Hepatocellular injury and the mortality risk among patients with COVID-19: A retrospective cohort study

Abstract

BACKGROUND Clearly, infection with severe acute respiratory syndrome coronavirus 2 is not limited to the lung but also affects other organs. We need predictive models to determine patients’ prognoses and to improve health care resource allocation during the coronavirus disease 2019 (COVID-19) pandemic. While treating COVID-19, we observed differential outcome prediction weights for markers of hepatocellular injury among hospitalized patients. AIM To investigate the association between hepatocellular injury and all-cause in-hospital mortality among patients with COVID-19. METHODS This multicentre study employed a retrospective cohort design. All adult patients admitted to Al-Azhar University Hospital, Assiut, Egypt and Abo Teeg General Hospital, Assiut, Egypt with confirmed COVID-19 from June 1, 2020, to July 30, 2020 were eligible. We categorized our cohort into three groups of (1) patients with COVID-19 presenting normal aminotransferase levels; (2) patients with COVID-19 presenting one-fold higher aminotransferase levels; and (3) patients with COVID-19 presenting two-fold higher aminotransferase levels. We analysed the association between elevated aminotransferase levels and all-cause in-hospital mortality. The survival analysis was performed using the Kaplan–Meier method and tested by log-rank analysis. RESULTS In total, 376 of 419 patients met the inclusion criteria, while 29 (8%) patients in our cohort died during the hospital stay. The median age was 40 years (range: 28-56 years), and 51% were males ( n = 194). At admission, 54% of the study cohort had liver injury. The pattern of liver injury was hepatocellular injury with an aspartate aminotransferase (AST) predominance. Admission AST levels were independently associated with all-cause in-hospital mortality in the logistic regression analysis. A one-fold increase in serum AST levels among patients with COVID-19 led to an eleven-fold increase in in-hospital mortality ( P < 0.001). Admission AST levels correlated with C-reactive protein ( r = 0.2; P < 0.003) and serum ferritin ( r = 0.2; P < 0.0002) levels. Admission alanine aminotransferase levels correlated with serum ferritin levels ( r = 0.1; P < 0.04). Serum total bilirubin levels were independently associated with in-hospital mortality in the binary logistic regression analysis after adjusting for age and sex but lost its statistical significance in the fully adjusted model. Serum ferritin levels were significantly associated with in-hospital mortality ( P < 0.01). The probability of survival was significantly different between the AST groups and showed the following order: a two-fold increase in AST levels > a one-fold increase in in AST levels > normal AST l...

Aspartate transferase-to-platelet ratio index-plus: A new simplified model for predicting the risk of mortality among patients with COVID-19

“…We observed a significant difference in AST between survivors and nonsurvivors at hospital admission. The AST-dominant pattern of hepatocellular injury among patients with COVID-19 has been reported many times in previous studies[ 6 , 7 ]. Likewise, the levels of serum ferritin were significantly higher among nonsurvivors.…”

“…Previously, many reports have cited hepatocellular injury with an aspartate aminotransferase (AST)-dominant pattern at hospital admission[ 6 , 7 ]. In addition, it has been demonstrated that AST elevation at admission is associated with severe COVID-19 disease status and poor outcomes, including intensive care admission, need for mechanical ventilation[ 7 ], and all-cause in-hospital mortality[ 6 ]. It has also been reported that elevated serum ferritin on admission is associated with fatal outcomes in patients with COVID-19[ 8 , 9 ].…”

COVID-19 and liver disease: Are we missing something?

“…We read with great interest the article by “Madian et al [ 1 ]”. Limited data is available for hepatic injury in coronavirus disease 2019 (COVID-19) disease.…”

COVID-19 associated liver injury: A general review with special consideration of pregnancy and obstetric outcomes

“…For example, the numeric value for serum AST has been incorporated in clinical calculators created to predict progression from mild or moderate to severe COVID-19 disease[ 57 ]. Moreover, elevated AST has been found to be independently associated with increased risk of death, apart from other markers of hepatic dysfunction[ 29 , 34 , 50 , 58 , 59 ]. In a study including 206 patients across 26 institutions in Brazil, AST level greater than twice the upper limit of normal significantly increased the risk of in-hospital mortality when adjusted for age and biologic sex[ 29 ].…”