Objective

2

To identify the factors that influence liver injury in patients with the coronavirus disease 2019 （COVID-19） and to further analyze the correlation between traditional Chinese medicine （TCM） treatment and liver injury.

Methods

2

Clinical data of 390 COVID-19 patients with normal liver function at admission were retrospectively collected including baseline characteristics such as age， gender， underlying liver disease and comorbidities， TCM treatment， immune and inflammation-related indicators， blood routine， glomerular filtration rate and coa-gulation， liver function and other indicators. The drug-induced liver injury during hospitalization was assessed， and Cox regression analysis was used to determine the risk factors related to liver injury. Participants were assigned into the TCM （288 cases） and non-TCM （102 cases） groups. The liver function indicators including alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bilirubin （TBIL）， and albumin （ALB） were detected at admission （day 0 during treatment） and after 3-， 7-， 10-， and 14-day treatment.

Results

2

There were 179 cases of liver injury during hospitalization. Cox regression analysis showed that age （

P

= 0.001）， CD4

+

T cells （

P

= 0.009） and serum amyloid A （

P

= 0.014） were independently associated with the occurrence of liver injury in COVID-19 patients， while the use of TCM treatment was not （

P

= 0.287）. Regarding the baseline data， there were significant differences in lactate， neutrophil count， lymphocyte count， monocyte count， ratio of neutrophil count and lymphocyte count， and platelet mean distribution width between TCM group and non-TCM group （

P

＜0.05 or

P

＜0.01）. Therefore， the above six variables with statistical differences were matched with a 1∶1 ratio using propensity score matching （PSM， 89 pairs， 178 cases）， and no significant difference was found after matching （

P

＞0.05）. After PSM， liver function indexes including ALT， TBIL and ALB were not significant different between TCM group and non-TCM group after 3-， 7-， 10-， and 14-day treatment （

P

＞0.05）. However， The AST level of the TCM group was significantly lower than that of the non-TCM group after 3-day treatment （

P

= 0.036）. There was no significant difference in the number of patients with abnormal ALT， AST and TBIL after 3-， 7-， 10-， and 14-day treatment （

P

＜0.001）.

Conclusion

2

Age， CD4

+

T cells and serum amyloid A are independently associated with the occurrence of liver injury in COVID-19 patients. TCM treatment has not yet been found to increase the incidence of liver injury in patients with COVID-19.