الفهرس 
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Abstract
COVID-19 pandemic is one of the major public health problems facing the world. It has become evident that, COVID-19 infection is complicated by many complications other than pulmonary complications including hepatic dysfunction affecting patients‘ outcome (Marco et al., 2022).
This study was conducted on 583 COVID-19 infected patients who presented with an evidence of hepatic dysfunction and aimed to evaluate their outcome.They were classified into the following groups according to their preexisting hepatic condition: group I: Included 248 COVID-19 patients with an evidence of preexisting liver disease who were subdivided into 2 subgroups according to their hepatic state of compensation, decompensated group GIa included 64patients and compensated group GIb included 184 patients. group II: Included 235 COVID-19 patients without preexisting liver disease. group III: Included 100 COVID-19 patients with normal hepatic functions.
Patients excluded from the study were:
Patients refuse to participate in the study and patients who skipped or did not have all necessary data to participate in the study.
All patients were subjected to:
Pretreatment assessment included: Thorough history taking and complete clinical examination, full laboratory investigations (CBC, liver and renal function tests, CRP, ESR, Procalcitonin, serum ferritin and D-dimer), virology (SARS-Cov-2 by PCR, HBs Ag and HCV Ab), imaging Studies (abdominal ultrasound ± triphasic CT when indicated) and high resolution CT chest.
Follow up during hospitalization:
Close clinical assessment for signs and symptoms of improvement or deterioration, laboratory findings changes in comparison with pretreatment basic values, virological follow up (PCR for SARS-Cov-2 every 5 days during treatment for all patients).
Statistical analysis of the present data revealed:
The mean age of the patients in the studied groups was 66.16, 64.12, 60.78 and 60.41 respectively with statistical significance between the studied groups (P=0.011). Morever, there was statistical significant difference between the studied groups regarding sex (P=0.045). There was no statistical significant difference between the studied groups regarding history of past infection with COVID-19 (P=0.835). (Table 1) However, there was statistically significant difference between the studied groups regarding fever (P=0.004), but there was no statistical significant difference as regards difficulty of breathing (P=0.97) and cough (P=0.230). Regarding gastrointestinal symptoms, there was no statistical significant correlation between the studied groups for diarrhea, abdominal pain and vomiting with P value was (0.096, 0.052 and 0.260) respectively. While, for upper GIT bleeding, there was no statistical significant difference between the studied groups as regards hematemesis (P=0.148), while, this not the same for melena (P<0.001). Clinically, there was no statistical significant differencs between the studied groups as regards pulse, RR, temperature, systolic blood pressure whether on admission or follow up and for diastolic blood pressure and O2 saturation at time of admission, while, for follow up there was statistical significant difference regarding diastolic blood pressure and O2 saturation P value was (0.030, 0.014) respectively.
Also, there was statistical significant difference as regards need for oxygen therapy (P=0.033) and mechanical ventilation (P=0.019). Regarding CBC parameters, there was high statistical significant difference regarding platelets count at the time of admission (P <0.001) and follow up (P <0.001), with statistical significant difference as regards Hb concentration at time of admission (P=0.006) and follow up (P=0.006), while, there was no statistical significant difference as regards TLC, neutrophilic percentage and lymphocytic percentage with P values (0.293, 0.583, 0.416) respectively at time of admission and (0.724, 0.456, 0.129) respectively for follow up investigations. Regarding renal function tests, there was statistically significant difference regarding blood urea whether on admission or follow up (P<0.001) and serum creatinine on admission (P=0.008) and follow up (P<0.001). Hepatic profile showed statistical significant difference between the studied groups regarding elevated ALT, AST,ALP, s. bilirubin, s. albumin, PC % and INR at time of admission (P<0.001) or for follow up (P<0.001). Also, there was statistical significance regarding GGT on admission (P=0.010) and for follow up (P=0.003). As regards inflammatory markers, there was statistical significant difference regarding serum ferritin on admission and follow up (P=0.006, 0.043) and for follow up values only CRP and ESR (P=0.009, 0.002) respectively, but at time of admission there was no statistical significance (P=0.322, 0.101), While, for D-dimer there was no statistical significant difference on admission (P=0.509) and for follow up (P=0.698), also, serum procalcitonin showed no statistical significant difference between the studied groups (P=0.910). Additionally, there was no statistical significant difference between the studied groups regarding pulmonary involvement in COVID-19 CT chest indings (P=269). Regarding pelviabdominal ultrasonography, there was statistically significant difference between the studied groups regarding liver size, echopattern, hepatic focal lesions, portal vein diameter, ascites and splenic size (P<0.001).