ASPARTATE AMINOTRANSFERASE, AGE AND D-DIMER IN COVID-19 PATIENTS: A USEFUL PROGNOSTIC MODEL

Introduction: Some patients with SARSCov-2 infection develop severe disease (SARS);however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. Aim: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods Type of study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS+MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Results: 166 patients were included, 114(68.7%) men, mean age 50.6±13.3 years-old, 27(16.3%) developed SARS+MV. In the comparative analysis between those with SARS+MV versus stable patients without MV we found significant raises of ALT (225.4±341.2 vs. 41.3±41.1;P=0.003), AST 325.3±382.4 vs. 52.8±47.1;P=0.001), LDH (764.6±401.9 vs. 461.0±185.6;P=0.001), D dimer (7765±9109 vs. 1871±4146;P=0.003), age (58.6±12.7 vs. 49.1±12.8;P=0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS+MV;with these variables was constructed the model called AAD, where: [AAD= 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value ≤ 2.75 had sensitivity=0.797 and 1-specificity= 0.391, AUROC=0.74 (95%CI: 0.62-0.86;P<0.0001), to predict the risk of developing SARS+MV (OR=5.8, 95%CI: 2.2-15.4;P=0.001). Conclusions: Elevation of AST (probable marker of liver damage) is an important predictor of progression to SARS, together with elevation of D-dimer and age early (at admission) and efficiently predict which patients will potentially require MV.

Aspartate aminotransferase as predictor of severity in SARSCoV-2 infection: linear regression model

Background and aim: Some patients with SARSCov-2 infection develop severe disease (SARS);however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. AIM: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods. Type of Study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS + MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Result(s): 166 patients were included, 114(68.7%) men, mean age 50.6 +/- 13.3 years-old, 27(16.3%) developed SARS + MV. In the comparative analysis between those with SARS + MV versus stable patients without MV we found significant raises of ALT (225.4 +/- 341.2 vs. 41.3 +/- 41.1;P = 0.003), AST 325.3 +/- 382.4 vs. 52.8 +/- 47.1;P = 0.001), LDH (764.6 +/- 401.9 vs. 461.0 +/- 185.6;P = 0.001), D dimer (7765 +/- 9109 vs. 1871 +/- 4146;P = 0.003), age (58.6 +/- 12.7 vs. 49.1 +/- 12.8;P = 0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS + MV;with these variables was constructed the model called AAD, where: [AAD = 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value = 2.75 had sensitivity = 0.797 and 1-specificity = 0.391, AUROC = 0.74 (95%CI: 0.62-0.86;P 0.0001), to predict the risk of developing SARS + MV (OR = 5.8, 95%CI: 2.2-15.4;P = 0.001). Conclusion(s): Elevation of AST (probable marker of liver damage) is an important predictor of progression to SARS, together with elevation of D-dimer and age early (at admission) and efficiently predict which patients will potentially require MV. Conflicts of interest: The authors have no conflicts of interest to declare. [Formula presented] [Formula presented] Copyright © 2020

Impact of liver enzymes on SARSCoV-2 infection and on the severity of clinical disease

Background and aim: SARSCov-2 infection, currently responsible virus for the pandemic, can have a multi-organic impact, recent studies show that liver injury could be a manifestation of the disease, and liver disease could also be related to a worst prognosis. AIM: To compare the characteristics of patients with severe COVID-19 due to SARSCov-2 disease requiring intubation versus stable patients. Methods. Type of Study: Observational, a case-control, nested in a cohort study. Procedure: Complete medical records of patients admitted for COVID-19 at a third level center were reviewed. Clinical and biochemical data were collected and then characteristics between seriously ill patients who required intubation were compared versus stable patients without mechanical ventilation. Result(s): We included 166 patients with COVID-19 due to SARSCov-2 infection, 114(68.7%) were men, mean age was 50.6 +/- 13.3 years old, 27(16.3%) were assessed as seriously ill patients requiring intubation for SARS. The comparative analysis between those who required intubation versus those who remained without requiring intubation showed significant elevation of ALT, AST, LDH and D-dimer, also older age, see Table. Conclusion(s): This is the first study in a Mexican cohort, which demonstrate that seriously ill patients have significant raises of liver enzymes (AST, ALT) with prognostic implications in the SARSCov-2 disease course. Conflicts of interest: The authors have no conflicts of interest to declare.Copyright © 2020