Prevalence of elevated liver enzymes in patients with novel coronavirus disease (COVID-19) infection and their clinical characteristics and outcomes

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is an unprecedented global pandemic caused by the novel betacoronavirus SARS-CoV-2 Extrapulmonary clinical features such as abnormal liver enzymes are often present, and almost 50% of patients experienced different degrees of liver injury in studies from China However, the prevalence of elevated liver enzymes and the association with clinical outcomes in U S based cohorts have not been well studied Aims: 1 ) To assess the prevalence of elevated liver enzymes in patients with COVID-19 in a U S based cohort 2 ) To compare differences in clinical characteristics and outcomes in patients with and without elevated alanine aminotransferase (ALT) Methods: In this retrospective cohort study, we analyzed data from patients hospitalized at the Johns Hopkins Health System (JHHS) between February 1, 2020, and July 1, 2020, who tested positive for SARSCoV- 2. Identified COVID-19 patients were then stratified into two groups, those with elevated ALT (>35 U/L for men and > 25 U/L for women) at admission or subsequently and thosewith normal ALT Pearson's chi-squared test and analysis of variance and were used to compare variables between the two groups Clinical outcomes assessed included the need for mechanical ventilation or vasopressor support, hospital length of stay (LOS), and mortality Results: During the study period, 2293 patients with COVID-19 were hospitalized at JHHS The mean age was 60 (SD 17 7) years;52 5% were men 35 6% were black, 31 2% white, and 26 3% Hispanic 33 7% were obese;1479 (64 5%) had abnormal liver ALT values Compared to those with normal ALT, patients with elevated ALT were more likely to be non-white (72 3% vs 61 9%, p < 0 001), Hispanic (30 4% vs 18 5%, p < 0 001), obese (43 7% vs 34 2%, p < 0 001), and have underlying liver disease (7 1% vs 3 0%, p < 0 001) Those with elevated ALT more often required mechanical ventilation (23 7% vs 6 0%, p < 0 001) and vasopressor support (23 0% vs 7 2%, p < 0 001) The group with elevated ALT had a longer hospital LOS (11 0 vs 5 9 days, p < 0 001) However, there were no differences in mortality found between the two groups (13 8% vs 15 6%, p = 0 3) Conclusion: There was a high prevalence of elevated ALT among inpatients with COVID-19 (64 5%) The presence of elevated ALT was associated with adverse clinical outcomes, including the need for mechanical ventilation and vasopressor support and prolonged hospital LOS.