University of Minnesota Medical School Department of Medicine faculty, Jose Debes, MD, MS, associate professor in the Division of Infectious Diseases and International Medicine, and Thomas Leventhal, MD, assistant professor in the Division of Gastroenterology, Hepatology and Nutrition, are collaborating on new research that hopes to predict the onset of acute liver injury in patients with COVID-19 as well as mortality and other outcomes.

Drs. Debes and Leventhal have been colleagues and friends since 2007, and their work continues to overlap since both possess an interest in liver disease. 

As the coronavirus pandemic began to spread in the U.S., the duo realized that research priorities needed to shift. “When the pandemic started, we realized that there were many discussions to be had in many different ways,” Dr. Leventhal said. “The thought was that we could do a project that may provide some clinically relevant data that might predict outcomes. We felt it was important for us to put other things on hold to get this project done.”

The immune-pathology of COVID-19-related liver disease is still largely unknown, but with experience in studying hepatitis E infections and a testing assay (procedure) already in place, Dr. Debes recognized that the emerging patient population created by COVID-19 would provide an opportunity. “I knew that we could utilize some of the same concepts and models and apply it to this pandemic,” Dr. Debes said. 

Dr. Leventhal explained their current work: “In general, our project is taking blood samples from people infected with COVID-19 and looking at markers of inflammation that are very specific to the liver. We are then looking at the clinical data of what happens to these people throughout their hospital course. Did they require a ventilator? What was the length of stay in the ICU? Did they survive the infection? Did they have a severe liver injury? Our thought was that if we could figure out which types of hepatic inflammatory markers are abnormal in this population, then we could possibly predict future outcomes for this very serious disease.”

The immune markers being researched are cytokines—immune molecules with unique functions that are secreted by different cells. Particular cytokines are released during viral infections of the liver compared to other infections. For this study, they’re looking at roughly 25 cytokines and trying to determine if any of them are elevated, thus suggesting a mechanism for potential liver injury.

Data shows that individuals with COVID-19 infection and liver damage are more likely to end up in an ICU, making it a good predictive indicator. “We know it happens in about 25% of patients who have some form of inflammation, but we don’t understand why. We don’t know if the virus is affecting the liver or if it’s an overall systemic reaction,” Dr. Debes said. 

Establishing a correlation between liver inflammation and the degradation of a person's overall health would provide valuable information to providers as they assess the future of each COVID-19 patient in their facility. By predicting who will have liver disease, they can also tacitly determine who is more likely to end up in the ICU or who will require more serious medical interventions.

The researchers recently received a CO:VID (Collaborative Outcomes: Visionary Innovation & Discovery) Grant and IRB approval and are now in need of specific samples to analyze. As with much of the current COVID-19 research, the process has been hastened. “Our hope is that we’ll have the information pretty quickly, with our target number of samples in approximately two to three months,” Dr. Levanthal said.