Presentation, patterns and predictive value of baseline liver tests on outcomes in COVID-19 patients without chronic liver disease

Table 3 Associations between liver chemistries and outcomes

	In-hospital mortality				In-hospital mortality or need for mechanical ventilation
	Unadjusted analysis-HR (95%CI)	P value	Adjusted analysis1-HR (95%CI)	P value	Unadjusted analysis-HR (95%CI)	P value	Adjusted analysis1-HR (95%CI)	P value
AST
Normal	Ref.		Ref.		Ref.		Ref.
> 1 to ≤ 4 × ULN	1.29 (1.17-1.42)	< 0.001	1.65 (1.47-1.85)	< 0.001	1.29 (1.13-1.46)	< 0.001	1.73 (1.47-2.04)	< 0.001
> 4 to ≤ 10 × ULN	1.66 (1.38-1.99)	< 0.001	1.69 (1.33-2.14)	< 0.001	1.67 (1.27-2.20)	< 0.001	2.09 (1.42-3.07)	< 0.001
> 10 × ULN	3.50 (2.56-4.78)	< 0.001	2.64 (1.73-4.04)	< 0.001	3.89 (2.48-6.10)	< 0.001	3.38 (1.78-6.40)	< 0.001
ALT
Normal	Ref.		Ref.		Ref.		Ref.
> 1 to ≤ 4 × ULN	0.84 (0.77-0.91)	< 0.001	1.21 (1.09-1.34)	< 0.001	0.72 (0.63-0.81)	< 0.001	1.20 (1.02-1.40)	0.02
> 4 to ≤ 10 × ULN	0.88 (0.71-1.09)	0.24	1.22 (0.93-1.61)	0.15	0.79 (0.57-1.09)	0.15	1.40 (0.87-2.26)	0.16
> 10 × ULN	1.71 (1.20-2.45)	0.003	1.34 (0.81-2.22)	0.26	1.42 (0.80-2.51)	0.23	1.36 (0.58-3.19)	0.48
Alkaline phosphatase
Normal	Ref.		Ref.		Ref.		Ref.
Elevated	1.27 (1.14-1.43)	< 0.001	1.29 (1.12-1.48)	< 0.001	1.19 (1.01-1.42)	0.04	1.39 (1.12-1.72)	0.003
Bilirubin
Normal	Ref.		Ref.		Ref.		Ref.
Elevated	1.55 (1.32-1.82)	< 0.001	1.12 (0.92-1.37)	0.27	1.69 (1.34-2.13)	< 0.001	0.96 (0.71-1.30)	0.79
AST:ALT ratio
≤ 1	Ref.		Ref.		Ref.		Ref.
> 1	2.08 (1.82-2.37)	< 0.001	1.72 (1.46-2.02)	< 0.001	2.61 (2.13-3.19)	< 0.001	1.84 (1.41-2.40)	< 0.001
Pattern of liver injury2
Normal or non-severe	Ref.		Ref.		Ref.		Ref.
Hepatocellular	0.93 (0.80-1.09)	0.39	0.90 (0.74-1.11)	0.33	0.84 (0.66-1.07)	0.15	1.18 (0.85-1.65)	0.33
Mixed	1.14 (0.74-1.75)	0.56	1.06 (0.65-1.73)	0.82	1.00 (0.52-1.93)	0.99	1.02 (0.44-2.37)	0.96
Cholestatic	1.17 (0.85-1.61)	0.33	1.57 (1.07-2.28)	0.02	1.25 (0.81-1.93)	0.31	2.05 (1.17-3.58)	0.01

¹Adjusted for age (time-varying), sex (time-varying), race (time-varying), ethnicity, and comorbidities (obesity, hypertension, diabetes, coronary artery disease, chronic kidney disease, end-stage renal disease, chronic obstructive pulmonary disease, heart failure, and cancer).

²Defined as: Normal or non-severe [alanine aminotransferase (ALT) ≤ 3 × ULN and alkaline phosphatase ≤ 2 × upper limit of normal (ULN)], hepatocellular (ALT > 3 × ULN and alkaline phosphatase ≤ 2 × ULN), mixed (ALT > 3 × ULN and alkaline phosphatase > 2 × ULN), and cholestatic (ALT ≤ 3 × ULN and alkaline phosphatase > 2 × ULN).

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CI: Confidence interval; HR: Hazard ratio; ULN: Upper limit of normal.