Association of liver abnormalities with in-hospital mortality in patients with COVID-19

Abstract

Background and Aims The evolution and clinical significance of abnormal liver chemistries and the impact of hepatitis B infection on outcome in patients with COVID-19 is not well characterized. This study aimed to explore these issues. Methods This large retrospective cohort study included 2073 patients with COVID-19 having definite outcomes in Wuhan, China. Longitudinal liver function tests were conducted and determined their associated factors and death risk by multivariate regression analyses. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. The characteristics of liver abnormalities and outcomes of patients with COVID-19 with and without hepatitis B were compared after 1:3 propensity score matching. Results Of the 2073 patients, 1282 (61.8%) had abnormal liver chemistries during hospitalization, and 297 (14.3%) had a liver injury. The mean levels of AST and D-Bil increased early after symptom onset in deceased patients and showed disparity compared with that in discharged patients throughout the clinical course of the disease. Abnormal admission AST (adjusted hazard ratio [HR]: 1.39, 95%CI: 1.04-1.86, P =0.027) and D-Bil (adjusted HR: 1.66, 95%CI: 1.22-2.26, P =0.001) levels were independent risk factors for mortality due to COVID-19. A nomogram was established based on the results of multivariate analysis and showed sufficient discriminatory power and good consistency between the prediction and the observation. HBV infection in patients did not increase the risk of COVID-19-associated poor outcomes. Conclusions Abnormal AST and D-Bil levels at admission were independent predictors of COVID-19 mortality. Therefore, monitoring liver chemistries, especially AST and D-Bil levels, in hospitalized patients with COVID-19, is necessary.

COVID-19 and liver disease: mechanistic and clinical perspectives

“…The prognostic significance of elevated liver enzymes in patients infected with SARS-CoV-2 is currently debated. Some reports have demonstrated that elevations of serum liver enzyme levels are associated with adverse outcomes, including shock, intensive care unit (ICU) admission and mechanical ventilation 43 , 65 , 71 – 74 . However, these studies could be prone to bias if patients with severe disease received more intensive laboratory monitoring, increasing the likelihood of detecting liver injury.…”

Cytokine Storm of COVID-19 and its Impact on Patients with and without Chronic Liver Disease

“…Therefore, it appears that the cytokine storm is one of the important defining fac- tors contributing to morbidity and mortality in those with liver disease. 54 A raised AST and direct bilirubin at baseline were independent predictors of COVID-19 mortality.…”

“…After propensity matching, the baseline and peak values of liver function tests, the trajectory of COVID-19 and severity of liver scores and outcomes are often equivalent in those with compensated cirrhosis. 54,55 In contrast, in decompensated liver disease, there is a marked risk of COVID-19-associated liver and coagulation failure. Particularly, studies have reported such events in patients with Child-Turcotte-Pugh B and C cirrhosis with increased decompensation events like ascites, coagulopathy, and hepatic encephalopathy and inhospital mortality.…”

Immunological and physiopathological approach of COVID-19 in pregnancy

“…Generally, on the basis of current data, many authors argue with weak evidence of a causal association between SARS-CoV-2 infection and obstetric complications, stating that further investigations are needed. Hypertension, kidney disease, thrombocytopenia or liver injury are frequently seen in moderate to severe COVID19 cases [ 205 , 206 , 210 , 211 ]. If they occur during pregnancy, patients could fulfill complete or incomplete clinical and/or laboratory PE or HELLP syndrome criteria [ 71 ].…”