Hepatology Consultants Often Disagree on Etiology of Abnormal Liver Biochemistries in COVID-19 but Agree on Management

Background Coronavirus disease 2019 (COVID-19) is associated with elevated liver biochemistries in approximately half of hospitalized patients, with many possible etiologies. Aim To assess agreement on the etiology of abnormal liver biochemistries and diagnostic recommendations in COVID-19. Methods Twenty hepatology consultations were reviewed by three senior hepatologists who provided a differential diagnosis and diagnostic recommendations. Kappa agreement on the primary etiology was calculated. Results Kappa agreement between hepatologists on the primary etiology of elevated liver biochemistries was 0.10 (p = 0.03). Agreement was greater around drug-induced liver injury 0.51 (p < 0.0001) and SARS-CoV-2-related liver injury 0.17 (p = 0.03). Serial liver biochemistries were recommended in all consultations over other evaluations. Conclusion In COVID-19, elevated liver biochemistries present a diagnostic challenge and can often be monitored conservatively.

Automated summary

In the context of COVID-19, abnormal liver biochemistries present a diagnostic challenge with various potential etiologies. The agreement on the primary etiology among hepatologists was low overall, but greater for drug-induced liver injury and SARS-CoV-2-related liver injury. Monitoring liver biochemistries serially was a common recommendation for diagnostic evaluations.