Objectives: Initial reports indicate a high incidence of abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with COVID-19 and possible association with acute kidney injury (AKI). We aimed to investigate clinical features of elevated transaminases on admission, its association with AKI, and outcomes in patients with COVID-19. Methods: A retrospective analysis of the registered data of hospitalized patients with laboratory-confirmed COVID-19 and assessment of the AST and ALT was performed. Multinomial logistic regression was used to determine factors associated with community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI). Results: The subjects comprised 828 patients (mean age = 65.0±16.0 years; 51.4% male). Hypertension was present in 70.3% of patients, diabetes mellitus in 26.0%, and chronic kidney disease in 8.5%. In-hospital mortality was 21.0%. At admission, only 41.5% of patients had hypertransaminasemia. Patients with elevated transaminases at admission were younger, had higher levels of inflammatory markers and D-dimer, and poorer outcomes. The AKI incidence in the study population was 27.1%. Patients with hypertransaminasemia were more likely to develop AKI (33.5% vs. 23.3%, p =0.003). Patients with predominantly elevated AST (compared to elevated ALT) were more likely to have adverse outcomes. Multinomial logistic regression found that hypertension, chronic kidney disease, elevated AST, and hematuria were associated with CA-AKI. Meanwhile, age > 65 years, hypertension, malignancy, elevated AST, and hematuria were predictors of HA-AKI. Conclusions: Elevated transaminases on admission were associated with AKI and poor outcomes. Patients with elevated AST were more likely to have adverse outcomes. Elevated AST on admission was associated with CA-AKI and was a predictor of HA-AKI.

AKI is common among patients hospitalized with COVID-19 and is associated with severity of disease and adverse outcomes in this population. Applying preventative measures against the development of acute kidney injury could improve prognosis.

Background and Aims Initial reports indicate a high incidence of abnormal liver tests and acute kidney injury (AKI) in the novel coronavirus infection (COVID-19). However, outcomes in hospitalized patients with COVID-19 and elevated aspartate transaminase (AST) and alanine transaminase (ALT) levels at admission and their associations with AKI are not well understood. The aim of the study was to investigate the incidence of cytolysis at admission and its contribution to the development of AKI, severity of COVID-19 and outcomes. Method A retrospective analysis of the register of patients hospitalized with COVID-19 was performed (n=481). COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical computer tomography (CT) picture. We excluded patients with previously known liver disease, re-hospitalization, acute surgical pathology, single serum creatinine measurement during hospitalization. Abnormality in aminotransferases was defined as ALT and/or AST >40 U/L. Definition of AKI was based on KDIGO criteria. P value <0.05 was considered statistically significant. Results 462 patients were included (50.4% males, mean age 63±16 years, mean Charlson index 3±2.4, 67% with hypertension, 48% with obesity, 25% with diabetes mellitus). 26,4% (122) of patients were hospitalized in the intensive care unit (ICU), 71,3% (87) of them were treated with mechanical ventilation. The median length of stay was 11 [9;15] days, in the ICU – 4 [2;9] days. 20% (92) of patients died. At admission 43% (200) of the patients had abnormal level of aminotransferases. Elevated AST was more common than ALT, (39% (178) vs 29% (132)). The median levels of AST and ALT at admission were 54.5[44;72] and 45.9[34;66] U/L in the group with cytolysis and 26[19;33] and 19[11;27] U/L in the group without it, respectively. The AKI incidence in the register was 24.8%. The 1st stage of AKI was observed in the majority of the patients (46% - 1st stage, 36% - 2nd stage, 18% - 3rd stage. Patients in ICU compared to non-ICU patients more often had AKI (50% vs 13%, p<0.001). In-hospital mortality was significantly higher in the group with AKI (54% vs 10% for patients with and without AKI development, respectively, p<0.001). Groups with and without aminotransferases elevation were similar in age, gender, presence of comorbidities, coagulation status, statins and frequency of antibiotic intake before admission. Increase in AST and/or ALT levels at admission showed no association with AKI severity. The higher incidence of elevated ALT or/and AST was observed in ICU compared with non-ICU patients (59% vs 37%, p<0.001). Patients with elevation of aminotransferases at admission compared to patients without it had more severe lung injury by CT scan (22.4% vs 18.6%, with 50-75% lung injury; 5.5% vs 0.4% with 75-90% lung injury, p=0.008 for the trend), higher ferritin (598[404;715] vs 391[189;587] µkg/l, p=0.03) and serum creatinine levels (91[78;118] vs 86[74;109] µmol/l, p=0.008), higher rate of AKI development (29% vs 18%, p=0.005) and in-hospital mortality (26% vs 15,4%, p=0.005). Elevated ALT and/or AST at admission were the independent predictors for the development of AKI (OR 1.87 95%CI 1.17-2.92, p=0.005) and in-hospital mortality (OR 1.89 95%CI 1.17-3.08, p=0.006). Conclusion Syndrome of cytolysis is common among hospitalized patients with COVID-19. Development of AKI and disease severity were associated with elevated levels of aminotransferases at admission, and are predictors for AKI development and in-hospital mortality in this population.

Objective: Initial reports indicate a high incidence of acute kidney injury(AKI) in the novel coronavirus infection (COVID-19). Hypertension(HTN) frequently coexists with COVID-19 and may be a possible risk factor for AKI. The aim of the study was to investigate the contribution of HTN for the AKI development in patients hospitalized with COVID-19. Design and method: A retrospective analysis of the register of patients with COVID-19 was performed. COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical CT picture. AKI definition was based on KDIGO criteria. P value < 0.05 was considered statistically significant. Results: The register included 721 patients(49.6% male, age 64 ± 15.7 years, HTN in 66%, controlled in 80%, obesity in 50.8%, diabetes mellitus(DM) in 24.2%, chronic kidney disease(CKD) in 6%). The median length of stay was 11[9;15] days, in the ICU – 4[2;9] days. 18.9% of patients died. Mean blood pressure at admission was 130 ± 17/80 ± 11 mmHg in the hypertensive group. 40.3% of patients received angiotensin-converting enzyme inhibitors(ACEi) or angiotensin II-receptors blockers(ARBs) regularly before admission. In 79% therapy was continued, in 21% - withdrawn. The AKI incidence in the register was 27.2%, in hypertensive patients– 30.1%. ACEi /ARBs intake wasn‘t associated with AKI. Hypertensive patients compared to normotensives were older (69 ± 12vs50 ± 15, p < 0.0001), more often had DM (31.7%vs10%, p < 0.0001), CKD (8%vs2%, p = 0.01). History of HTN was associated with higher mortality (23.6%vs10.7%, p = 0.001). HTN incidence was higher in patients with AKI (80%vs61%, p < 0.0001) and HTN was a risk factor for AKI development (OR 2.45, 95% CI 1.49–4.13, p = 0.0002). Hypertensive patients with AKI compared to patients without AKI had longer duration of hospitalization (13 ± 7vs12 ± 6 days, p = 0.003), were more likely to be treated with mechanical ventilation (50%vs13%, p < 0.0001), more often were in the ICU (46.5%vs16.4%, p < 0.001 and had higher in-hospital mortality (48%vs9.7%, respectively, p < 0.0001).The AKI development and history of HTN were predictors of mortality: OR 8.90 (95%CI 5.7–13.78, p < 0.0001) and OR 2.58 (95%CI 1.46–4.75, p = 0.0006), respectively. Conclusions: AKI is common among patients hospitalized with COVID-19 and is associated with the presence of HTN. HTN and AKI development are the significant predictors of in-hospital mortality in this population.