Clinical Outcome and Risk Assessment in Hospitalized COVID-19 Patients with Elevated Transaminases and Acute Kidney Injury: A Single Center Study

Abstract

Objectives: Initial reports indicate a high incidence of abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with COVID-19 and possible association with acute kidney injury (AKI). We aimed to investigate clinical features of elevated transaminases on admission, its association with AKI, and outcomes in patients with COVID-19. Methods: A retrospective analysis of the registered data of hospitalized patients with laboratory-confirmed COVID-19 and assessment of the AST and ALT was performed. Multinomial logistic regression was used to determine factors associated with community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI). Results: The subjects comprised 828 patients (mean age = 65.0±16.0 years; 51.4% male). Hypertension was present in 70.3% of patients, diabetes mellitus in 26.0%, and chronic kidney disease in 8.5%. In-hospital mortality was 21.0%. At admission, only 41.5% of patients had hypertransaminasemia. Patients with elevated transaminases at admission were younger, had higher levels of inflammatory markers and D-dimer, and poorer outcomes. The AKI incidence in the study population was 27.1%. Patients with hypertransaminasemia were more likely to develop AKI (33.5% vs. 23.3%, p =0.003). Patients with predominantly elevated AST (compared to elevated ALT) were more likely to have adverse outcomes. Multinomial logistic regression found that hypertension, chronic kidney disease, elevated AST, and hematuria were associated with CA-AKI. Meanwhile, age > 65 years, hypertension, malignancy, elevated AST, and hematuria were predictors of HA-AKI. Conclusions: Elevated transaminases on admission were associated with AKI and poor outcomes. Patients with elevated AST were more likely to have adverse outcomes. Elevated AST on admission was associated with CA-AKI and was a predictor of HA-AKI.

Factors Associated with Acute Kidney Injury in COVID-19 Hospitalized Patients in Central Java, Indonesia

“…Potential contributing factors may encompass ischemic damage, damage induced by systemic inflammation akin to sepsis, and coagulation abnormalities involving both microvascular and macrovascular thrombosis. 38 The kidneys are susceptible to damage during COVID-19 infection, leading to acute kidney injury (AKI). This study observed a 23.3% incidence of increased creatinine among patients with COVID-19.…”

Urine Parameters in Patients with COVID-19 Infection

“…Especially in those patients requiring ICU support, AKI is associated with poor prognosis and increased risk of mortality. As a result of the studies mentioned above, we have observed that many laboratory parameters are useful as potential biomarkers to predict renal damage associated with COVID-19 [ 15 , 17 , 21 , 22 , 23 , 24 , 27 , 30 , 48 , 49 , 50 ].…”