Prognostic Value of Transaminases and Bilirubin Levels at Admission to Hospital on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

Abstract

Introduction: Given the impact of COVID-19 on the world healthcare system, and the efforts of the healthcare community to find prognostic factors for hospitalization, disease progression, and mortality, the aim of the present study was to investigate the prognostic impact of transaminases and bilirubin levels at admission to hospital on disease progression and mortality in COVID-19 patients. Methods: Using the CoviCamp database, we performed a multicenter, observational, retrospective study involving 17 COVID-19 Units in southern Italy. We included all adult patients hospitalized for SARS-CoV-2 infection with at least one determination at hospital admission of aminotransaminases and/or total bilirubin. Results: Of the 2054 patients included in the CoviCamp database, 1641 were included in our study; 789 patients (48%) were considered to have mild COVID-19, 347 (21%) moderate COVID-19, 354 (22%) severe COVID-19, and 151 patients (9%) died during hospitalization. Older age (odds ratio (OR): 1.02; 95% confidence interval (CI) 1.01–1.03), higher Charlson comorbidity index (CCI) (OR 1.088; 95%CI 1.005–1.18), presence of dementia (OR: 2.20; 95% CI: 1.30–3.73), higher serum AST (OR: 1.002; 95% CI: 1.0001–1.004), and total bilirubin (OR: 1.09; 95% CI: 1.002–1.19) values were associated with a more severe clinical outcome. Instead, the 151 patients who died during hospitalization showed a higher serum bilirubin value at admission (OR 1.1165; 95% CI: 1.017–1.335); the same did not apply for AST. Discussion: Patients with COVID-19 with higher levels of AST and bilirubin had an increased risk of disease progression.

COVID-19 as Another Trigger for HBV Reactivation: Clinical Case and Review of Literature

“…Abnormalities in liver function have been observed in 14.8–53.0% of patients with COVID-19 [ 14 , 15 , 16 ]. Different pathogenetic mechanisms have been hypothesized as a possible cause of liver damage in this setting: the direct action of SARS-CoV-2 on liver cells, the cytokine storm, a hypoxic-ischemic liver injury, a drug-induced liver injury and the reactivation of a pre-existing liver disease [ 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…HBsAg-negative/anti-HBc-positive patients with COVID-19 are at low risk of HBV reactivation during immunosuppression since this treatment does not include anti-CD20 agents [ 8 , 14 , 15 , 20 , 23 , 29 , 32 , 33 , 34 , 35 , 36 ]. In this low-risk setting, pre-emptive therapy may be preferred to prophylaxis, with the timely start of nucleo(t)side analogues in the event that HBsAg becomes positive and/or HBV DNA detectable in serum.…”

Pre-existing chronic kidney disease (CDK) was not associated with a severe clinical outcome of hospitalized COVID-19: results of a case-control study in Southern Italy

“…All the patients with CKD were enrolled as Cases (Case group). For each Case, 2 patients without CKD, pair matched for gender, age (+5 years), number of co-morbidities (excluding CKD), were chosen from the Campania COVID-19 cohort (CoviCamp cohort) (Control group) [10][11][12]. Exclusion criteria included minority age, and lack of clinical data and/or of informed consent.…”

Impact of chronic liver disease on SARS-CoV-2 infection outcomes: Roles of stage, etiology and vaccination

“…ALI has been demonstrated to be a predictor of unfavorable SARS-CoV-2 infection course[ 8 , 9 ]. High levels of AST and TBIL at hospital admission are associated with an increased risk of COVID-19 progression[ 10 ]. The coexistence of previous liver disease worsens the outcomes of COVID-19.…”