ABSTRACT
Background: The role of the abnormal liver function test (LFT) as prognostic factors in patients with COVID-19 has not been fully investigated, particularly outside resource-rich countries. We aimed at evaluating the prognostic value of abnormal LFTs on admission and during hospitalization of patients with COVID-19 in South America. Methods: We performed a retrospective study that included 298 adult patients hospitalized for COVID-19, confirmed by PCR, between 05/2020-02/2021 in 6 hospitals from 5 countries in South America. We analyzed demographic, clinical, routine and inflammatory laboratory markers, comorbidities, and radiological studies on admission and during hospitalization. Abnormal liver enzymes with more than twice the upper limit (ALEx2) were also evaluated in relation to a variety of factors on admission and during hospitalization. De novo-ALEx2 was defined as the presence of ALEx2 at one week of hospitalization in patients without ALEx2 on admission. Patients were followed until hospital discharge or death. Multivariable logistic regression was used to evaluate the association between ALEx2 on admission and during hospitalization in relation to mortality. Results: Of the total of 298 patients, 60% were male with a mean age of 60 years, and 74% of patients had at least one comorbidity. A total of 68 (22.8%) patients died during hospitalization. ALEx2 on admission was present in 87 (29.2%) patients, and was found to be independently associated with 1-week mortality [Odds ratio (OR) = 3.55;95% confidence interval (CI) 1.05-12.05]. Of 211 patients with LFTs information at one week of hospitalization 84 (39.8%) developed de novo-ALEx2. Cardiovascular comorbidity OR 3.1 (95% CI 1.14-8.45), active smoking OR 6.45 (95% CI 1.98-21), a high white blood cell count at 1 week of hospitalization OR 1.13 (95% CI 1.04-1.23), and de novo-ALEx2 at 1 week of hospitalization OR 2.93 (95% CI 1.05-8.19) were all independent risk factors for overall mortality. Conclusion: A moderate elevation of liver enzymes during admission was associated with a worse early-evolution of patients hospitalized with COVID-19 in South America. In addition, moderate elevation of LFTs at one week of hospitalization was an independent risk factor for overall mortality in these patients.
ABSTRACT
Background: Recent reports have revealed that coronavirus disease 2019 (COVID-19) is associated with liver injury The burden of liver injury in liver transplant (LT) recipients remains unknown We conducted a multi-center study to evaluate the prevalence, pattern and predictors of liver injury in LT recipients with COVID-19 and its impact on clinical outcomes Methods: The was carried out by the consortium of investigators to study COVID-19 in chronic liver disease (COLD) (registered Clinicaltrials gov NCT04439084) Inclusion criteria constituted: age > 18 years, laboratory confirmed diagnosis of COVID-19 and history of LT. We collected de-identified data on patients diagnosed before May 30, 2020 For the analysis on liver injury, only patients who had laboratory values for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) prior to- and during COVID-19 infection were included The primary outcome was the presence of acute liver injury The secondary outcome was all-cause mortality within 90 days of diagnosis Logistic regression analyses were used to determine interdependent risk factors of primary outcome Results: We included 112 adult LT recipients from 21 US medical centers with confirmed diagnosis of COVID-19 The median age of the cohort was 61 years (IQR 20), and 54 5% (n = 61) were male There were 39 3% (n = 44) Hispanic, 27 7% (n = 31) non-Hispanic white, and 25 9% (n = 29) non-Hispanic African-American The all-cause mortality was 22 3% (n = 25);72 3% (n = 81) were hospitalized and 26 8% (n = 30) were admitted to the intensive care unit (ICU) 81 patients had data for analysis of liver injury 34 6% of LT patients had liver injury, Mild to moderate liver injury (ALT 2-5x ULN) in 22 2% (n=18) and severe (ALT > 5x ULN) in 12.3% (n = 10). Younger age (p = 0 009, odds ratio (OR) 2 06 [1 20-3 54]), Hispanic ethnicity (p = 0 011;OR 6 01[1 51-23 9]), metabolic syndrome (p = 0 016;OR 5 87 [1 38-24 99]), receipt of vasopressors (p = 0 018;OR 7 34 [1 39-38 52]) and antibiotic use (p = 0 046;PR 6 93 [1 04-46 26]) were associated with independent risk of liver injury on multivariate logistic regression Immunosuppression was modified in approximately half the patients (49.4%, [n = 40]) Reduction in immunosuppression during COVID-19 was not associated with liver injury (p = 0 156) or risk for mortality (p = 0.084). Presence of liver injury was significantly and independently associated with higher overall mortality (p = 0 007;OR = 6 91 [95% CI: 1 68-28 48]) in LT recipients Conclusion: Mild to moderate liver injury was common in LT patients diagnosed with COVID-19 Immunosuppression was modified during COVID-19 in half the patients but was not associated with liver injury or mortality Younger age, Hispanic ethnicity, metabolic syndrome, vasopressor and antibiotic use were associated with independent risk of liver injury Lastly, liver injury was associated with higher mortality rate in LT recipients with COVID-19.
ABSTRACT
Background: A significant number of those infected with COVID-19 present with gastrointestinal-related manifestations, particularly acute liver injury Most data originate from China, and it is unclear that similar patterns hold in different ethno-social contexts Methods: We performed a retrospective assessment of all individuals diagnosed with COVID-19 in an ethnically diverse county hospital in Minnesota Individuals with a positive COVID-19 test between March 1 and May 25, 2020 were included We evaluated the role of race, ethnicity, and co-morbidities on the pattern of liver injury, hospital admission, and mortality Logistic regressions were performed using SAS 9.4. Statistical significance was reported at a 05 level Results: 2164 individuals diagnosed with COVID-19 were identified. Median age was 39 years (IQR 28-51) and 52.4% were males. 12.5% were classified as white, 38 6% as African American, 34 6% as Hispanic, and 14 2% as other/unknown Of those admitted to the hospital (N=323), median values for liver markers were as follow: ALT 26 IU/L (IQR 18-45), AST 40 IU/L (IQR 27-63), total bilirubin 0 5mg/dl (IQR 0 3-0 6) and alkaline phosphatase 74 IU/L (IQR 59-100, Table) Only 2 6% and 3 7% of individuals without chronic liver disease presented with elevated ALT or AST, respectively, whereas 9 9% and 14 1% of those with chronic liver disease presented with elevated ALT or AST, respectively Men were more likely to have abnormal ALT and AST (p=0 002 and p=0 005 respectively) Hispanic ethnicity was associated with an elevated ALT on admission, OR 2 5 (95% CI 1 2-5 1) An elevated AST, but not ALT, on admission was associated with an increased OR of mortality, OR 4 2 (95% CI 1 4-12 1), this effect was present after adjusting for race Conclusion: Our findings suggest that elevated AST on admission, but not ALT, was associated with increased risk of mortality related to COVID-19 Overall, minimal hepatic injury was inflicted by COVID-19 in those without concurrent liver disease, regardless of race or ethnicity.