Liver function test abnormalities at hospital admission are associated with severe course of SARS-CoV-2 infection: a prospective cohort study

Abstract

ObjectiveLiver injury has frequently been reported in COVID-19 patients. The clinical relevance of liver injury related to SARS-CoV-2 infection remains unclear with a need for prospective studies on the impact of liver function test (LFT) abnormalities at baseline.DesignData of 217 patients without pre-existing liver disease prospectively included in the COVID-19 registry of the LMU university hospital were analysed in order to assess the association of abnormal LFT at admission and course of the disease. Severe course was defined as admission to the intensive care unit (ICU) or as COVID-19-related death.ResultsAbnormal LFT at baseline was present in 58% of patients, with a predominant elevation of aspartate aminotransferase (AST) (42%), gamma-glutamyltransferase (GGT) (37%) and alanine aminotransferase (ALT) (27%), hypoalbuminaemia was observed in 33%. Elevation of ALT and GGT, as well as hypoalbuminaemia, was associated with higher proportions of patients requiring ICU treatment and mechanical ventilation. After adjusting for age, gender and comorbidities, hypoalbuminaemia combined with abnormal AST or GGT at hospital admission was a highly significant independent risk factor for ICU admission (OR 46.22 and 38.8, respectively) and for a composite endpoint of ICU admission and/or COVID-19-related death (OR 42.0 and 26.9, respectively).ConclusionAbnormal LFTs at hospital admission, in particular GGT and albumin, are associated with a severe course of SARS-CoV-2 infection.

Liver injury, hypoalbuminaemia and severe SARS-CoV-2 infection

“…A review of 310 patients admitted with COVID-19 to our institution in Dublin revealed abnormal liver blood tests were present in almost 50% of patients, in particular raised gamma-glutamyl transferase (gGT) levels (table 1), similar to that noted by Weber and colleagues. 1 In our patient cohort, hypoalbuminaemia on admission to hospital was also an independent predictor of mortality, validating the findings of their prospective study. Multivariate analysis of our cohort showed a significant association between COVID-19-related mortality and serum albumin on admission (OR 0.90, 0.85-0.96; p=0.002); in a model incorporating older age, male sex, high MULBSTA score (a predictive score of viral pneumonia mortality 4 ) and body mass index, hypoalbuminaemia predicted death, with area under the curve receiver operating characteristic at 0.8 (figure 1).…”

“…We have read with interest the recent study published in Gut by Weber et al 1 outlining liver abnormalities in 217 patients admitted with COVID-19 infection in Germany. Along with respiratory failure, deranged liver blood tests have been demonstrated in many cohort studies of patients admitted with SARS-CoV-2 infection, the clinical relevance of which has been unclear to date.…”

Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

“…In our case series, the liver function (both transaminases and bilirubin levels) at presentation and during the course of the disease was unremarkable, even in the severe cases. This is in contrast with the literature on immunocompetent patients with COVID-19, in whom liver function test abnormalities are associated with a severe course of the SARS-CoV-2 infection [13]. In a meta-analysis, including 3428 patients from 20 retrospective studies, liver dysfunction was significantly higher in critically ill patients with unfavorable outcomes in COVID-19 [14,15], as could also be observed in other coronaviral diseases (SARS and MERS) [16][17][18].…”

COVID-19 and liver disease: mechanistic and clinical perspectives

“…The prognostic significance of elevated liver enzymes in patients infected with SARS-CoV-2 is currently debated. Some reports have demonstrated that elevations of serum liver enzyme levels are associated with adverse outcomes, including shock, intensive care unit (ICU) admission and mechanical ventilation 43,65,[71][72][73][74] . However, these studies could be prone to bias if patients with severe disease received more intensive laboratory monitoring, increasing the likelihood of detecting liver injury.…”