COVID-19 infection may lead to long-term liver injury

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COVID-19 infection is associated with increased liver stiffness, a possible sign of long-term liver damage, according to the results of a new study presented today at the Radiological Society of North America (RSNA) Annual Meeting.

Our study is part of emerging evidence that COVID-19 infection can lead to persistent liver damage after acute illness. “


Firouzeh Heidari, MD, Postdoctoral Fellow, Massachusetts General Hospital, Boston

Liver stiffness is a marker of liver damage such as inflammation and fibrosis. Fibrosis is the accumulation of scar tissue in the liver. Over time, healthy liver tissue diminishes and the liver fails to function properly. Progressive fibrosis can lead to liver cancer and liver failure.

In a retrospective study, researchers compared liver stiffness in patients with a history of COVID-19 infection with two control groups. All patients underwent ultrasonic shear wave elastography between 2019 and 2022 at Massachusetts General Hospital. Shear wave elastography is a specialized technique that uses sound waves to measure tissue stiffness.

Patients were classified into one of three groups based on when they had elastography and whether they tested positive for COVID-19. The COVID-19 positive group included her 31 patients whose COVID-19 PCR test results were positive at least 12 weeks before her elastography test. The pandemic control group consisted of a random sample of her 50 patients who underwent elastography during the COVID-19 pandemic and had a history of only negative COVID-19 PCR test results. The pre-pandemic control group consisted of a random sample of her 50 patients who underwent elastography testing before the COVID-19 pandemic.

The mean age was 53.1 years in COVID-positive patients, 55.2 years in the pandemic control group, and 58.2 years in the pre-pandemic control group. Of the entire cohort, 67 were female. In the COVID-positive group, elastography testing was performed on average 44 weeks after a positive PCR test result.

After adjusting for age, sex, and duration, statistical analysis of elastography results revealed that COVID-positive patients exhibited statistically significantly higher liver stiffness than control patients.

COVID-positive patients had higher median live stiffness (7.68 kPa) than pandemic control patients (5.99 kPa).

Unexpectedly, the pre-pandemic control group also had a higher median stiffness (7.01) compared to the pandemic control group. The reason for this finding is not yet known, but it is believed to be the result of altered referral patterns during the pandemic. Furthermore, patients referred for elastography before the pandemic were found to be older than those referred after the start of the pandemic.

“It is not yet known whether the increased liver stiffness observed after COVID-19 infection adversely affects patient outcomes,” Dr. Heidari said. can predict the severity of long-term liver injury.To better understand the post-acute situation, we are enriching the existing database with additional patient data and a wider range of covariates. I would like to know the effects of COVID-19 within the liver.”

Co-authors are Theodore Pierce, MD, Anthony Samir, MD, MPH, Arinc Ozturk, MD, Madhangi Parameswaran, MBBS, M.Res., Marian Martin, MD, MPH, and Hannah Edenbaum, MS.

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