ABSTRACT
PURPOSE AND BACKGROUND: COVID-19 has changed the course of civilization, bringing mankind to its knees. To date, there have been over 200,000 deaths related to COVID-19 in the United States. Recent medical literature has suggested that certain comorbidities increase mortality among COVID-19 patients. Our study aims to analyze the association between acute liver failure (ALF) and mortality in patients infected with COVID-19. MATERIAL AND METHODS: A retrospective analysis of 864 COVID-19 infected patients admitted to Nassau University Medical Center in New York between March 13th, 2020 and May 13th, 2020 was performed. The primary outcome of interest was mortality. Logistic regression analysis controlling for confounding variables was used to determine the association of acute liver failure with mortality. ALF is identified by acute liver injury (shown by elevations in liver enzymes), hepatic encephalopathy, and an international normalized ratio (INR) greater than or equal to 1.5. These parameters were analyzed via daily blood work and clinical assessment. RESULTS: A total of 624 patients infected with COVID-19 met the inclusion criteria. Of those 624, 43 (6.9%) patients developed ALF during the course of their hospitalization and their mortality rate was 74.4%. The majority of the patients with ALF were male, which constituted 60% of the ALF group. Multivariate logistic regression model predicting mortality and controlling for age, CAD, Intubation, HTN, and DM was performed to determine the association of ALF with mortality. Our study showed that patients infected with COVID-19 who progressed to ALF had a 4-fold higher odds of death relative to those who did not have ALF (95% CI: 1.63 - 10.02;p-value 0.0028). CONCLUSION: Our study suggests that patients who developed ALF after being infected with COVID-19 had a 4-fold higher risk of death than those infected with COVID-19 who did not have ALF, controlling for age, CAD, Intubation, HTN, and DM. A potential limitation to this study may be the relatively small sample size and missing lab values used to determine ALF, which further reduced the size of the dataset. A greater sample size would clearly increase the power of the study and aid in assessing outcomes in patients infected with COVID-19 and ALF. (Table presented.)
ABSTRACT
PURPOSE AND BACKGROUND: The novel coronavirus (COVID-19) threatened the existence of mankind in its debut in the year 2019. Although primarily affecting the pulmonary system, patients infected with COVID-19 displayed widespread systemic insult. A majority of patients exhibited hepatic injury throughout their course of infection. In this study we investigate the use of N-acetylcysteine (NAC) in patients hospitalized due to COVID-19 with acute hepatitis and its effect on overall outcomes. MATERIAL AND METHODS: A retrospective analysis of medical records was performed on 864 patients hospitalized with COVID-19 infection from March 13th, 2020 to May 13th, 2020 at Nassau University Medical Center in New York. The primary outcome of interest was mortality. Logistic regression analysis controlling for confounding variables was used to determine the association of NAC and mortality in patients infected with COVID-19. The review included patients with acute hepatitis demonstrated by alanine aminotransferase (ALT) and aspartate aminotransferase (AST) greater than 120 U/L (3 times the upper level of normal) during their hospitalization. Patients received NAC in the form of oral, intravenous (IV), or both. Statistical analysis was performed to assess all-cause mortality within these three groups who received NAC and to those who did not receive NAC. RESULTS: A total of 138 patients were included in this study. Among them, 114 received oral NAC, 15 received IV, and 9 received both. Multivariate logistic regression model predicting mortality and controlling for age, CAD, Intubation, HTN, and DM was performed to determine the association of NAC and mortality. This study showed a statistically significant (p-value < 0.05) decrease in all-cause mortality in patients who received oral NAC when compared to those who received IV NAC or both. Furthermore, this study also indicated that patients who did not receive any form of NAC had a statistically significant (p-value < 0.05) increased risk of all-cause mortality compared to those who received any form of NAC. CONCLUSION: This study suggests that patients with acute hepatitis who received NAC had decreased mortality when compared to patients who did not receive NAC. Oral NAC was associated with the lowest risk of all-cause mortality amongst patients who received NAC as IV or both. In addition, patients with acute hepatitis who received any form of NAC had overall decreased all-cause mortality as compared to patients who did not receive NAC. A potential limitation to this study may be the relatively small sample size and missing lab values used to determine the effectiveness of NAC, which further reduced the size of the dataset. A greater sample size would increase the power of the study and aid in assessing outcomes in patients infected with COVID-19.