Background and Aims Liver enzyme abnormalities in coronavirus 2019 (COVID-19) are being addressed in the literature. The predictive risk of elevated liver enzymes has not been established for COVID-19 mortality. In this study, we hypothesized that elevated liver enzymes at admission can predict the outcome of COVID-19 disease with other known indicators, such as comorbidities. Methods This retrospective study included all the consecutive hospitalized patients with confirmed COVID-19 disease from March 4 th to May 31 st , 2020. The study was conducted in Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. We assessed demography, clinical variables, COVID-19 severity, laboratory parameters, and outcome. Results We included 1,512 patients, and median age was 47 years (interquartile range: 34–60) with 36.9% being female. Liver enzyme level (aspartate aminotransferase and/or alanine aminotransferase) was elevated in 450/1,512 (29.76%) patients. Comorbidity was present in 713/1,512 (47.16%) patients. Patients with liver enzymes’ elevation and presence of comorbidity were older, more frequently hospitalized in ICU and had more severe symptoms of COVID-19 at the time of admission. Presence of liver enzymes’ elevation with comorbidity was a high risk factor for death (OR: 5.314, 95% CI: 2.278–12.393), as compared to patients with presence of comorbidity (OR: 4.096, 95% CI: 1.833–9.157). Conclusions Comorbidity combined with liver enzymes’ elevation at presentation independently increased the risk of death in COVID-19 by at least 5-fold.

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42), and epigastric pain (SMD: -1.23; 95% CI: -1.66--0.29). No serious adverse events were reported. Conclusions Modified Zhi Zhu Decoction and Xiao Pi Kuan Wei Decoction may be considered as an alternative for patients unresponsive to prokinetics. Confirmatory head-tohead trials should be conducted to investigate their comparative effectiveness against prokinetics.

Hepatocellular carcinoma with tumor thrombus extending to hepatic vein, inferior vena cava (IVC), and right atrium is rare and considered to be fairly advanced with a poor prognosis. We report two such cases from a single tertiary care center in South India. Treatment options in such patients are limited as the disease is extensive. We conducted a literature search for such case reports on PubMed. Compared with published literature, one of our cases had hepatic vein, IVC, left renal vein with tumor thrombus in the right atrium which has not been reported so far. Both the patients were started on systemic chemotherapy but succumbed to illness 4 and 7 weeks after initiation of chemotherapy.