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
Severe acute respiratory syndrome coronavirus 2 primarily infects the respiratory system. Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019 (COVID-19). In addition, increasing evidence exists for the direct multiorgan effect. However, the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood.
To explore the impact of abnormal liver chemistries in hospitalized patients with COVID-19 and whether it is associated with worse outcomes, namely mortality, the need for vasopressor drugs, and mechanical ventilation.
We examine whether abnormal liver chemistries in COVID-19 hospitalized patients can be of prognostic value. We determined the prevalence of elevated liver chemistries in a large cohort of hospitalized patients with COVID-19 infection and identified whether an independent association exists between abnormal liver chemistries and clinical severity or the risk of in-hospital mortality.
This retrospective, observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System. 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 ALT at the time of admission. Other more prevalent abnormal liver chemistries were AST (44.4%), ALP (16.1%), and 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.
This study found that abnormal liver chemistries (AST, ALT, T-Bil, ALP, and albumin) at the time of hospital admission are associated with worse outcomes in COVID-19 patients, namely mortality (ALT, T-Bil, and ALP), the need for vasopressor drugs (AST, T-Bil, and ALP), and mechanical ventilation (AST, and T-Bil). Consequently, in hospitalized COVID-19 patients, elevated liver chemistries, specifically ALT, AST, ALP, and T-Bil levels, can be used to stratify risk and predict the need for advanced therapies.
Abnormal liver chemistries are common at the time of hospital admission are associated with worse outcomes in COVID-19 patients. In particular, abnormal levels of AST, T-Bil, ALP, and hypoalbuminemia correlate with the severity of COVID-19 infection, and abnormal liver chemistries (ALT, T-Bil, and ALP) during hospitalization are strongly associated with all-cause mortality in patients with COVID-19. Furthermore, liver injury measured in patients with COVID-19 on admission is associated with the need for vasopressor drugs (AST, T-Bil, and ALP) and mechanical ventilation (AST, and T-Bil).