Transaminases are Potential Biomarkers of Disease Severity in COVID-19 Patients: A Single-Center Experience

Abstract

Background: Considering the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), the clinical implications of gastrointestinal (GI) and hepatic manifestations of coronavirus disease 2019 (COVID-19) in the U.S. population require analysis. Methods: We retrospectively reviewed all adult patients with COVID-19 admitted to our facility. Patients were divided into two groups based on the presence of GI symptoms and transaminitis at presentation. Univariable analysis was performed to assess the differences between study groups. Kruskal-Wallis and Pearson's chi-square tests were used to compare the median of continuous and categorical variables, respectively. Multivariate logistic regression analysis was performed to identify predictors of mechanical ventilation, cytokine release syndrome (CRS), and mortality after adjusting for baseline variables. Results: A total of 84 patients were analyzed. After adjusting for baseline comorbidities, presence of GI symptoms (aOR, adjusted odds ratio 4.2, 95% CI, 1.17-15.60, p=0.03) and transaminitis on admission (aOR 5.69, 95% CI, 1.47-21.99, p=0.01) were associated with CRS. Transaminitis on admission and elevated total bilirubin during hospitalization were associated with an increased need for mechanical ventilation (aOR 6.17, 95% CI, 1.49-25.44, p=0.02 and aOR 7.29, 95% CI, 1.73-30.75, p=0.007, respectively). An elevated aspartate aminotransferase (AST) on admission (aOR 13.41, 95% CI, 1.08-165.69, p=0.04) and elevated total bilirubin during hospitalization (aOR 82.68, 95% CI, 1.67-4074.8, p=0.02) were independently associated with an increased risk of mortality in COVID-19 patients. Conclusion: COVID-19 patients with transaminitis on admission had a higher risk of requiring mechanical ventilation and developing CRS. Patients with elevated AST on admission and elevated total bilirubin had higher mortality. Patients with GI symptoms did not have worse outcomes.

Are gastrointestinal symptoms associated with higher risk of Mortality in COVID-19 patients? A systematic review and meta-analysis

“…Therefore, we further reviewed the literatures in our analysis. Among the literatures that had data on the age of patients with/without GI symptoms, all of the European and American literatures (n = 8 of 8, 100%) [ 15 , 19 , 33 , 34 , 37 , 45 , 46 , 49 ] reported that patients with GI symptoms were younger than those without. And OR values were < 1 in 7 [ 15 , 19 , 33 , 34 , 37 , 46 , 49 ] of these 8 literatures.…”

“…Among the literatures that had data on the age of patients with/without GI symptoms, all of the European and American literatures (n = 8 of 8, 100%) [ 15 , 19 , 33 , 34 , 37 , 45 , 46 , 49 ] reported that patients with GI symptoms were younger than those without. And OR values were < 1 in 7 [ 15 , 19 , 33 , 34 , 37 , 46 , 49 ] of these 8 literatures. On the other hand, 7 [ 12 , 16 , 18 , 25 , 29 , 36 , 57 ] of 13 Asian studies [ 12 , 16 , 18 , 25 , 29 , 30 , 36 , 38 , 40 , 43 , 50 , 52 , 57 ] reported that patients with GI symptoms were older, and OR values were > 1 in 6[ 12 , 16 , 25 , 29 , 36 , 57 ] of these 7 studies.…”

Clinical Characteristics, Surgical Management And Outcomes Of Abdominal Pain Among SARS-COV-2 Infected Patients: A Chart Review

“…The studies summarized no significant difference in total bilirubin, AST, and ALT levels between patients with GI symptoms and those without COVID-19. [16,17] Furthermore, according to studies, the colon has similar ACE2 expression as the liver. The small intestine has a high level of expression than that in the liver, and the expression levels in the colon and small intestine vary Clinical Characteristics, Surgical Management And Outcomes Of Abdominal Pain Among SARS-COV-2 Infected Patients: A Chart Review compared to the liver and lung [18].…”

Diagnostic performance of lactate dehydrogenase (LDH) isoenzymes levels for the severity of COVID-19

“…Those with increased transaminase levels on admission are more likely to develop hypoxia or severe inflammation (21). Furthermore, patients with elevated liver enzyme levels on admission or follow-up have an increased risk of life-threatening complications, ICU admission and death (22,23). Some authors reported increased CK levels and suggested associations of its elevation with poor prognosis in the course of COVID-19 (2,24,25).…”

“…Furthermore, patients with elevated liver enzyme levels on admission or follow-up have an increased risk of life-threatening complications, ICU admission and death [20] [21] . Some authors reported increased CK levels and suggested associations of its elevation with poor prognosis in the course of COVID-19 [2] [22] [23] .…”