Page 28 - Care-for-vulnerable-populations-during-COVID-19-pandemic

Acute Liver Injury from Local Hospitals Data

Three of the seven cases of (PCR) positive COVID-19 patients had acute liver injury. Acute
liver injury is defined as jaundice with total bilirubin of more than 51 mmol/l, liver enzymes
(ALT, AST, ALP, GGT) ≥2 upper limit normal, INR of ≥1.5. So these three cases have acute
liver injury. First case, the thirty-six-year-old male with DM passed away. In second case, it is a
59 years old male with DM and hypertension (at the time of data analysis) he was still intubated
in ICU. The third case is a 58-year-old male with similar premorbid history, DM and
hypertension was also intubated in ICU.

With regard to LFT, the ALT on admission of the 2 patients who are still alive were quite
normal. The patient who passed away, the ALT was high on arrival. The peak value of the
patient who passed away has 3 upper limits of normal and the others are about 3 to 4 times upper
limit of normal. If you look at the AST on admission, the one who passes away also had a higher
AST and this AST can go up to 8 times the limit of normal, so between 4 to 8 times. This is an
AST predominant elevation in terms of a liver injury. In terms of alkaline phosphatase, it was
quite normal on admission and increased to about two times the upper limit of normal at peak.
The bilirubin of the person who passed away peaked at 127 mmol/l and the others also had
enough rise of bilirubin to be considered as acute liver injury and the INR can go up to about 1.5.