Liver Test Abnormalities in Patients With COVID-19 Not Associated With Cytokine Storm

Researchers evaluated liver test abnormalities in patients hospitalized with COVID-19 and assessed cytokine levels in individuals with vs without abnormal test results.

Cytokine-mediated inflammation in patients hospitalized with COVID-19 was not associated with abnormal liver function tests, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

Researchers conducted a single-center study of 143 patients diagnosed with COVID-19 who were hospitalized at the Hospital de Clinicas in Buenos Aires, Argentina, and compared them with 53 non-COVID-19 healthy control individuals. Researchers confirmed COVID-19 infection via positive PCR tests and classified the COVID-positive patients into 3 groups (mild, moderate, and severe) according to severity, indicated by oxygen (O2) saturation levels below 94% and concomitant pneumonia infection.

The investigators collected blood samples from the patients and the control individuals at initial evaluation to assess liver function as well as the serum levels of 27 pro- and anti-inflammatory cytokines. Abnormal liver tests included total bilirubin over 1 mg/dL, alanine aminotransferase levels over 31 UI/L, or alkaline phosphatase levels over 104 UI/L.

Of the 143 patients admitted to the hospital with COVID-19, 84 (59%; 95% CI, 41-67) had abnormal liver tests and 57% demonstrated an AST/ALT ratio above 1. Of the 53 non-COVID control individuals, 17 (32%; 95% CI, 20-46) had abnormal liver tests.

Significant correlations existed between abnormal liver function tests and body mass index (BMI) over 30 (P =.02), pneumonia (P =.001), O2 saturation levels less than 94% (P =.001), and COVID-19 severity (P=.001). After including multiple variables, such as age over 60 years, gender, BMI over 30, presence of pneumonia, medication use, ferritin levels over 300 µg/L, and fibrinogen levels over 400 mg/dL, abnormal liver function tests correlated positively with COVID-19 severity (odds ratio, 4.68; 95% CI, 1.21-18.16; P =.03).

Compared with the non-COVID-19 control individuals, patients with COVID-19 demonstrated elevated levels of the cytokines: interleukin-1 receptor antagonist (IL-1ra), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-8 (IL-8), interleukin-13 (IL-13), interferon-gamma-inducible protein 10 (IP-10), and platelet-derived growth factor-bb (PDGF-bb).

However, the researchers did not find any significant differences in cytokine levels when they analyzed the patients with COVID-19 who had abnormal liver tests vs patients with COVID-19 who had normal liver function tests.

“Liver test abnormalities in COVID-19 patients were associated with the severity of the disease,” the study authors wrote. “Cytokine-mediated inflammation may not play an important role in the pathogenesis of liver test abnormalities.”


Piskorz M, Gonzalez Ballerga E, Pisarevsky AA, et al. Liver test abnormalities in COVID-19 patients may not be related to cytokine storm. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Abstract EP1192.

This article originally appeared on Gastroenterology Advisor