Liver Transaminase Levels and Neutrophil to Lymphocyte Ratio as Prognostic and Predictor in Coronavirus Disease 2019

Abstract

Introduction: COVID 19 was a disease caused by the SARS-CoV 2 virus with severe respiratory distress syndrome. SARS-CoV 2 can attack the gastrointestinal and liver system. In several studies, elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were reported, ranging from 14% to 53%. The increase of neutrophil to lymphocyte ratio (NLR) also increases the risk of mortality in COVID 19. This research wants to study ALT, AST, and NLR as prognostic and predictor in COVID 19.
 Methods: A cross sectional retrospective study conducted on COVID 19 patients. The diagnostic criteria are based on the recommendations of the Indonesian Ministry of Health. The patient's blood was examined in a central laboratory at hospital. Data analysis were done using SPSS version 22. 
 Results: A total of 126 patients with COVID 19 were included in this study. There are 57 (45.2%) patients having abnormal liver test. There was a significant difference in the mean AST and NLR between COVID 19 patients with nonsurvival and survive outcome (82.91 ± 103.82 vs. 40.54 ± 33.59 U/L; p = 0.0001 and 7.42 ± 3.65 vs. 3.47 ± 2.41; p = 0.0001). High AST (≥34.5 U/L) and NLR (≥4.7) independently associated with nonsurvival outcome in COVID 19 patient with odds ratio (OR) 5.31 and 9.49 [1.89 – 14.95, 95% CI; p = 0.002 and 3.57 – 25.22, 95% CI; p = 0.0001].
 Conclusion: This study revealed that high AST and NLR at hospital admission was associated with high mortality risk in COVID 19 patients. Therefore, the AST and NLR can be a significant prognostic of outcome in COVID 19 patients.