# Liver-Related COVID-19 Consequences: Dynamics of Liver Health in 2.5 Years

## TL;DR

This study found that most patients with no prior liver issues had improved liver health 2.5 years after a COVID-19 infection, though some showed signs of liver fibrosis linked to metabolic dysfunction and heart disease.

## Contribution

The study is the first to track liver health dynamics over 2.5 years post-COVID-19 in patients without pre-existing liver conditions.

## Key findings

- Liver test abnormalities improved in most patients 2.5 years after initial COVID-19 infection.
- Persistent liver issues were linked to hospitalization severity and cardiovascular disease history.
- Liver fibrosis signs were associated with metabolic dysfunction and not directly with initial disease severity.

## Abstract

Objectives: This study aimed to assess the dynamics of liver tests (LT) and detect signs of liver fibrosis and steatosis 2.5 years after the first COVID-19 episode in patients without pre-existing liver-related conditions. Methods: The study included 65 adult patients hospitalized with COVID-19 (including 18 with severe or critical illness) in 2020. After 2.5 years, in addition to regular LT, liver health status was assessed by the FIB-4 index, hyaluronic acid, cytokeratin 18 fragment M30 (serum, ELISA), cardiometabolic risk factors, and the multiparametric ultrasound examination. Results: LT abnormalities in the acute COVID-19 period were observed more frequently (p = 0.036) in patients with severe or critical COVID-19 (83%) than in patients with non-severe COVID-19 (55%). LT dynamics in 2.5 years showed an improvement of liver health status in most patients (p = 0.006). Persistent LT abnormalities were associated with LT abnormalities during hospitalization (p = 0.021). After 2.5 years, the presence of cardiometabolic risk factors and signs of liver fibrosis were associated with the severity of the first COVID-19 episode. However, regression analyses did not support disease severity as a predictor for LT abnormalities and liver stiffness. The latter was predicted by cardiovascular diseases in the anamnesis. Conclusions: In most patients, LT normalized despite potential risk factors. Simultaneously, in some patients, signs of liver fibrosis after COVID-19 might be stimulated by COVID-19-related metabolic dysfunction and the presence of cardiovascular diseases.