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Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients.
Krishnan, Arunkumar; Prichett, Laura; Tao, Xueting; Alqahtani, Saleh A; Hamilton, James P; Mezey, Esteban; Strauss, Alexandra T; Kim, Ahyoung; Potter, James J; Chen, Po-Hung; Woreta, Tinsay A.
  • Krishnan A; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Prichett L; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Tao X; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Alqahtani SA; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Hamilton JP; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Mezey E; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Strauss AT; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Kim A; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Potter JJ; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Chen PH; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
  • Woreta TA; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States. tworeta1@jhmi.edu.
World J Gastroenterol ; 28(5): 570-587, 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1674889
ABSTRACT

BACKGROUND:

Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019 (COVID-19). However, the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood.

AIM:

We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality.

METHODS:

This retrospective, observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System (Baltimore, MD, United States). Demographic data, clinical characteristics, laboratory findings, treatment measures, and outcome data were collected. Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis.

RESULTS:

A total of 2698 (70.4%) had abnormal alanine aminotransferase (ALT) at the time of admission. Other more prevalent abnormal liver chemistries were aspartate aminotransferase (AST) (44.4%), alkaline phosphatase (ALP) (16.1%), and total bilirubin (T-Bil) (5.9%). Factors associated with liver injury were older age, Asian ethnicity, other race, being overweight, and obesity. Higher ALT, AST, T-Bil, and ALP levels were more commonly associated with disease severity. Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization. Abnormal AST, T-Bil, and ALP were associated with a need for vasopressor drugs, whereas higher levels of AST, T-Bil, and a decreased albumin levels were associated with mechanical ventilation.

CONCLUSION:

Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient's severity and prognosis. Elevated liver chemistries, specifically ALT, AST, ALP, and T-Bil levels, can be used to stratify risk and predict the need for advanced therapies in these patients.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Liver Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: World J Gastroenterol Journal subject: Gastroenterology Year: 2022 Document Type: Article Affiliation country: Wjg.v28.i5.570

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Liver Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: World J Gastroenterol Journal subject: Gastroenterology Year: 2022 Document Type: Article Affiliation country: Wjg.v28.i5.570