Higher Mortality and Intensive Care Unit Admissions in COVID-19 Patients with Liver Enzyme Elevations.

Lucia Taramasso,Laura Magnasco,Emanuele Delfino,Andrea De Maria,Sara Mora,Chiara Dentone,Matteo Bassetti,Antonio Di Biagio,Francesca Bovis,Federica Portunato,Mauro Giacomini,Malgorzata Mikulska,Antonio Vena,Daniele Roberto Giacobbe

doi:10.3390/microorganisms8122010

Lucia Taramasso, Laura Magnasco + Show 12 more

Open Access

https://doi.org/10.3390/microorganisms8122010

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Abstract

The aim of the present study is to evaluate if an independent association exists between liver enzyme elevations (LEE) and the risk of mortality or intensive care unit (ICU) admissions in patients with COVID-19. This was a single-center observational study, recruiting all consecutive adults with COVID-19. The elevation of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) to the highest level between COVID-19 diagnosis and hospital discharge was categorized according to a standardized toxicity grade scale. In total, 799 patients were included in this study, 39% of which were female, with a mean age of 69.9 (±16.0) years. Of these patients, 225 (28.1%) developed LEE of grade ≥2 after a median of three days (interquartile range (IQR): 0–8 days) from the diagnosis of COVID-19, and they were estimated to have a higher hazard of death or ICU admission (adjusted hazard ratio (aHR): 1.46, 95% confidence interval (CI): 1.14–1.88). The clinical and laboratory variables associated with the development of LEE were male sex, higher respiratory rate, higher gamma glutamyl transpeptidase (GGT) and lower albumin levels at baseline. Among the analyzed treatments, steroids, tocilizumab and darunavir/ritonavir correlated with LEE. In conclusion, LEE were associated with mortality and ICU admission among COVID-19 patients. While the origin of LEE is probably multifactorial, LEE evaluation could add information to the clinical and laboratory variables that are commonly evaluated during the course of COVID-19.

Highlights

In last few months, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the etiological agent of COVID-19, has caused an increasing number of respiratory illness worldwide [1,2]
We confirmed that liver enzyme elevation (LEE) were associated with mortality and intensive care unit (ICU) admission among COVID-19 patients in a large cohort of European patients
We found that even low-grade LEE were associated with these outcomes, and that the association became stronger for higher levels of LEE, with grade 4 LEE predicting the risk of death

Summary

Introduction

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the etiological agent of COVID-19, has caused an increasing number of respiratory illness worldwide [1,2]. It has become evident that patients with COVID-19 did experience respiratory illness, and immunologic dysregulation [3] and heart [4], kidney [5] and liver [6,7] involvement in a systemic disease involving multiple organs. In this context, it has been a common experience to deal with patients with abnormal liver enzyme levels, as it is estimated that about 46% of hospitalized COVID-19 patients have elevated plasma aspartate aminotransferase (AST) and 35% have elevated alanine aminotransferase (ALT) levels already at the time of hospital admission [8]. The secondary aim was to identify the clinical, therapeutic and laboratory factors independently associated with LEE

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