Title

Severity of liver test abnormalities in coronavirus disease 2019 depends on comorbidities and predicts early in-hospital mortality.

Authors

S. K. Satapathy, Zucker School of Medicine at Hofstra/NorthwellFollow
C. Kuntzen, Zucker School of Medicine at Hofstra/NorthwellFollow
H. Qiu
Y. Jiang
H. C. Bodenheimer, Zucker School of Medicine at Hofstra/NorthwellFollow
N. C. Roth, Zucker School of Medicine at Hofstra/NorthwellFollow
J. S. Hirsch, Zucker School of Medicine at Hofstra/NorthwellFollow
A. J. Trindade, Zucker School of Medicine at Hofstra/NorthwellFollow
D. E. Bernstein, Zucker School of Medicine at Hofstra/NorthwellFollow
Northwell Health COVID-19 Research Consortium

Publication Date

2021

Journal Title

Eur J Gastroenterol Hepatol

Abstract

Background and aims

Liver chemistry abnormalities (LCA) are common in patients with coronavirus disease 2019 (COVID-19), but their causes and clinical impact have not been adequately studied. We assessed the associations between LCA and clinical characteristics, inflammatory serum markers, in-hospital mortality.

Methods

Ten thousand eight hundred fifty-six adult patients with COVID-19 hospitalized in 13 hospitals in New York (1 March to 27 April 2020) were analyzed retrospectively. Abnormalities of liver chemistries [aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, or total bilirubin] were defined as absent, mild-moderate (at least one value up to four times elevated), or severe.

Results

LCA were mild-moderate in 63.9% and severe in 7.6% at admission. Risk factors for severe LCA were male sex and chronic liver disease. Conversely, hypertension and diabetes mellitus were less likely associated with severe LCA. AST elevation correlated weakly to modestly with inflammatory markers. On adjusted analysis, in-hospital mortality was 1.56 times and 1.87 times increased in patients with mild-to-moderate and severe LCA, respectively. Diabetes, hypertension, male sex, and age greater than 60 years was associated with incremental risk of mortality with increase severity of LCA, especially in the first week of hospitalization. HTN was not associated with increased in-hospital mortality unless LCA was present.

Conclusion

Increasing severity of LCA on hospital admission predicts early in-hospital mortality in COVID-19 patients. Mortality associated with the known risk factors, hypertension, diabetes, male sex, and old age was accentuated in the presence of LCA. AST correlated modestly with inflammatory markers.

Document Type

Article

Status

Faculty

Facility

School of Medicine

Primary Department

Hepatology

Additional Departments

Gastroenterology; COVID-19 Publications

PMID

33560687

DOI

10.1097/meg.0000000000002055