Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2020; 12(9): 619-627
Published online Sep 27, 2020. doi: 10.4254/wjh.v12.i9.619
Transaminitis is an indicator of mortality in patients with COVID-19: A retrospective cohort study
Vishnu Charan Suresh Kumar, Prateek Suresh Harne, Samiran Mukherjee, Kashvi Gupta, Umair Masood, Anuj Vikrant Sharma, Jivan Lamichhane, Amit Singh Dhamoon, Bishnu Sapkota
Vishnu Charan Suresh Kumar, Prateek Suresh Harne, Samiran Mukherjee, Jivan Lamichhane, Amit Singh Dhamoon, Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
Kashvi Gupta, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
Umair Masood, Anuj Vikrant Sharma, Bishnu Sapkota, Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY 13202, United States
Bishnu Sapkota, Division of Gastroenterology, Syracuse VA medical Center, Syracuse, NY 13202, United States
Author contributions: Suresh Kumar VC, Harne SP, Masood U and Sapkota B contributed to the conceptualization; Suresh Kumar VC, Harne SP and Mukherjee S contributed to the data curation; Suresh Kumar VC, Harne SP, Mukherjee S and Sapkota B contributed to the methodology; Suresh Kumar VC, Lamichhane J and Sapkota B contributed to the project administration; Suresh Kumar VC, Harne SP, Mukherjee S, Masood U, Sharma A, Lamichhane J and Sapkota B contributed to the resources; Suresh Kumar VC, Harne SP, Gupta K, Dhamoon SA and Sapkota B wrote the original article; Suresh Kumar VC, Harne SP, Gupta K, Masood U, Sharma A, Dhamoon SA and Sapkota B contributed to the review and editing; Gupta K contributed to the formal analysis; Gupta K, Dhamoon SA and Sapkota B contributed to the validation; Sharma A, Lamichhane J, Dhamoon SA and Sapkota B supervised the manuscript.
Institutional review board statement: This study was approved by SUNY Upstate IRB.
Informed consent statement: This study was approved by the SUNY Upstate IRB board and an informed consent document was not needed. Please refer to the IRB document for further details.
Conflict-of-interest statement: None of the authors have any affiliations with or involvement in any organization or entity with any financial interest or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Data sharing statement: Not available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Vishnu Charan Suresh Kumar, MBBS, Doctor, Department of Internal Medicine, SUNY Upstate Medical University, 750 E Adams Street, Syracuse, NY 13202, United States. drvishnucharan@gmail.com
Received: June 20, 2020
Peer-review started: June 20, 2020
First decision: July 2, 2020
Revised: July 3, 2020
Accepted: August 24, 2020
Article in press: August 24, 2020
Published online: September 27, 2020
Abstract
BACKGROUND

Since its discovery in Wuhan, China in December of 2019, the novel coronavirus has progressed to become one of the worst pandemics seen in the last 100 years. Recently, there has been an increased interest in the hepatic manifestations of coronavirus disease 19 (COVID-19).

AIM

To describe the demographic and clinical characteristics of COVID-19 positive patients and study the association between transaminitis and all-cause mortality.

METHODS

This is a descriptive retrospective cohort study of 130 consecutive patients with a positive COVID PCR test admitted between March 16, 2020 to May 14, 2020 at a tertiary care University-based medical center. The Wilcoxon-rank sum test and paired t-test were used for comparing non-parametric and parametric continuous variables respectively and a multivariable logistic regression models to study the association between transaminitis and mortality using SAS version 9.4 (SAS Institute, Cary, NC, United States).

RESULTS

Out of the 130 patients, 73 (56%) patients were found to have transaminitis and 57 (44%) did not. When compared to patients without transaminitis, the transaminitis group was found to have a higher median body mass index (30.2 kg/m2vs 27.3 kg/m2, P = 0.04). In the multivariate analysis those with transaminitis were found to have 3.4 times higher odds of dying as compared to those without transaminitis adjusting for gender, the Age-adjusted Charlson Comorbidity Index and admission to the intensive care unit (P = 0.03).

CONCLUSION

Our study showed that transaminitis on admission was associated with severe clinical outcomes such as admission to the intensive care unit, need for mechanical ventilation, and mortality.

Keywords: COVID-19, Liver, Mortality, Transaminitis, Liver enzymes, Aspartate aminotransferase, Alanine aminotransferase

Core Tip: Gastrointestinal symptoms have been well described in coronavirus disease 19 (COVID-19). In recent studies, transaminitis has been seen in patients with COVID-19. Our study has compared the characteristics between patients with transaminitis and patients without transaminitis. Transaminitis on presentation is an indicator of higher mortality in patients with COVID-19. This study shows the importance of identifying transaminitis in patients with COVID-19. It will help clinicians prognosticate based on the presence or absence of transaminitis on initial presentation.