Liver injury in COVID-19: prevalence and association with patient-centered outcomes- an analysis of the international severe acute respiratory and emerging infection consortium (ISARIC) database

Abstract

Background and Aim: Extrapulmonary manifestations are common in COVID-19 and elevations in components of liver function tests have been reported. Multiple mechanisms may contribute to these derangements. Using a large clinical dataset, we evaluated the prevalence and severity of derangements in liver function tests and their association with patient-centered outcomes. Methods: Using information available on the International Severe Acute Respiratory and emerging Infection Consortium database, we included patients with laboratory confirmed or suspected SARS-COV2 infection admitted to the hospital. The main exposure was the baseline liver function and main outcomes were hospital mortality, admission to an intensive care unit (ICU), receipt of oxygen therapy, non-invasive ventilation (NIV) or invasive ventilation, inotropes/vasopressors, renal replacement therapy, and the durations of hospital and ICU stay. We used generalized linear models to determine the association between exposure variables and outcomes. Results: From 708052 patients in the database, we included 17531 after excluding those with missing baseline information on liver function tests and outcomes. Nearly14% of patients had stage 2 liver injury at baseline and over 75% of the cohort had stage 3 liver injury. Stage 2 and 3 were associated with higher odds of mortality [ Stage 2- OR 1.82 (95%CI: 1.47-2.25) p value<0.001 and Stage 3- OR 1.50 (95%CI: 1.24-1.82) p value<0.001]. Stage 2 was also associated with higher odds of mechanical ventilation [ Stage 2- OR 1.6 (95%CI:1.34-2.06) p value<0.001] and a higher odds of ICU admission [ OR 1.13 (95%CI:0.95-1.35) p value=0.17]. For stage 3, this association with a higher probability of mechanical ventilation [OR 0.84 (95% CI:0.69-1.02) p value 0.08] and ICU admission [OR 0.24 (95% CI:0.21-0.28) p value<0.001)] was not observed. Conclusion: Liver function abnormalities are common among COVID-19 patients and are associated with worse clinical outcomes.