S1088 Impact of Liver Injury in COVID-19 Patients: Single Center Retrospective Cohort Study

Abstract

INTRODUCTION: Patients with COVID-19 infection may be at risk for liver injury, but the mechanism, and clinical significance of injury remains unclear. Proposed mechanisms include direct virus-induced insults, immune-mediated damage (due to excessive inflammatory response), and drug-induced injury. This study evaluates the impact of liver insults on the hospital outcome of COVID-19 patients admitted to a suburban New York safety-net hospital. METHODS: In our retrospective unmatched single-center study, we identified the first 639 confirmed COVID-19 patients (age≥18 years) who were admitted to our facility from March 2020 to May 2020. Elevated liver-related enzymes (ALT >40 U/L, AST >40 U/L, or ALP >120) were used to stratify patients with or without liver injury. The primary outcome was all-cause in-hospital mortality; other in-patient outcomes including cardiac arrest, ARDS, arrhythmia, shock, and intubation rate were measured. Chi-square tests and independent T-sample tests were used to analyze categorical and continuous variables, respectively. Multivariate logistic regression analyses were performed to measure the odds of in-patient mortality and other outcomes. All statistical analyses were performed using SPSS. RESULTS: Out of the total 639 COVID-19 patients, 476 (74.5%) [Mean age 58.89 ± 15.61, 63.0% male] had evidence of liver injury. COVID-19 liver injury cohorts had statistically significant higher rates of all cause in-patient mortality (35.5% vs 22.7%; OR 2.84; 95% CI 1.71–4.71 P-value = 0.003). COVID-19 liver injury was observed more often in our Hispanic patient population (38.2%).Other meaningful in-patient outcomes such as cardiac arrest (26.1% vs 14.1%; OR 2.65; 95% CI 1.52–4.59, P-value = 0.002), requirement of intubation (30% vs 14.7%; OR 2.87; 95% CI 1.70–4.85; P-value< 0.001), ARDS (43.1% vs 30.7%; OR 1.89; 95% CI 1.23–2.91; P-value = 0.005), arrhythmia (5.2% vs 0.6%; OR 3.16; 95% CI 0.95–10.33; P-value = 0.035) and shock (15% vs 2.8%; OR 2.06; 95% CI 1.15–3.70; P-value = 0.009) were observed more commonly in COVID-19 patients with evidence of liver injury. CONCLUSION: COVID-19 patients with liver injury demonstrated nearly a three times higher risk of in-patient mortality and other poor hospitalization outcomes. Hispanic patients appeared particularly vulnerable to liver injury and poor outcome.Table 1.: Baseline Characteristics of COVID-19 Hospitalizations with vs. without liver injuryTable 2.: Hospitalization outcomes among patients with COVID-19 and liver injury