Liver damage in COVID-19 patients was documented as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels or an elevated AST/ALT ratio, known as the De Ritis ratio. However, the prognostic value of the elevated De Ritis ratio in COVID-19 patients is still unknown. The aim of our study was to evaluate the prognostic value of the De Ritis ratio compared to other abnormal laboratory parameters and its relation to mortality. We selected 322 COVID-19 patients in this retrospective study conducted between November 2020 and March 2021. The laboratory parameters were measured on admission and followed till patient discharge or death. Of the 322 COVID-19 patients, 57 (17.7%) had gastrointestinal symptoms on admission. The multivariate analysis showed that the De Ritis ratio was an independent risk factor for mortality, with an OR of 29.967 (95% CI 5.266–170.514). In ROC analysis, the AUC value of the the De Ritis ratio was 0.85 (95% CI 0.777–0.923, p < 0.05) with sensitivity and specificity of 80.6% and 75.2%, respectively. A De Ritis ratio ≥1.218 was significantly associated with patient mortality, disease severity, higher AST and IL-6 levels, and a lower ALT level. An elevated De Ritis ratio on admission is independently associated with mortality in COVID-19 patients, indicating liver injury and cytokine release syndrome.

Patients with cirrhosis are vulnerable to hepatic decompensation events and death following COVID-19 infection. Therefore, primary vaccination with COVID-19 vaccines is fundamental to reducing the risk of COVID-19 related deaths in patients with cirrhosis. However, limited data are available about the effectiveness of mRNA vaccines compared to other vaccines. The aim of our study was to investigate the efficacy of mRNA vaccines versus other vaccines in cirrhosis. In this retrospective study, we compared clinical characteristics and vaccine effectiveness of 399 COVID-19 patients without cirrhosis (GROUP A) to 52 COVID-19 patients with cirrhosis (GROUP B). 54 hospitalised cirrhosis controls without COVID-19 (GROUP C) were randomly sampled 1:1 and matched by gender and age. Of the cirrhosis cases, we found no difference (p = 0.76) in mortality rates in controls without COVID-19 (11.8%) compared to those with COVID-19 (9.6%). However, COVID-19 patients with cirrhosis were associated with higher rates of worsening hepatic encephalopathy, ascites and esophageal varices. Patients with cirrhosis receiving mRNA vaccines had significantly better survival rates compared to viral vector or inactivated vaccines. Primary vaccination with the BNT162b2 vaccine was the most effective in preventing acute hepatic decompensating events, COVID-19 infection requiring hospital admission and in-hospital mortality.

Background: Besides the respiratory tract infection caused by COVID-19, 14-53% of COVID-19 patients had hepatic dysfunction on admission. Liver damage in COVID-19 patients was witnessed as increased alanine aminotransferase (ALT), aspartate aminotransferase (AST) or elevated AST/ALT ratio, known as the De Ritis ratio. However, the prognostic value of the elevated De Ritis ratio in COVID-19 patients is still unknown. The aim of our study was to evaluate the prognostic value of the De Ritis ratio compared to other abnormal laboratory parameters and the relation to mortality.Methods: 322 COVID-19 patients were selected in this retrospective study between November 2020 and March 2021. Laboratory parameters were measured on admission and followed till discharge or death. Multivariate binary logistic regression and Receiver Operating Characteristic (ROC) curves were performed to evaluate the impact of abnormal laboratory findings to predict mortality. In addition, clinical characteristics and laboratory data of COVID-19 patients were compared by different levels of De Ritis ratio.Results: Of the 322 COVID-19 patients, 57 (17.7%) had gastrointestinal symptoms on admission. Median age was 66 (54-77) years and 178 were men. The mortality rate was 11.2%. 30 patients (9.3%) had preexisting liver disease; 20 (6.2%) were liver cirrhosis. In COVID-19 recovered patients the De Ritis ratio was significantly smaller (p<.001) than in deaths (mean: 1.0 vs. 1.8). Mean values of AST, total bilirubin, albumin, CRP, PCT, IL-6 were significantly higher in COVID-19 deaths compared to survivors (p<.05). AST, De Ritis ratio, total bilirubin, IL-6, albumin and age were independently associated with mortality. The De Ritis ratio proved to be an independent risk factor for mortality with an OR of 29.967 (CI 5.266-170.514). In ROC analysis, AUC value of the the De Ritis ratio was 0.85 (95% CI 0.777-0.923, p<.05) with sensitivity and specificity 80.6% and 75.2%, respectively. Patients with De Ritis ratio ≥ 1.218 were significantly associated with mortality, severity, higher AST and IL-6, however with lower ALT.Conclusions: The elevated De Ritis ratio on admission is independently associated with mortality in COVID-19 patients. Patients with De Ritis ratio ≥1.218 are significantly susceptible to liver damage and cytokine released storm.

Hypocalcemia is a common condition in liver cirrhosis and is associated with the severity of SARS-CoV-2 infection. However, there is a lack of data demonstrating the prognostic value of hypocalcemia in COVID-19 patients with cirrhosis. This study aimed to evaluate the prognostic value of hypocalcemia for COVID-19 severity, mortality and its associations with abnormal liver function parameters. We selected 451 COVID-19 patients in this retrospective study and compared the laboratory findings of 52 COVID-19 patients with cirrhosis to those of 399 COVID-19 patients without cirrhosis. Laboratory tests measuring albumin-corrected total serum calcium were performed on admission, and the levels were monitored during hospitalization. The total serum calcium levels were significantly lower in cirrhosis cases (2.16 mmol/L) compared to those without cirrhosis (2.32 mmol/L). Multivariate analysis showed that hypocalcemia in COVID-19 patients with cirrhosis was a significant predictor of in-hospital mortality, with an OR of 4.871 (p < 0.05; 95% CI 1.566–15.146). ROC analysis showed the AUC value of total serum calcium was 0.818 (95% CI 0.683–0.953, p < 0.05), with a sensitivity of 88.3% and a specificity of 75%. The total serum calcium levels showed a significant negative correlation with the Child–Turcette–Pugh score (r = −0.400, p < 0.05). Hypocalcemia on admission was a significant prognostic factor of disease progression in COVID-19 patients with cirrhosis.