The role of liver steatosis as measured with transient elastography and transaminases on hard clinical outcomes in patients with COVID-19

Abstract

Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years.

Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients

“…In contrast to the high prevalence of biochemical abnormalities suggestive of liver involvement in COVID-19, the prevalence of chronic liver disease (2.8%) and cirrhosis (1.3%) observed in our cohort was low [3,19]. We assume this might be due to the awareness of the risks of acquiring COVID-19 among liver patients and preventive measures taken to avoid exposure to infection.…”

“…Coronavirus disease 2019 (COVID- 19) is a multisystemic disease, with pandemic features [1]. The clinical picture is characterized by respiratory symptoms of various severity, including the development of pneumonia and respiratory failure with the need for oxygen supplementation, and these patients require hospital admission.…”

“…This view is supported by the lack of larger series of liver biopsies, and the microinjury of muscles in COVID-19 leading to the elevation of aminotransferases [17]. Additionally, studies that were using liver dedicated non-invasive diagnostic devices such of Fibroscan came to conflicting conclusions in terms of liver involvement and prognostic impact of the indicators of liver health among patients with COVID-19 [18,19].…”

FibroScan-AST Score Predicts 30-Day Mortality or Need for Mechanical Ventilation among Patients Hospitalized with COVID-19

“…The authors excluded patients with a history of chronic liver disease (CLD) and liver biopsy was not performed to support the findings obtained by TE. As opposed to these findings, a recent study from Barcelona failed to demonstrate any influence of LSM, CAP, baseline ALT and prior liver disease on the clinical course of COVID-19 in a cohort of 98 hospitalized patients, with 9% of them having CLD [ 17 ]. Nevertheless, elevated baseline AST especially in patients aged > 65 years was a strong predictor of adverse clinical outcomes.…”

“…On the other hand, patients with non-cirrhotic chronic liver disease (CLD) seem to have comparable survival to patients without CLD. However, more specific data on the prevalence, severity and prognostic impact of liver steatosis, fibrosis and non-alcoholic steatohepatitis (NASH), on the course of COVID-19 are scarce with conflicting results published [ 15 , 16 , 17 , 18 ]. In fact, there are no specific data considering the impact of NASH, as the inflammatory phenotype of NAFLD, because liver biopsy as the gold standard method to diagnose NASH is rarely performed in the setting of COVID-19.…”