Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19?

Abstract

Introduction The most dreaded pandemic grappling world now, the Coronavirus Disease 2019 (COVID-19), chiefly involves the respiratory system; nevertheless, it is a multisystem disorder. Its involvement of the hepatic system is considerable; however, still emerging are its clinical implications and effects on morbidity and mortality. The aim of this study is to report on the various aspects of its hepatic involvement by describing the alterations in tests of liver function and its significance in the disease outcome in a cohort of hospitalized COVID-19 patients at a tertiary centre in northern India. Methods This is a retrospective cohort study conducted in a tertiary-care hospital in northern India. All confirmed hospitalized COVID-19 cases aged 15 and above from Apr till Oct 2020 with no pre-existing liver disease were included. The primary endpoint was death at 28 days. Statistical analysis included descriptive analysis, sensitivity-specificity, and univariable and multivariable regression analysis as well as survival analysis. Results A total of 708 COVID-19 patients fulfilled the inclusion criteria included 561 (79.2%) males and 147 (20.8%) females. The median age was 49 (IQR=25) years. Mild and moderate/severe disease were seen in 508 (71.8%) and 200 (28.2) patients respectively. Serum bilirubin, Aspartate-aminotransferase (AST) and Alanine-aminotransferase (ALT) were elevated in 6.92%, 69.91% and 80.22% of patients respectively. In univariable logistic regression, AST [odds ratio; OR 1.008 95% CI (1.005-1.012) per 1 IU/L increase] and ALT [OR 1.005 95% CI (1.002-1.007) per 1 IU/L increase] were significantly associated with the odds of moderate-to-severe disease but only AST was significant after adjustment to age, sex, and comorbidity [adjusted odds ratio; aOR 1.007 95% CI (1.003-1.011) per 1IU/L increase]. Serum albumin was negatively associated with the odds of moderate to severe disease and remained significant in the adjusted model [aOR 0.217 95%CI (0.149-0.316) per 1g/dL increase]. Ninety-six patients succumbed to illness [case fatality rate; CFR 13.6%). In adjusted Cox Proportional-Hazards Model for mortality, AST [adjusted hazard ratio; aHR 1.002 95% CI (1.000-1.003) per 1 IU/L increase] and serum albumin [aHR 0.396 95% CI (0.285-0.549) per 1g/dL increase] showed significant association with mortality. Conclusion Liver function abnormalities are common in COVID 19 patients. In particular, AST and serum albumin levels are effective predictors of disease severity and mortality and can be used as markers of fatal disease in the management as well as prognostication of COVID-19.

Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre

“…Despite many studies that have confirmed male gender as being associated with more severe COVID-19 and a higher rate of death [23,[45][46][47], our study found no association between male gender and outcomes; older age (>65 years) was associated with death similar to other reports [41,48]. Our findings are consistent with data reporting that underlying diseases are more likely to affect COVID-19 severity than liver damage [39,42,49].…”

Decision tree analysis as predictor tool for in-hospital mortality in critical SARS-CoV-2 infected patients

“…Our results are in line with results found in the specialized literature, a recent meta-analysis including 32 initial studies revealed that elevated AST activity is associated with almost three times higher mortality risk in patients with COVID-19, results validated in 18 of the 32 studies, including a total of 6383 patients [27]. A recent article, based on a retrospective study assessing the hepatic involvement in CO-VID-19 severe evolution, evaluated patients without prior hepatic pathology and revealed that both increased AST and hypoalbuminemia were independent predictors for disease severity and mortality in COVID-19 patients [28]. Moreover, AST value on hospital admission was a good mortality predictor for COVID-19 patients [29].…”

SARS-CoV-2 induced liver injury: Incidence, risk factors, impact on COVID-19 severity and prognosis in different population groups

“…The timing of LFT determination during disease course, different definitions, but mostly, the geographical variability in the prevalence of underlying diseases are the determinants for the observed discrepancies[ 18 ]. With respect to worldwide published data the overall prevalence of abnormal LFTs ranges from 2.5% to 96.8% (Table 2 ), while SLI accounts for 4.94%-21.8% of COVID-19 patients[ 7 , 20 , 22 , 23 , 38 , 80 , 180 ]. Patients with SLI are younger and more likely to be male[ 23 ].…”