ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Clinical Infectious Diseases
Determinants of Abnormal Liver-Related Biomarkers in Adult COVID-19 Patients
Provisionally accepted
- 1Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 2Universitatsklinikum des Saarlandes, Homburg, Germany
- 3Universitat Osnabruck, Osnabrück, Germany
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Background: Serum hepatic injury markers indexes are altered in COVID-19 patients. We aimed to explore the factors that could be associated with abnormal serum hepatic injury markers in adult COVID-19 patients. Methods: Eight main hepatic injury markers markers were examined. Demographic and haematological information, mean CT values (MCTVs) of liver and pancreas, and abdominal subcutaneous fat thickness were recorded. Regression analysis was conducted to identify factors related to abnormal hepatic injury markers markers. Results: 1,007 adult COVID-19 patients (444 males and 563 females) were included, among whom 697 patients (69.2%) had at least one abnormal hepatic injury markers marker. Females had lower risks of elevated Total Bilirubin (TBil), Direct Bilirubin (Dbil), ALT, AST, GGT and decreased albumin, with ORs of 0.61 (95%CI: 0.42-0.89), 0.36 (95%CI: 0.16-0.83), 0.20 (95%CI: 0.12-0.32), 0.42 (95%CI: 0.30-0.58), 0.36 (95%CI: 0.22-0.60) and 0.40 (95%CI: 0.30-0.54). Patients with greater ratios of subcutaneous fat thickness to abdominal diameters also had lower risks of abnormalities in these six markers. Older patients had higher serum levels of AST but lower levels of albumin and ALT. The risks of abnormal DBil and AST were 3.26 and 1.62 times higher in patients with a history of HBV infection. Patients with many abnormal hepatic injury markers indexes had significantly lower MCTVs of liver and pancreas and higher levels of fibrinogen and LDH in blood. Conclusions: Sex, age, HBV infection, fibrinogen, LDH, liver and pancreas MCTVs, and ratio of abdominal subcutaneous fat thickness to the sum of the abdominal diameters were independently associated with many abnormal serum hepatic injury markers markers in adult COVID-19 patients. Trial registration: Not applicable. This study is not a clinical trial.
Keywords: liver injury, COVID-19, abnormal hepatic injury markers, normal hepatic injury markers, adultpatients
Received: 09 Jul 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Zhang, Hu, Liu, Ning, Li and Xiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guangqin Xiao
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