In the article (1), we noticed that significant differences were reported between patients with acute respiratory distress syndrome (ARDS) and those with non-ARDS for laboratory parameters such as CRP, IL-6, LDH, CK, and D-dimer, but that no increases in serum levels of liver function markers and/or of liver function impairment were observed. However, a number of scientific studies have already shown that, in the context of COVID-19, liver can be involved in 16%–53% of cases, especially if there is a severe SARS-Cov-2 infection (2, 3). For a large number of these cases, only an asymptomatic increase in transaminases, but no significant increase in bilirubin or liver function impairment, was described. However, there have also been reports of severe liver damage during SARS-CoV-2 infection (4). We therefore recommend that, in addition to the laboratory parameters proposed by Dreher et al., the serum levels of liver enzymes are also closely monitored, especially in the case of a severe course with ARDS.
Prof. Dr. Alexander L. Gerbes
Dr. med. Sabine Weber
University Hospital Munich
Department of Medicine II
Liver Centre Munich, Germany
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Dreher M, Kersten A, Bickenbach J, et al.: The characteristics of 50 hospitalized COVID-19 patients with and without ARDS. Dtsch Arztebl Int 2020; 117: 271–8 VOLLTEXT|
|2.||Zhang C, Shi L, Wang FS: Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020; 5: 428–30 CrossRef|
|3.||Ong J, Young BE, Ong S: COVID-19 in gastroenterology: a clinical perspective. Gut 2020; 69: 1144–5 CrossRef MEDLINE|
|4.||Weber S, Mayerle J, Irlbeck M, Gerbes AL: Severe liver failure during SARS-CoV-2 infection. Gut 2020; 69: 1365–7 CrossRef MEDLINE|