Retrospective Cohort Study
Copyright ©The Author(s) 2021.
World J Gastroenterol. Nov 14, 2021; 27(42): 7350-7361
Published online Nov 14, 2021. doi: 10.3748/wjg.v27.i42.7350
Table 1 Baseline characteristics of the study population (n = 10614)
Demographics

Sex
Male6243 (58.8%)
Female4371 (41.2%)
Race
White4037 (38.0%)
Black2248 (21.2%)
Asian914 (8.6%)
Other/multiracial2942 (27.7%)
Unknown473 (4.5%)
Ethnicity
Non-Hispanic or Latino or other/unknown8338 (78.6%)
Hispanic or Latino2276 (21.4%)
Age (yr)65 (54-77)
Body mass index (kg/m2)128.3 (24.9-32.6)
< 305120 (61.4%)
≥ 303220 (38.6%)
Presence of co-morbid conditions
Hypertension6204 (58.5%)
Diabetes mellitus3764 (35.5%)
Coronary artery disease1328 (12.5%)
Heart failure832 (7.8%)
Malignancy791 (7.5%)
Chronic obstructive pulmonary disease608 (5.7%)
Chronic kidney disease (stage I-IV)391 (3.7%)
End-stage renal disease434 (4.1%)
Liver chemistries (within 24 h)
AST (IU/L)146 (31-72)
Normal4377 (41.3%)
> 1 to ≤ 4 × ULN5713 (53.8%)
> 4 to ≤ 10 × ULN437 (4.1%)
> 10 × ULN85 (0.8%)
ALT (IU/L)33 (21-56)
Normal4883 (46.0%)
> 1 to ≤ 4 × ULN5159 (48.6%)
> 4 to ≤ 10 × ULN484 (4.6%)
> 10 × ULN88(0.8%)
Alkaline phosphatase (IU/L)175 (59-98)
Normal9242 (87.1%)
> 1 to ≤ 4 × ULN1333 (12.6%)
> 4 to ≤ 10 × ULN35(0.3%)
> 10 × ULN2 (0.02%)
Bilirubin (mg/dL)10.5 (0.4-0.7)
Normal10119 (95.4%)
> 1 to ≤ 4 × ULN486 (4.6%)
> 4 to ≤ 10 × ULN5 (0.05%)
> 10 × ULN3 (0.03%)
Table 2 Correlations between baseline liver chemistry elevations and demographic characteristics of the study population

Elevated ALP
P value
Elevated AST
P value
Elevated ALT
P value
Elevated Bilirubin
P value
Sex0.001< 0.0010.34< 0.001
Female619 (14.2%)2191 (50.1%)2336 (53.4%)124 (2.8%)
Male751 (12.0%)4044 (64.8%)3395 (54.4%)370 (5.9%)
Race< 0.001< 0.001< 0.0010.51
Asian134 (14.7%)613 (67.1%)533 (58.3%)43 (4.7%)
Black228 (10.1%)1332 (59.3%)1146 (51.0%)117 (5.2%)
Other/multiracial468 (15.9%)1845 (62.7%)1836 (62.4%)139 (4.7%)
Unknown74 (15.6%)300 (63.4%)304 (64.3%)17 (3.6%)
White466 (11.6%)2145 (53.2%)1912 (47.4%)178 (4.4%)
Ethnicity < 0.001< 0.001< 0.0010.51
Hispanic or Latino398 (17.5%)1410 (62.0%)1450 (63.7%)97 (4.3%)
Non-Hispanic or Latino864 (11.3%)4384 (57.3%)3852 (50.4%)361 (4.7%)
Unknown or other108 (15.7%)441 (64.0%)429 (62.3%)36 (5.2%)
BMI (kg/m2) < 0.0010.08< 0.001< 0.001
< 30730 (14.3%)2996 (58.5%)2694 (52.6%)269 (5.3%)
≥ 30336 (10.5%)1946 (60.4%)1885 (58.5%)111 (3.5%)
Diabetes mellitus0.03< 0.001< 0.001< 0.001
No920 (13.4%)1158 (60.7%)3897 (56.9%)356 (5.2%)
Yes450 (12.0%)2077 (55.2%)1834 (48.7%)138 (3.7%)
Hypertension< 0.001< 0.001< 0.0010.36
No642 (14.6%)2683 (60.9%)2649 (60.1%)215 (4.9%)
Yes728 (11.7%)3552 (57.3%)3082 (49.7%)279 (4.5%)
Coronary artery disease0.690.006< 0.0010.09
No1194 (12.9%)5501 (59.3%)5184 (55.8%)420 (4.5%)
Yes176 (13.3%)734 (55.3%)547 (41.2%)74 (5.6%)
Congestive heart failure< 0.001< 0.001< 0.001< 0.001
No1223 (12.5%)5811 (59.4%)5419 (55.4%)432 (4.4%)
Yes147 (17.7%)424 (51.0%)312 (37.5%)62 (7.5%)
COPD0.24< 0.001< 0.0010.46
No1301 (13.0%)5939 (59.4%)5504 (55.0%)462 (4.6%)
Yes69 (11.4%)296 (48.7%)227 (37.3%)32 (5.3%)
CKD (stage I-IV) 0.820.001< 0.0010.59
No1321 (12.9%)6036 (59.1%)5582 (54.6%)478 (4.7%)
Yes49 (12.5%)199 (50.9%)149 (38.1%)16 (4.1%)
End-stage renal disease < 0.001< 0.001< 0.0010.09
No1265 (12.4%)6044 (59.4%)5621 (55.2%)481 (4.7%)
Yes105 (24.2%)191 (44.0%)110 (25.4%)13 (3.0%)
Malignancy0.58< 0.001< 0.0010.049
No1273 (13.0%)5827 (59.3%)5380 (54.8%)446 (4.5%)
Yes97 (12.3%)408 (51.7%)351 (44.4%)48 (6.1%)
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
NormalRef.Ref.Ref.Ref.
> 1 to ≤ 4 × ULN1.29 (1.17-1.42)< 0.0011.65 (1.47-1.85)< 0.0011.29 (1.13-1.46)< 0.0011.73 (1.47-2.04)< 0.001
> 4 to ≤ 10 × ULN1.66 (1.38-1.99)< 0.0011.69 (1.33-2.14)< 0.0011.67 (1.27-2.20)< 0.0012.09 (1.42-3.07)< 0.001
> 10 × ULN3.50 (2.56-4.78)< 0.0012.64 (1.73-4.04)< 0.0013.89 (2.48-6.10)< 0.0013.38 (1.78-6.40)< 0.001
ALT
NormalRef.Ref.Ref.Ref.
> 1 to ≤ 4 × ULN0.84 (0.77-0.91)< 0.0011.21 (1.09-1.34)< 0.0010.72 (0.63-0.81)< 0.0011.20 (1.02-1.40)0.02
> 4 to ≤ 10 × ULN0.88 (0.71-1.09)0.241.22 (0.93-1.61)0.150.79 (0.57-1.09)0.151.40 (0.87-2.26)0.16
> 10 × ULN1.71 (1.20-2.45)0.0031.34 (0.81-2.22)0.261.42 (0.80-2.51)0.231.36 (0.58-3.19)0.48
Alkaline phosphatase
NormalRef.Ref.Ref.Ref.
Elevated1.27 (1.14-1.43)< 0.0011.29 (1.12-1.48)< 0.0011.19 (1.01-1.42)0.041.39 (1.12-1.72)0.003
Bilirubin
NormalRef.Ref.Ref.Ref.
Elevated1.55 (1.32-1.82)< 0.0011.12 (0.92-1.37)0.271.69 (1.34-2.13)< 0.0010.96 (0.71-1.30)0.79
AST:ALT ratio
≤ 1Ref.Ref.Ref.Ref.
> 12.08 (1.82-2.37)< 0.0011.72 (1.46-2.02)< 0.0012.61 (2.13-3.19)< 0.0011.84 (1.41-2.40)< 0.001
Pattern of liver injury2
Normal or non-severe Ref.Ref.Ref.Ref.
Hepatocellular0.93 (0.80-1.09)0.390.90 (0.74-1.11)0.330.84 (0.66-1.07)0.151.18 (0.85-1.65)0.33
Mixed1.14 (0.74-1.75)0.561.06 (0.65-1.73)0.821.00 (0.52-1.93)0.991.02 (0.44-2.37)0.96
Cholestatic1.17 (0.85-1.61)0.331.57 (1.07-2.28)0.021.25 (0.81-1.93)0.312.05 (1.17-3.58)0.01