IS TRANSAMINITIS AN INDEPENDENT RISK FACTOR FOR ALL-CAUSE MORTALITY IN COVID-19?

ABSTRACT

Background Elevated transaminases (AST, ALT) have been seen with COVID-19, especially in severely sick patients. It is unclear whether SARS-CoV-2 directly causes hepatic injury. Other reasons can be hepatotoxic drugs (tocilizumab, remdesivir), sepsis, cytokine induced damage and hypoxic liver injury. Liver histopathology reports have shown macrovesicular steatosis, mild acute hepatitis, mild portal inflammation and sinusoidal microthrombi. Viral RNA using PCR of liver tissue was identified in 55% of patients in a study. Association of transaminitis with all-cause mortality in COVID-19 needs further research. Methods In this single center study, adult patients with confirmed SARS-CoV-2 infection by nasopharyngeal RT-PCR who were hospitalized from March 1st to August 20, 2020, were included. Data were manually extracted using the hospital electronic medical record retrospectively after IRB approval. Patients were divided into two cohorts survivors (n=182) and non survivors (n=41). Categorical variables were compared by conducting a chi-square test or Fisher's exact test while continuous ones were compared by conducting a median two-sample test. Multivariate logistic regression analysis was done including age, gender, baseline and peak transaminases (AST, ALT). Statistical analysis was done with SAS software. Missing values were adjusted using f variance. Results A total of 223 patients were included in the study. Of 233 patients, 182 were discharged alive from the hospital and 41 were non survivors. Median liver function tests (AST, ALT, ALP, Albumin, INR) and inflammatory markers (LDH, CRP, Ferritin, D-dimer) on admission and peak values during hospitalization are presented in table-1. It showed that LDH value varied significantly between two cohorts similar to ferritin and D-dimer. Treatment options like remdisivir and tocilizumab were used more commonly in cohort 2 which could have led to higher peak ALT and AST during hospitalization, however, there was no statistical significance. Further, multivariate analysis (adjusted for age and sex) showed that higher ALT and AST on admission was not associated with higher odds of all cause mortality in hospitalized COVID-19 patients. Conclusion Our data revealed that transaminitis (elevation in ALT and AST) on admission is not an independent risk factor for all cause mortality in COVID-19. (Table presented.)