Background and Aims COVID-19 is associated with hepatocellular liver injury of uncertain significance. We aimed to determine whether development of significant liver injury during hospitalization is related to concomitant medications or processes common in COVID-19 (e.g. ischemia, hyperinflammatory or hypercoagulable states) and to determine whether it can result in liver failure and death. Methods 834 consecutive patients hospitalized with COVID-19 were included. Clinical, medication and laboratory data were obtained at admission and throughout hospitalization using an identified database. Significant liver injury was defined as an AST≥ 5X ULN; ischemia was defined as vasopressor use for a minimum of 2 consecutive days; hyper-inflammatory state as hs-CRP ≥100mg/L and hypercoagulability as D-dimer ≥5mg/L, any time during hospitalization. Results 105 (12.6%) patients developed significant liver injury. Compared to those without significant liver injury, ischemia [OR 4.3 (2.5-7.4, p <0.0001)] and tocilizumab use [OR 3.6 (1.9-7.0, p=0.0001)] were independent predictors of significant liver injury. While AST correlated closely with ALT (R=0.89) throughout hospitalization, AST did not correlate with INR (R= 0.10) or with bilirubin (R=0.09). Death during hospitalization occurred in 136 (16.3%) patients. Multivariate logistic regression showed that significant liver injury was not associated with death [OR 1.4 (0.8-2.6, p=0.2)], while ischemic [OR 2.4 (1.4-4.0, p=0.001)] hypercoagulable [OR 1.7 (1.1-2.6, p=0.02)], and hyperinflammatory [OR 1.9 (1.2-3.1, p=0.02)] disease states were significant predictors of death. Conclusions Liver test abnormalities known to be associated with COVID-19 are secondary to other insults, mostly ischemia or drug-induced liver injury, and do not lead to liver insufficiency or death.

The short-term prognosis of coronavirus disease 2019 (COVID-19) is impacted by underlying cirrhosis and other comorbidities. (1) However, as shown in our multicenter study, inpatient mortality was similar in patients with cirrhosis + COVID-19 and cirrhosis without COVID-19, but was higher than a contemporaneous cohort of hospitalized patients with COVID-19 without cirrhosis. (2) We herein describe the 90-day postdischarge outcomes in that age-matched and sexmatched cohort of patients admitted with cirrhosis + COVID-19, cirrhosis only, and COVID-19 only.

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