High aspartate aminotransferase to alanine aminotransferase ratio on admission as risk factor for poor prognosis in COVID-19 patients

Abstract

This study aimed to analyze aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio in COVID-19 patients. After exclusion, 567 inpatients were included in this study and separated into two groups according to their AST/ALT ratio on admission. Death was regarded as poor prognosis in this study. Of 567 patients, 200 (35.3%) had AST/ALT ≥ 1.38. Of the 200 patients, older age (median age 60 years), myalgia (64 [32%] cases), fatigue (91 [45.5%] cases), some comorbidities and outcomes were significantly different from patients with AST/ALT < 1.38. They also had worse chest computed tomography (CT) findings, laboratory results and severity scores. Levels of platelet count (OR 0.995, 95% CI [0.992–0.998]) and hemoglobin (OR 0.984, 95% CI [0.972–0.995]) were independently associated with AST/ALT ≥ 1.38 on admission. Furthermore, a high AST/ALT ratio on admission was an independent risk factor for poor prognosis (OR 99.9, 95% CI [2.1–4280.5]). In subsequent monitoring, both survivors and non-survivors showed decreased AST/ALT ratio during hospitalization. In conclusion, high AST/ALT ratio might be the indication of worse status and outcomes in COVID-19 patients.

Elevated serum SDMA and ADMA at hospital admission predict in-hospital mortality of COVID-19 patients

“…Although severe COVID-19 is an inflammation-driven disease, leukocyte cell count was the only traditional inflammatory marker that was weakly associated with mortality, whilst neither the SOFA score nor other commonly used laboratory parameters like CRP and PCT were able to significantly identify high-risk patients. In addition, three previously published risk scores that are based on a variety of different traditional diagnostic parameters 5 , 7 , 8 failed to significantly predict mortality in our COVID-19 cohort.…”

“…S8 ). In addition, we tested three previously published COVID-19 mortality risk scores 5 , 7 , 8 ; none of these scores showed a significant prediction of mortality in our patient cohort (supplementary Fig. S9 ).…”

“…A severity score consisting of age, oxygen saturation, mean arterial pressure, blood urea nitrogen, C-reactive protein, and the international normalized ratio was shown to improve prediction of COVID-19-related in-hospital mortality 5 . Other groups proposed redefining established risk factors of cardiac disease 6 or organ damage markers like aspartate aminotransferase and alanine aminotransferase 7 to better predict worse outcomes in COVID-19 patients. Another risk score for prediction of mortality of hospitalized COVID-19 patients comprised age, heart rate, oxygen saturation, lactate dehydrogenase activity, pro-calcitonin (PCT) and the presence or absence of chronic obstructive pulmonary disease or congestive heart failure 8 .…”

Myoglobin and C-reactive protein are efficient and reliable early predictors of COVID-19 associated mortality

“…The analysis of recently published studies reveals the role of systemic vasculitis and cytokine-mediated coagulation disorders, predominantly responsible for multi-organ failure in patients with severe COVID-19 complications. The hematological (lymphocyte count 11 , 12 , neutrophil count 13 , neutrophil–lymphocyte ratio (NLR)) 14 , 15 , inflammatory (C-reactive protein (CRP)) 16 , immunological (interleukin (IL)-6) 17 and biochemical (D-dimer 18 , troponin, creatine kinase (CK) 19 biomarkers, as well as procalcitonin (PCT) 16 , 20 , erythrocyte sedimentation rate (ESR) 21 , aspartate aminotransferase (AST)) 22 , and those particularly related to coagulation cascades in disseminated intravascular coagulation (DIC) 23 and acute respiratory distress syndrome (ARDS) 24 have been reported to be important biomarkers associated with COVID-19 disease. New laboratory biomarkers could be identified through the accurate analysis of multicentric case series; in particular, homocysteine and angiotensin II could play a significant role in this regard 24 .…”

Correlation between early features and prognosis of symptomatic COVID-19 discharged patients in Hunan, China

“…These results demonstrated the relationship between impaired liver function and longer hospitalization days. Qin et al found that a high level of AST or ALT might be the prediction of a worse prognosis in COVID-19 patients 16 . Also, Lei et al analyzed COVID-19 patients for liver enzymes and found that elevated AST was strongly associated with the mortality risk 17 .…”