Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2022; 28(5): 570-587
Published online Feb 7, 2022. doi: 10.3748/wjg.v28.i5.570
Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients
Arunkumar Krishnan, Laura Prichett, Xueting Tao, Saleh A Alqahtani, James P Hamilton, Esteban Mezey, Alexandra T Strauss, Ahyoung Kim, James J Potter, Po-Hung Chen, Tinsay A Woreta
Arunkumar Krishnan, Saleh A Alqahtani, James P Hamilton, Esteban Mezey, Alexandra T Strauss, Ahyoung Kim, James J Potter, Po-Hung Chen, Tinsay A Woreta, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Laura Prichett, Xueting Tao, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Saleh A Alqahtani, Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh 12713, Saudi Arabia
Author contributions: Krishnan A and Woreta TA conceptualized and designed the research; Woreta TA supervised the project; Prichett L and Tao XT performed the formal analysis; Krishnan A performed interpretation of data and writing the original draft; Krishnan A, Woreta TA, Alqahtani SA, Hamilton JP, Mezey E and Chen PH performed the review and editing of the draft; All authors revised the manuscript for important intellectual content; All authors approved the final version of the article, including the authorship list
Institutional review board statement: This study was approved by the Institutional Review Board (IRB00249001) of the Johns Hopkins University School of Medicine.
Informed consent statement: Informed consent was waived for a retrospective review of patient charts.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tinsay A Woreta, MD, Assistant Professor, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Hal 407, Baltimore, MD 21287, United States. tworeta1@jhmi.edu
Received: May 17, 2021
Peer-review started: May 17, 2021
First decision: July 14, 2021
Revised: July 21, 2021
Accepted: January 20, 2022
Article in press: January 20, 2022
Published online: February 7, 2022
Processing time: 252 Days and 15.2 Hours
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.

Keywords: Severe acute respiratory syndrome coronavirus 2; Liver injury; Liver tests; Aspartate aminotransferase; Alanine aminotransferase; bilirubin

Core Tip: Severe acute respiratory syndrome coronavirus-2 primarily infects the respiratory system. However, increasing evidence exists for the direct multiorgan effect. Liver injury in hospitalized patients is associated with a poor prognosis. We investigated whether abnormal liver chemistries in Coronavirus Disease 2019 (COVID-19) hospitalized patients can be of prognostic value. We show that abnormal liver chemistries were commonly observed on hospital admission and are associated with worse outcomes in COVID-19 patients, namely mortality, the need for vasopressor drugs, and mechanical ventilation. In hospitalized COVID-19 patients, elevated liver chemistries, specifically alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin levels, can be used to stratify risk and predict the need for advanced therapies. These results strongly suggest that abnormal liver chemistries at the time of hospital admission are associated with worse outcomes in COVID-19 patients and should be closely followed in admitted patients.