Published online Feb 7, 2022. doi: 10.3748/wjg.v28.i5.570
Peer-review started: May 17, 2021
First decision: July 14, 2021
Revised: July 21, 2021
Accepted: January 20, 2022
Article in press: January 20, 2022
Published online: February 7, 2022
Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019 (COVID-19). However, the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood
We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality.
This retrospective, observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System (Baltimore, MD, United States). Demographic data, clinical characteristics, laboratory findings, treatment measures, and outcome data were collected. Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis
A total of 2698 (70.4%) had abnormal alanine aminotransferase (ALT) at the time of admission. Other more prevalent abnormal liver chemistries were aspartate aminotransferase (AST) (44.4%), alkaline phosphatase (ALP) (16.1%), and total bilirubin (T-Bil) (5.9%). Factors associated with liver injury were older age, Asian ethnicity, other race, being overweight, and obesity. Higher ALT, AST, T-Bil, and ALP levels were more commonly associated with disease severity. Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization. Abnormal AST, T-Bil, and ALP were associated with a need for vasopressor drugs, whereas higher levels of AST, T-Bil, and a decreased albumin levels were associated with mechanical ventilation
Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient’s severity and prognosis. Elevated liver chemistries, specifically ALT, AST, ALP, and T-Bil levels, can be used to stratify risk and predict the need for advanced therapies in these patients.
Core Tip: Severe acute respiratory syndrome coronavirus-2 primarily infects the respiratory system. However, increasing evidence exists for the direct multiorgan effect. Liver injury in hospitalized patients is associated with a poor prognosis. We investigated whether abnormal liver chemistries in Coronavirus Disease 2019 (COVID-19) hospitalized patients can be of prognostic value. We show that abnormal liver chemistries were commonly observed on hospital admission and are associated with worse outcomes in COVID-19 patients, namely mortality, the need for vasopressor drugs, and mechanical ventilation. In hospitalized COVID-19 patients, elevated liver chemistries, specifically alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin levels, can be used to stratify risk and predict the need for advanced therapies. These results strongly suggest that abnormal liver chemistries at the time of hospital admission are associated with worse outcomes in COVID-19 patients and should be closely followed in admitted patients.