The effect of liver test abnormalities on the prognosis of COVID-19

Abstract

Introduction COVID-19 caused by the SARS-CoV-2 continues to spread rapidly across the world. In our study, we aim to investigate the relationship between the liver enzymes on admission (AST, ALT, ALP, GGT) and severity of COVID-19. We evaluated course of disease, hospital stay, liver damage and mortality. Materials and methods Our study included 614 patients who were hospitalized with the diagnosis of COVID-19 between 03.16.20 and 05.12.20. Patients with liver disease, hematological and solid organ malignancy with liver metastases were excluded, resulting in 554 patients who met our inclusion criteria. We retrospectively evaluated liver transaminase levels, AST/ALT ratio, cholestatic enzyme levels and R ratio during hospital admission and these were compared in terms of morbidity, mortality and clinical course. Results Mean age of 554 subjects were 66.21 ± 15.45 years, 328 (59.2%) were men. The mean values of liver enzymes on admission were AST (36.2 ± 33.6 U/L), ALT (34.01 ± 49.34 U/L), ALP (78.8 ± 46.86 U/L), GGT (46.25 ± 60.05 U/L). Mortality rate and need for intensive care unit were statistically significant in subjects that had high ALT–AST levels during their admission to the hospital ( p = 0.001). According to the ROC analysis AST/ALT ratio was a good marker of mortality risk (AUC = 0.713: p = 0.001) and expected probability of intensive care unit admission (AUC = 0.636: p = 0.001). R ratio, which was used to evaluate prognosis, showed a poor prognosis rate of 26.5% in the cholestatic injury group, 36.1% in the mixed pattern group and 30% in the hepato-cellular injury group ( p 0.001). Conclusions ALT–AST elevation and AST/ALT ratio >1 was associated with more severe course and increased mortality in COVID-19.

Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study

“…It has also been observed that an interaction of the virus with Kupffer cells and intra-hepatic T lymphocytes could stimulate a liver damage [ 41 , 42 ]. A further hypothesis concerns the systemic reaction induced by the virus, which would activate inflammatory molecules such as IL-6 and TNF-alpha, thus triggering a liver damage [ 34 , 43 – 45 ].…”

Liver injury in the era of COVID-19

“…Furthermore, Medetalibeyoglu et al [ 58 ] stated that an AST/ALT ratio > 1 in 554 COVID-19 patients was associated with more frequent admission to the intensive care unit and with the severity of pneumonia, compared to those with an AST/ALT ratio < 1 ( P = 0.033 and P = 0.016, respectively). An analysis of the AUC value under the ROC curve for the AST/ALT ratio revealed its high diagnostic accuracy in the prediction of mortality, severity of pneumonia and the risk of intensive care unit admission (AUC = 0.713/ P = 0.001, AUC = 0.577/ P = 0.002 and AUC = 0.636/ P = 0.001, respectively)[ 58 ].…”

Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission

“…A recent systematic review reported a 19% (range 1–53%) pooled prevalence of liver function abnormalities in COVID-19 patients [ 6 , 8 ]. However, studies reporting liver injury in COVID-19 patients are retrospective, with high clinical and statistical heterogeneity [ 6 , [9] , [10] , [11] , [12] , [13] ]. Most of these studies described a substantial increase in the incidence of liver injury after hospitalization.…”