Abnormal Liver Function Tests Were Associated With Adverse Clinical Outcomes: An Observational Cohort Study of 2,912 Patients With COVID-19

Abstract

Background and Aim: The impact of liver function test (LFTs) abnormality on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains controversial. The aim of this study was to assess the impact of abnormal LFTs on clinical outcomes in a large cohort of hospitalized patients with COVID-19.Methods: We retrospectively collected data on 2,912 consecutive patients with COVID-19 who were admitted to a makeshift hospital in China between 5 February and 23 March 2020. The association between LFTs abnormalities (baseline and peak values) and clinical outcomes was measured by using Cox regression models.Results: On admission 1,414 patients (48.6%) had abnormal LFTs, with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) elevation in 662 (22.7%), 221 (7.6%), 52 (1.8%), 135 (4.6%), and 536 (18.5%) patients, respectively, and hypoalbuminemia in 737 (25.3%) patients. During a median 13 (IQR: 8–19) days of hospitalization, 61 patients (2.1%) died, 106 patients (3.6%) admitted to intensive care unit (ICU), and 75 patients (2.6%) required mechanical ventilation. After adjustment for confounders, baseline abnormal LFTs were independently associated with increased risks of mortality (adjusted HR 3.66, 95%CI 1.64–8.19, p = 0.002), ICU admission (adjusted HR 3.12 95%CI 1.86–5.23, p < 0.001), and mechanical ventilation (adjusted HR 3.00, 95%CI 1.63–5.52, p < 0.001), which was homogeneous across the severity of COVID-19 infection. Among the parameters of LTFs, the associations with the outcomes were more pronounced for AST and albumin abnormality. In contrast, ALT elevation was not significantly associated with those outcomes. Similar results were observed for peak values of LFTs during hospitalization.Conclusions: Abnormality of AST, albumin, TBIL, ALP, and GGT but not ALT were independently associated with adverse outcomes.

Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients

“…Interestingly, mild (<3 × ULN) elevation of ALT was found protective in terms of mortality, whereas ALT > 3 × ULN re-gained detrimental effect on survival. We do not see a mechanistic explanation for this protective effect of mildly elevated ALT, and the same phenomenon was reported in a recently published study from China [27].…”

COVID-19 Pandemic: Insights into Interactions between SARS-CoV-2 Infection and MAFLD

“…Although the exact effect of COVID-19 on the liver is currently unclear, it can be noted that liver biochemistry abnormalities appear to be common in COVID-19 patients, affecting approximately 17-58% of individuals with COVID-19 [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] (Table 1). Liver biochemistry abnormalities manifest primarily as mild and moderate elevations of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) in the early stages of the disease [25,[48][49][50].…”

COVID-19 Associated Hepatitis in Children (CAH-C) during the second wave of SARS-CoV-2 infections in Central India: Is it a complication or transient phenomenon

“…Prima facie, the findings of CAH-C cases do not resemble that of MIS-C, they lacked the markedly elevated inflammatory markers or systemic derangements seen in MIS-Cat all times of testing (25).…”

“…Prima facie, the findings of CAH-C cases do not resemble that of MIS-C, they lacked the markedly elevated inflammatory markers or systemic derangements seen in MIS-Cat all times of testing (25) . Interestingly, these cases had distinct immunological imprints having raised anti SARS-CoV-2 antibodies (titers >50 COI) in all the cases, significant Widal titers (>1:160 O, H), along with positive dengue IgM, positive anti-EBV IgM was seen in 8/37 cases and anti-VZV IgM in 7/37 patients respectively.…”