ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is an unprecedented global pandemic caused by the novel betacoronavirus SARS-CoV-2 Extrapulmonary clinical features such as abnormal liver enzymes are often present, and almost 50% of patients experienced different degrees of liver injury in studies from China However, the prevalence of elevated liver enzymes and the association with clinical outcomes in U S based cohorts have not been well studied Aims: 1 ) To assess the prevalence of elevated liver enzymes in patients with COVID-19 in a U S based cohort 2 ) To compare differences in clinical characteristics and outcomes in patients with and without elevated alanine aminotransferase (ALT) Methods: In this retrospective cohort study, we analyzed data from patients hospitalized at the Johns Hopkins Health System (JHHS) between February 1, 2020, and July 1, 2020, who tested positive for SARSCoV- 2. Identified COVID-19 patients were then stratified into two groups, those with elevated ALT (>35 U/L for men and > 25 U/L for women) at admission or subsequently and thosewith normal ALT Pearson's chi-squared test and analysis of variance and were used to compare variables between the two groups Clinical outcomes assessed included the need for mechanical ventilation or vasopressor support, hospital length of stay (LOS), and mortality Results: During the study period, 2293 patients with COVID-19 were hospitalized at JHHS The mean age was 60 (SD 17 7) years;52 5% were men 35 6% were black, 31 2% white, and 26 3% Hispanic 33 7% were obese;1479 (64 5%) had abnormal liver ALT values Compared to those with normal ALT, patients with elevated ALT were more likely to be non-white (72 3% vs 61 9%, p < 0 001), Hispanic (30 4% vs 18 5%, p < 0 001), obese (43 7% vs 34 2%, p < 0 001), and have underlying liver disease (7 1% vs 3 0%, p < 0 001) Those with elevated ALT more often required mechanical ventilation (23 7% vs 6 0%, p < 0 001) and vasopressor support (23 0% vs 7 2%, p < 0 001) The group with elevated ALT had a longer hospital LOS (11 0 vs 5 9 days, p < 0 001) However, there were no differences in mortality found between the two groups (13 8% vs 15 6%, p = 0 3) Conclusion: There was a high prevalence of elevated ALT among inpatients with COVID-19 (64 5%) The presence of elevated ALT was associated with adverse clinical outcomes, including the need for mechanical ventilation and vasopressor support and prolonged hospital LOS.
ABSTRACT
Background: Patients with coronavirus disease 2019 (COVID-19) often present with various degrees of liver injury Thus, patients with pre-existing chronic liver disease (LD) may be at increased risk of complications from COVID-19, but this has not yet been well characterized Aim: To examine the impact of pre-existing LD on outcomes in patients with COVID-19 Methods: In this retrospective cohort study, we analyzed data from COVID-19 patients hospitalized at the Johns Hopkins Health System between February 1, 2020, and July 1, 2020, who tested positive for COVID-19 Identified patients were then stratified into two groups based on the presence or absence of pre-existing LD The LD group consisted of patients with a diagnosis of pre-existing liver disease at the time of diagnosis of COVID-19 We studied outcomes, including the need for hemodialysis or vasopressor support, hospital length of stay (LOS), and in-hospital mortality We described categorical data as percentages, and continuous data as mean with standard error (SD) We used Pearson's chi-squared tests and analysis of variance to compare variables between the patients with and without LD Results: In a study of 2,293 patients with laboratoryconfirmed COVID-19, 129 (17.8%) patients had pre-existing LD Among them, 32 (24 8%) patients had cirrhosis;18 (14 0%) had non-alcoholic fatty liver disease;20 (15 5%) had chronic hepatitis C;5 (3 87%) had chronic hepatitis B, and 5 (3 87%) were liver transplant recipients Patients with LD were more often black (41 9%) compared to patients with no preexisting LD (35 1%, p = 0 029) LD patients had substantially higher prevalence of comorbidities, including hypertension (79 9% vs 61%, p < 0 001), diabetes (27 9% vs 15 6%, p < 0 001), chronic pulmonary disease (31 0% vs 18 4%, p < 0 0001), and anemia (43 4% vs 22%, p < 0 001) Those with LD required hemodialysis more often (10% vs 4 4%, p = 0 015) There was no difference in need for vasopressor support (20 0% vs 18 8%, p = 0 12) The hospital LOS was similar between the groups (9 5 vs 9 6 days) There was no difference in mortality between the two groups (10 0% vs 14 6%, p = 0 14) Conclusion: Patients with pre-existing LD and COVID-19 infection were more likely black, have underlying comorbidities and require hemodialysis However, they had similar hospital LOS and mortality as those without LD. These findings have important implications for patients with LD but require further validation.