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Category: Volume 09 Issue 01 January 2021
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Title: Hepatic Impacts of COVID19: Raised GGT is an Indicator of Severity of Disease

Authors: Dr Farhan Ali, Dr Adnan Bashir Bhatti, MD, Dr Farhat Karim, Dr Rabia Kanwal

 DOI: https://dx.doi.org/10.18535/jmscr/v9i1.49

Abstract

Introduction: The Coronavirus disease of 2019 (COVID19) is highly contagious disease of Coronaviridae family which mainly targets upper and lower respiratory tracts. But other organs like liver, gastrointestinal tract, heart, brain, kidneys, and vessels are also involved. The data regarding the effects of COVID19 on the liver is limited. We highlighted the impacts of COVID19 on the liver in the mild to moderate and the severe to critical groups of the patients.

Materials & Methods: This study was conducted at Department of Internal Medicine of the Capital Hospital, Islamabad, Pakistan, from March 1 to July 14, 2020, on 100 confirmed cases of the COVID19. The study group categorized into mild to moderate (mild symptoms to mild pneumonia, and SpO2 >93%), and severe (respiratory rate >30, SpO2 <93%, and/or >50% lung involvement on the imaging studies) to critical (respiratory failure, shock, and/or multi organ dysfunction syndrome) group. Liver function tests, serum albumin, PT, APTT were compared in groups; p-value less than 0.05 was considered significant.

Results: In our study 67% vs 33% are male and female, respectively. Major symptoms were fever (96%), fatigue (88%), myalgia (86%), cough (80%). The 76% vs 24% patients are categorized in mild to moderate group and in severe to critical group, respectively. Serum total bilirubin levels are increased in 12.5% vs 4% in the mild to moderate group and in the severe to critical group, respectively, with p-value 0.248; ALT level between 10-40IU/L in 36% vs 0% patients; 41-100IU/L in 60% vs 54%; >100IU/L in 2.6% vs 46% with p-value 0.000; AST level between 10-40IU/L in 51% vs 8.4%; 41-100IU/L  in  48% vs  50%; >100IU/L  in 0  vs  41.6% with p-value 0.000; ALP >130IU/L in 14.4% vs 16.7% with p-value 0.000;  and the GGT level between 10-40IU/L in 29% vs 0;  49-100IU/L in 44.7% vs 8.3%; >100IU/L in 26% vs 91.3%;  >200IU/L in 0% vs 51.1% with p-value 0.000 in mild to moderate and severe to critical group, respectively.

Conclusion: The GGT is the main enzyme affected in the severe to critical condition of COVID19. Thus, it can be used as an indicator of the severity of the disease and also very useful in assessing the recovery phase.

Keywords: Coronavirus disease, COVID19, Gamma-Glutamyl Transferase, GGT, Hepatic disease.

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Corresponding Author

Dr Adnan Bashir Bhatti, MD

Department of Internal Medicine, Capital Hospital, Islamabad, Pakistan