CLINICAL SIGNIFICANCE OF CIRCULATING ENZYMES IN PATIENTS WITH COVID-19
Keywords:
COVID-19, circulating enzymes, liver damage, lung damage, muscle damageAbstract
Laboratory tests in patients with COVID-19 are of particular importance to assure correct approach towards the patient, both at the time of diagnosis and further during the treatment. The goal of this study was to conduct detailed analysis of the levels of circulating enzymes: AST, ALT, GGT, LDH, CK and CK-MB in patients with COVID 19 depending on their clinical presentation. This study was designed as a retrospective observation study which was started after approval from the Ethics Committee of the General City Hospital “8th September”, Skopje. In total, the study includes 115 patients that are divided in two groups: Group A – COVID-19 asymptomatic patients and patients with mild symptoms, N=55 (36 men и 19 women; mean age: 53.3 ± 1.4 years) and Group B – COVID-19 patients with moderate and severe symptomatology for which in-hospital treatment was necessary, N=60 (38 men и 22 women; mean age: 56.1 ± 1.3 years). All the patients had positive PCR verification for SARS-CoV-2 and were admitted into the hospital’s Triage center and Department of infection diseases. The severe cases were further hospitalized in the COVID-19 wards. This study was conducted from September 2020 until December 2020. No significant age difference was observed between the two groups of patients. At the admission, patients who further developed moderate to severe clinical presentation of COVID-19 had higher values of circulating enzymes AST, ALT, GGT, LDH, CK and CK-MB, compared to asymptomatic and mild cases. Mean values of AST, GGT and LDH were significantly higher in the patients from Group B compared to Group A. During the medical treatment, in some of these patients the values of circulating enzymes dropped back to the reference values, whereas in some of them the values increased dramatically. The simultaneous increase of the values of inflammatory markers indicates that the patient is in severe clinical condition. By performing these routine serum enzyme assays in patients with COVID-19, damage to the lungs, liver, muscles and other tissues and organs can be estimated and further monitored, up to failure of individual organs and entire organ systems or return to the reference values and complete recovery. From the results of this study, supported with the available data from the literature, it can be concluded that the circulating enzymes AST, ALT, GGT, LDH, CK and CK-MB are prognostic factors for the disease outcome in patients with COVID-19. From a clinical perspective, these findings may be of help in early triage of the patients, but also for monitoring of damage of the lungs, liver and other tissues and organs, as well as for careful use of drugs that may cause liver toxicity in patients with COVID-19.
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