Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients.

Frane Paštrović ,Marko Zelenika,Mislav Barisic Jaman,Dominik Kralj,Vlatko Grabovac,Neven Ljubičić ,Lucija Jukić ,Armin Atić ,Josip Stojić ,Ivica Lukšić ,Tajana Filipec Kanižaj ,Marko Lucijanić ,Barbara Medić ,Bruno Baršić ,Mate Majerović ,Jasminka Peršec ,Željko Krznarić ,Maja Mijić ,Marko Milošević ,Rajko Ostojić ,Dora Grgić ,Tatjana Kereš ,Nevenka Piskač Živković ,Krešimir Luetić ,Ida Tješić Drinković ,Jelena Vučak Lončar ,Ivan Lerotić ,Ivica Grgurević

doi:10.3390/jcm10184222

Abstract

Background: Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. Methods: Consecutive patients with COVID-19 hospitalized in the regional referral center over the 12-month period were included. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. Results: Derangement of LBT occurred in 2854/3812 (74.9%) of patients, most frequently due to elevation of AST (61.6%), GGT (46.1%) and ALT (33.4%). Elevated AST, ALT, GGT and low albumin were associated with more severe disease at admission. However, in multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only AST remained associated with the risk of dying (HR 1.5081 and 2.1315, for elevations 1–3 × ULN and >3 × ULN, respectively) independently of comorbidity burden and COVID-19 severity at admission. Patients with more severe liver injury more frequently experienced defined adverse outcomes. Conclusions: Deranged LBTs are common among patients hospitalized with COVID-19 and might be used as predictors of adverse clinical outcomes.

Highlights

Coronavirus disease 2019 (COVID-19) is a multisystemic disease, with pandemic features [1]
Obesity was defined as body mass index (BMI) > 30 kg/m2
We further investigated associations of liver blood tests (LBT) with 30-day mortality using the time to event survival analyses stratified by the degree of derangement from normal values

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is a multisystemic disease, with pandemic features [1]. The clinical picture is characterized by respiratory symptoms of various severity, including the development of pneumonia and respiratory failure with the need for oxygen supplementation, and these patients require hospital admission. In some previous reports deranged liver blood tests (LBT) were associated with more severe forms of COVID-19 and adverse clinical outcomes, not all the authors came to the same conclusion [10,11,12,13,14]. Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. In multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only

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