Prevalence of abnormal liver biochemistry and its impact on COVID-19 patients’ outcomes: a single-center Greek study

Evagelos Cholongitas; Triada Bali; Vasiliki E. Georgakopoulou; Alexios Giannakodimos; Argyrios Gyftopoulos; Vasiliki Georgilaki; Dimitrios Gerogiannis; Dimitrios Basoulis; Eirini Iliadi; Georgios Karamanakos; Konstantinos Mimidis; Nikolaos V. Sipsas; Michael Samarkos

Authors Evagelos Cholongitas, Triada Bali, Vasiliki E. Georgakopoulou, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Konstantinos Mimidis, Nikolaos V. Sipsas, Michael Samarkos.

Abstract

Background Abnormalities in aminotransferases are frequently observed in hospitalized COVID-19 patients, but their clinical impact is poorly characterized.

Methods A total of 1046 patients hospitalized to the non-intensive care unit ward with documented COVID-19 were included retrospectively. Demographic, clinical and laboratory characteristics on admission and during hospital stay, including the presence of liver injury (LI), defined as aspartate aminotransferase (AST) >200 IU/L, were recorded.

Results On admission, 363 (34.7%) and 269 (25.7%) patients had abnormal AST and ALT values (i.e., >40 IU/L), respectively, while during hospitalization 53 (5%) patients fulfilled the criteria for LI. In multivariate logistic regression analysis, AST (odds ratio [OR] 1.023, 95% confidence interval [CI] 1.016-1.029; P<0.001), and ferritin (OR 1.01, 95%CI 1.001-1.02; P<0.001) were the baseline factors independently associated with the development of LI during hospital stay. One hundred twenty-three (11.7%) patients died during hospitalization. The independent variables associated with mortality were: age (hazard ratio [HR] 1.043, 95%CI 1.029-1.056; <0.001),
ferritin (HR 1.1, 95%CI 1.05-1.2; P<0.001), platelets (HR 0.996, 95%CI 0.994-0.999; P=0.003), and administration of remdesivir (HR 0.50, 95%CI 0.30-0.85; P=0.009). The patients with abnormal baseline AST (i.e., >40 IU/L), compared to those with normal AST values, had worse outcomes (log rank test: 8.8, P=0.003).

Conclusions Elevated aminotransferases are commonly seen in COVID-19 patients. They possibly reflect disease severity and may be associated with in-hospital mortality.

Keywords COVID-19, liver injury, liver function tests, disease severity, mortality

Ann Gastroenterol 2022; 35 (3): 290-296