Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2021; 27(42): 7350-7361
Published online Nov 14, 2021. doi: 10.3748/wjg.v27.i42.7350
Presentation, patterns and predictive value of baseline liver tests on outcomes in COVID-19 patients without chronic liver disease
David Bernstein, Nitzan Roth, Angela Kim, Marcia Epstein, David Hirschwerk, Charlotte L Kvasnovsky, Sanjaya K Satapathy
David Bernstein, Nitzan Roth, Sanjaya K Satapathy, Department of Medicine/Hepatology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
Angela Kim, Marcia Epstein, David Hirschwerk, Division of Infectious Diseases, Department of Medicine Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
Charlotte L Kvasnovsky, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States
Author contributions: Bernstein D, Roth N, and Satapathy SK developed the concept for the manuscript; Bernstein D wrote the manuscript; Kvasnovsky CL performed the statistical analysis; Kim A, Epstein M, and Hirschwerk D reviewed the literature; Bernstein D, Satapathy S, Roth N, Kim A, Epstein M, Hirschwerk D, and Kvasnovsky CL reviewed and edited the manuscript.
Supported by National Institute on Aging of the National Institute of Health, No. R24AG06419; National Library of Medicine of the National Institutes of Health, No. R01LM012836.
Institutional review board statement: This study protocol was approved by the Northwell Health Institutional Review Board.
Informed consent statement: Informed consent statement was waived.
Conflict-of-interest statement: The authors declare no conflicts of interest related to the content of the manuscript.
Data sharing statement: The data that support the findings of this study are available on request from The data are not publicly available due to restrictions as it could compromise the privacy of research participants.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: David Bernstein, FAASLD, MACG, MD, Professor, Department of Medicine/Hepatology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 400 Community Drive, Manhasset, NY 11030, United States.
Received: January 30, 2021
Peer-review started: January 30, 2021
First decision: June 4, 2021
Revised: July 12, 2021
Accepted: October 24, 2021
Article in press: October 24, 2021
Published online: November 14, 2021

Coronavirus disease 2019 (COVID-19) infection is known to cause abnormal hepatic enzymes. The long term consequences of such elevations are uncertain.


To assessed the prevalence and prognostic value of initial liver enzymes in a large cohort of COVID-19 patients.


We reviewed electronic medical records of 10614 COVID-19 patients without known chronic liver disease who were admitted to our health system from March 1, 2020, to April 30, 2020. We analyzed baseline demographics and liver chemistries. The primary outcome was in-hospital mortality, and the secondary outcome was a composite of in-hospital mortality or need for mechanical ventilation.


Subjects with abnormal liver tests had increased risks of mortality and composite outcome when compared to patients with normal measurements on unadjusted analysis and after adjustment for demographic factors.


In our diverse patient population, liver enzyme abnormalities are associated with increased mortality and the need for mechanical ventilation in subjects without chronic liver disease. Cholestasis patients are at the greatest risk for poor outcomes.

Keywords: COVID-19, Liver enzymes, Outcomes, Predictors

Core Tip: We believe that our paper is an important contribution to the literature for the following reasons: (1) The cohort size is the largest to date; (2) We show the importance of initial liver tests in predicting outcomes; (3) In this large cohort, the finding of initial cholestatic pattern of injury being most predictive of poor outcome has not yet been described; and (4) This is a cohort from a large urban health system in the United States (New York) whose subject demographics reflect more the population seen in the United States. The other publications listed below are more uniform populations not representative of what our practitioners see in daily practice