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Altered liver hemodynamics in patients with COVID-19: a cross sectional study

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Abstract

Aims

Abnormalities in liver biochemistry are common in COVID-19 patients. Hepatic vein Doppler waveform, typically triphasic, may become biphasic or monophasic in cirrhosis, correlating with liver dysfunction, fibrosis, inflammation, and portal hypertension. This study investigates liver ultrasound (US) features in COVID-19 patients, correlating hepatic vein Doppler waveform and portal vein velocity (PVV) with inflammatory indexes and clinical outcomes.

Methods

Fifty-seven patients with SARS-CoV-2 infection participated in a crosssectional study. Bedside upper abdomen US evaluations, including B-mode and Doppler, were conducted using a convex probe. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic, and the hepatic vein waveform index (HVWI) was calculated. PVV was measured over three cardiac cycles. Tracings were blindly analyzed by three operators to ensure consistency.

Results

Low HVWI and high PVV correlated with elevated LDH, ALT, d-dimer, and ferritin (p < 0.05). HVWI showed significant negative correlations with ferritin, d-dimer, and ALT (p < 0.05). d-Dimer and ferritin were higher in patients with biphasic/monophasic waveforms (p < 0.05). High PVV and larger spleen diameters predicted worse respiratory outcomes, including CPAP and tracheal intubation (p < 0.05). Optimal cut-off values for PVV (21.7 cm/s) and spleen diameter (9.84 cm) maximized sensitivity and specificity for predicting these outcomes. FIB-4 scores did not correlate with respiratory outcomes or hepatic hemodynamics (p > 0.05). Hemodynamic alterations were not significantly influenced by the presence of SLD (Steatotic Liver Disease).

Conclusions

COVID-19 patients exhibit altered intrahepatic hemodynamics, with hepatic vein waveform abnormalities potentially reflecting liver inflammation and fibrosis. PVV and spleen diameter may serve as non-invasive predictors of respiratory outcomes.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors have not disclosed any funding.

Author information

Authors and Affiliations

  1. Division of Clinical Immunology and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Luisa Siciliani & Mario Umberto Mondelli

  2. Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo University Hospital, University of Pavia, Pavia, Italy

    Giovanni Cappa & Caterina Zattera

  3. Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

    Giuseppe Albi

  4. Gastroenterology Department, Bolzano Regional Hospital, 39100, Bolzano, Italy

    Luca Marzi

Authors
  1. Luisa Siciliani
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  2. Giovanni Cappa
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  4. Giuseppe Albi
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  5. Mario Umberto Mondelli
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  6. Luca Marzi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Giovanni Cappa, Caterina Zattera e Giuseppe Albi. The first draft of the manuscript was written by Luisa Siciliaini and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Luisa Siciliani.

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The authors declare that they have no conflict of interests, none funding support.

Ethical approval

The study was conducted in accordance with Helsinki ethical standards and was approved by the Institutional Review Board of Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

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Informed consent was obtained from all individual participants included in the study.

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Siciliani, L., Cappa, G., Zattera, C. et al. Altered liver hemodynamics in patients with COVID-19: a cross sectional study. J Ultrasound 28, 437–445 (2025). https://doi.org/10.1007/s40477-025-01012-z

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  • DOI: https://doi.org/10.1007/s40477-025-01012-z

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