ABSTRACT
Background: COVID-19 pandemic has ravaged the world with more than 1 million cases, and 56,000 deaths as of early May 2020 The cytokine storm in COVID-19 is associated with multiorgan failure in critically ill patients COVID-19 induced transaminitis was associated with worse mortality outcomes based on the reported data from China We sought to analyze the temporal relationship of COVID-19 induced liver injury and its effect on mortality among the US population from Elmhurst Hospital, the reported epicenter of Queens, New York Methods: We conducted a retrospective study on all patients who presented to the ER with COVID-19 symptoms at our institute from March 2020 The included population had confirmed COVID-19 infection by nasopharyngeal RT-PCR swab General demographic information, labs, imaging, and survival data were collected Statistical analysis was performed using STATA software V 16 Results: 146 patients were analyzed of which 56 patients were excluded from analysis due to missing data 90 patients were included in the analysis Mean age 56 ± 15 years(CI 95%)(Males: n=77, 85 5%;Females: n=13, 14 4%) The most common comorbidity was diabetes mellitus II The most common gastrointestinal symptom was diarrhea (n=18;20%) The baseline demographic, comorbidities, vitals, and presentations are shown in table 1 Patients with higher AST more than 1-3 times the upper normal limits have a higher odds of death (OR=1 01 95% CI: 1 00-1 03;p-value=<0 05) On further analysis, AST levels between 40- 120 IU/ml compared to normal aminotransferase levels have higher odds of dying on the multivariate logistic regression model ( OR=6 31 95% CI: 1 70-23 43, p-value=0 0059) The mortality rate was noted to be even higher in patients with higher levels of AST, between 120 - 360 IU/ml, compared to normal aminotransferase (OR=8 50, 95% CI: 1 257-57 49, p-value=0 02) The cumulative odds of death among patients with any transaminitis was also statistically significant for high risk of death (OR= 1 06, p-value= 0 001) Furthermore, normal liver synthetic function with an albumin level 3-5 g/ dL are associated with favorable outcomes and are more likely to be discharged from the hospital (OR=0 04 95% CI: 0 004-0 45;p-value=<0 05) Subgroup analysis of albumin level in COVID-19 patients, albumin levels ranging from (3-5 g/dL) are 15 times higher odds of recovery/discharge from the hospital as compared to patients with albumin levels of (0-3 g/dL) [OR: 15 95, 95% CI: 3 90-65 5, P-value=0 0001] Association of mortality with ALT, T Bili, and INR was statistically non-significant in both univariate and multivariate models The results are shown in Table 2 Conclusion: COVID-19 induced liver injury is associated with higher mortality outcome especially with increasing odds of higher AST A normal hepatic synthetic function is a good indicator of hospital recovery specifically in patients with an albumin level of 3-5 g/dL(Table Presented).