Assessment of Liver Enzymes in Hospitalized Patients with COVID-19 and Its Relationship with Length of Stay, Recovery and Death

Background and Objective: In the epidemic of COVID-19, intensive care units usually bear a heavy burden due to overcrowding of patients who need hospitalization, which can be due to liver involvement in these patients. This study was conducted to assess the relationship between liver enzymes in COVID-19 patients and the need for hospitalization in the intensive care unit, as well as to investigate its relationship with the length of stay in the intensive care unit. Methods: In this analytical cross-sectional study, 622 hospitalized patients with COVID-19 who referred to Firoozgar Hospital were investigated in terms of length of stay, recovery or death and its relationship with abnormal liver enzymes. Findings: The mean level of AST and ALT in people hospitalized in ICU was 49 (95% CI: 43.4-54.6) and 29.2 (95% CI: 24.1-34.2), respectively, and it was 42.5 (95% CI: 36.7-48.3) and 31.2 (95% CI: 25.8-36.6), respectively, in the general ward. The mean level of AST and ALT in patients hospitalized for less than 7 days was 49.4 (95% CI: 43.9-54.8) and 27 (95% CI: 21.6-32.3), respectively, and in patients hospitalized for more than 7 days was 41.6 (95% CI: 35.6-47.5) and 32.2 (95% CI: 37.3-27.1), respectively. None of the abnormal data was significant based on hospital department and length of stay. Conclusion: The results of this study did not show any significant relationship between the need for admission to ICU and the abnormal levels of liver enzymes. Furthermore, no relationship was found between the length of stay and the severity of liver involvement based on the assessment of abnormal liver enzymes.

Liver enzymes and inpatient deaths in COVID-19 hospitalized patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [COVID-19] quickly turned into a pandemic. Gastrointestinal involvement, especially liver diseases, is one of the main complications of COVID-19 patients. Objectives: The current study aimed to evaluate the high incidence of liver involvement in COVID-19 hospitalized patients and its association with mortality. Methods: A total of 560 hospitalized patients with a confirmed diagnosis of COVID-19 were included. Death was considered as the outcome. In addition to liver enzymes, demographic, clinical, and other laboratory data were also collected. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels_ 40 were considered as abnormal. To investigate the association between abnormal levels of liver enzymes and death, multiple regression logistic was used. Results: According to the findings, 29.1% (95% CI = 25.3% - 32.9%) of patients had high levels (_ 40 IU) of ALT, and 45.1% (95% CI = 40.9% - 49.3%) had high levels of AST (_ 40 IU). The frequency (based on %) of high levels of AST (_ 40 U/liter) was significantly higher in patients who died [67.3% (95% CI = 54.5% - 80.1%] of COVID-19 than those who survived [44.9% (95% CI = 39.7% - 50.0%)] (Pvalue < 0.001). No significant difference was detected in ALT between expired [29.1% (95% CI = 16.7% - 41.5%)] and survived patients [30.7% (95% CI = 25.9% - 35.5%] (P-value = 0.791). AST was found to have an independent association with death in multiple logistic regression (Wald = 4.429, OR (95% CI) = 1.014 (1.008 - 1.020), P-value = 0.035). Conclusions: Liver involvement is a common finding in COVID-19 hospitalized patients. Higher levels of AST were significantly associated with an increased mortality rate in COVID-19 patients.