Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients

Abstract

Background: Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. Methods: Consecutive patients with COVID-19 hospitalized in the regional referral center over the 12-month period were included. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. Results: Derangement of LBT occurred in 2854/3812 (74.9%) of patients, most frequently due to elevation of AST (61.6%), GGT (46.1%) and ALT (33.4%). Elevated AST, ALT, GGT and low albumin were associated with more severe disease at admission. However, in multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only AST remained associated with the risk of dying (HR 1.5081 and 2.1315, for elevations 1–3 × ULN and >3 × ULN, respectively) independently of comorbidity burden and COVID-19 severity at admission. Patients with more severe liver injury more frequently experienced defined adverse outcomes. Conclusions: Deranged LBTs are common among patients hospitalized with COVID-19 and might be used as predictors of adverse clinical outcomes.

Prevalence of abnormal liver biochemistry and its impact on COVID-19 patients’ outcomes: a single-center Greek study

“…However, at baseline, only 1% and 0.2% of the patients had LI (i.e., AST>200 IU/L) or AST >400 IU/L, respectively. Thus, in accordance with previous studies [ 10 , 14 , 15 ], we confirmed that liver biochemistry abnormalities in COVID-19 patients are usually mild and predominantly hepatocellular, while AST values are more frequently abnormal than ALT. Nevertheless, no indication for liver dysfunction was observed, since no severe abnormalities in INR were recorded (range 0.7-1.3 in patients not receiving anticoagulants).…”

“…In our study we found that baseline AST was associated with poor survival, but this was not confirmed in multivariate analysis. In previous studies [ 7 , 14 , 21 ], abnormal liver biochemical tests have been related with severe course and poor outcome in patients admitted with SARS-CoV-2 infection, reflecting the prognostic impact of liver test abnormalities in this clinical setting. Nevertheless, in our cohort, the patients with abnormal baseline AST (i.e., >40 IU/L) had worse outcomes compared to those with normal AST values (log rank test: chi square: 8.8, P=0.003) ( Fig.…”

Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients

“…Both parameters are produced in the liver and regulated by IL‑6 promoted inflammation [ 8 ], although CRP is positively affected and albumin negatively affected by this process. These parameters are thus commonly deranged among other liver blood tests during the COVID-19 infection [ 9 ]. The CRP to albumin ratio (CAR) incorporates deviations of these parameters into a single direction and has been shown to be prognostic of more severe disease and higher mortality if elevated in COVID-19 patients [ 10 – 13 ].…”

Novel Biomarker-Based Score (Sad-60) for Predicting Mortality in Patients with Covid-19 Pneumonia: A Multicenter Retrospective Cohort of 1013 Patients

“…Recent studies have confirmed that these biomarkers provide substantive information about clinical deterioration and the risk of mortality [ 25 , 26 , 38–40 ]. In addition, some studies revealed the role of albumin in COVID-19 prognostication reflecting both possible liver damage, inflammation and the nutritional status of patients [ 41 , 42 ].…”