Approach to elevated liver enzymes in patients with COVID-19

Elevated liver enzyme levels: general principles
  • Consider etiologies unrelated to COVID-19, including Hepatitis A, B, and C

  • Avoid imaging of the liver unless it is likely to change management, as in the case of suspected venous thrombosis or biliary obstruction

  • Therapies for COVID-19 (including remdesivir or hydroxychloroquine) may increase liver enzymes but are not contra-indicated in patients with baseline abnormal liver tests

  • Regularly monitor liver enzymes in patients hospitalized with COVID-19

Elevated liver enzyme levels in liver transplant recipients or auto-immune hepatitis
  • Acute cellular rejection or disease flare should not be assumed without biopsy confirmation

Elevated liver enzyme levels in children
  • Because abnormal liver enzymes are uncommon in children with COVID-19, underlying liver disease or infection should be ruled out

  • Based on information from Fix, et al.1