses occur at later stages of the infection and therefore have a greater influence on LFT elevation during the course of hospitalisation than at the time of admission.8 Moreover, during hospitalisation, LFTs are influenced by multiorgan failure, hypoxia, treatment procedures, as well as antiviral and symptomatic medications. With the limitation of our data being from the early days of the COVID-19 pandemic, before the surge of variants of concern and the availability of effective treatment measures or effective vaccines, we therefore conclude that our results warrant enhanced awareness of liver injury in patients with COVID-19 already at the time of hospital admission.