In our study, fever is the most common symptom in COVID–19 patients, of which 60% were male patients, which is consistent with previous research reports. But our patients are generally older than the previous studies, especially populations older than 80 years old [5,6,8,9]. It shows that older, male patients are more likely to be infected by 2019-nCoV, the same with the previous studied. There are currently no specific drugs to deal with the COVID–19. Most of the patients in our study received Lopinavir/Ritonavi antiviral therapy. Because of the small sample size, the efficacy of the drug cannot be analyzed.
According to previous research reports, most of the COVID–19 patients just suffer mild symptoms and almost have good prognosis. However, the mortality rate of critical COVID–19 patients was significantly higher, up to 49%. Most of them were accompanied by multiple organ dysfunction, mainly involving lung, circulation, kidney, liver and myocardium. 2019-nCoV, SARS-CoV and MERS-CoV are all belong to coronaviruses, which can cause different degrees of liver damage after infection[5,12,13]. Lee Nreported that the incidence of liver enzyme abnormalities in patients with SARS-CoV infection in Hong Kong is 23 %, and Zhao LFreported that the incidence of liver function abnormalities in patients with SARS-CoV infection varies from region and the severity of the disease, which fluctuates between 21% and 66.9%，and there are varying degrees of liver dysfunction, manifested by an increase in AST, ALT, and a decrease in serum ALB. In this study, 30 COVID–19 patients had varying degrees of damage during treatment in the ICU, showing a decrease in ALB and elevated levels of AST, ALT, TB, and PT.
ALB is a protein synthesized by the liver and is an indicator of liver synthesis function. In the cases we collected, the results showed that most patients experienced a decrease in ALB on the first day when admitted to ICU, which was accompanied by the entire disease course. The 2019-nCoV virus may have direct damage to liver cells in acute phase, leading to a rapid decline of liver synthesis function. In the late stage of 2019-nCoV virus infection, the possible decline in serum proteins may be due to the subsequent effects of 2019-nCoV directly damaging liver cells, and serious consumption of the disease. Besides, liver function damage might also cause by the use of drugs such as Lopinavir/Ritonavi during treatment.
ALT and AST are two indicators used to evaluate liver function. The liver damage caused by general viral infectious diseases is mainly manifested by the increase in liver enzymes. Xu Zreported the pathological and anatomical characteristics of patient who was infected with 2019-nCoV and found that the liver biopsy specimens had moderate microvascular steatosis and mild active inflammation in the hepatic lobular duct area, which suggest that the damage may be caused by 2019-nCoV infection or drug-induced liver damage. Therefore, the virus itself has certain kind damage to the liver cell. The ALT and AST of all patients who were enrolled in our research had increased when they entered the ICU, and gradually rised with the progress of the disease. However, the use of drugs such as Lopinavir/Ritonavi may also cause liver damage when we gave for antiviral treatment. We compared the liver function between two groups of patients, and one of the group received the Lopinavir/Ritonavi therapy and another group not, and we found that the abnormal incidence of ALT, AST, TB and PT in the Lopinavir/Ritonavi group seems to be higher than another group of patient who did not take it, which proves that the drug did can aggravate liver damage in severe COVID–19 patients, but there was not statistically difference, which may due to the small sample size. We then divided the patients into normal dose groups and reduction dose groups according to the different doses of Lopinavir/Ritonavi therapy. It showed that the reduction dose group had less damage effect to ALT, AST, ALB, and Tb, the ALB and TB values have statistical differences on the second day (P <0.05), which further illustrates that there was a dose-dependent effect on the liver function, but the drug effect or its pharmacokinetics after reduction dose is not clear yet, and whether it has an impact on the prognosis of the disease itself is unknown.