Abstract
Background and Aim: The impact of liver function test (LFTs) abnormality on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains controversial. The aim of this study was to assess the impact of abnormal LFTs on clinical outcomes in a large cohort of hospitalized patients with COVID-19.Methods: We retrospectively collected data on 2,912 consecutive patients with COVID-19 who were admitted to a makeshift hospital in China between 5 February and 23 March 2020. The association between LFTs abnormalities (baseline and peak values) and clinical outcomes was measured by using Cox regression models.Results: On admission 1,414 patients (48.6%) had abnormal LFTs, with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) elevation in 662 (22.7%), 221 (7.6%), 52 (1.8%), 135 (4.6%), and 536 (18.5%) patients, respectively, and hypoalbuminemia in 737 (25.3%) patients. During a median 13 (IQR: 8–19) days of hospitalization, 61 patients (2.1%) died, 106 patients (3.6%) admitted to intensive care unit (ICU), and 75 patients (2.6%) required mechanical ventilation. After adjustment for confounders, baseline abnormal LFTs were independently associated with increased risks of mortality (adjusted HR 3.66, 95%CI 1.64–8.19, p = 0.002), ICU admission (adjusted HR 3.12 95%CI 1.86–5.23, p < 0.001), and mechanical ventilation (adjusted HR 3.00, 95%CI 1.63–5.52, p < 0.001), which was homogeneous across the severity of COVID-19 infection. Among the parameters of LTFs, the associations with the outcomes were more pronounced for AST and albumin abnormality. In contrast, ALT elevation was not significantly associated with those outcomes. Similar results were observed for peak values of LFTs during hospitalization.Conclusions: Abnormality of AST, albumin, TBIL, ALP, and GGT but not ALT were independently associated with adverse outcomes.
Highlights
The current coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has become a serious threat to global public health [1,2,3,4]
After adjustment for confounders, baseline abnormal liver function tests (LFTs) were independently associated with increased risks of mortality, intensive care unit (ICU) admission, and mechanical ventilation, which was homogeneous across the severity of COVID-19 infection
Among the parameters of LTFs, the associations with the outcomes were more pronounced for aspartate aminotransferase (AST) and albumin abnormality
Summary
The current coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has become a serious threat to global public health [1,2,3,4]. The clinical relevance of LFTs abnormalities remains controversial, with some studies suggesting its association with the severity of COVID-19 pneumonia and adverse outcomes, while others not. Most of those reports were small-sized and the parameters of LFTs, the diagnostic time point (i.e., on admission or during disease progression) and cut-off values of abnormal LFTs varies among studies [28, 29]. Due to LFTs were categorized in almost all previous studies, the actual relationship between the LFTs and outcomes (liner, dose-response, threshold/saturation effect pattern, or others) remains unknown It is yet unclear whether the effect of LFTs on the outcomes equal or differ among patients with different severity of COVID-19 infection. The aim of this study was to assess the impact of abnormal LFTs on clinical outcomes in a large cohort of hospitalized patients with COVID-19
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