S1098 Aspartate Aminotransferase Elevations Are Predictive of Outcomes in COVID-19 Infection in Patients Without Known Chronic Liver Disease

Abstract

INTRODUCTION: The novel coronavirus-19 (COVID-19) infection has been associated with abnormal liver chemistries. As clinicians learn about this novel virus, they continue to seek specific prognostic factors associated with disease outcomes. Our study assessed the predictive value of aspartate aminotransferase levels in a large cohort of COVID-19 patients without known chronic liver disease (CLD). METHODS: We reviewed the charts of 11,265 patients with confirmed COVID-19 infection via nasopharyngeal swabs admitted to our health system from March 1 to April 30, 2020. Baseline aspartate aminotransferase levels (AST) were drawn within 24 hours of presentation. Patients that had an age less than 18, CLD-related ICD-10 codes, or missing baseline data were excluded. The primary outcome was in-hospital mortality and the secondary outcome was a composite of in-hospital mortality or need for mechanical ventilation. For survival analyses, we censored patients as alive without the event of interest on hospital discharge or at 28 days, whichever was earlier. Multivariate models adjusted for age, sex, race, ethnicity, BMI, and presence of comorbidities. RESULTS: After exclusions, 10,614 patients met criteria. Over half of patients had elevations in AST (59%). The median age was 65 years (range: 18-107 years). The most common comorbidities were hypertension (58%), obesity (39%), and diabetes (36%). In Kaplan-Meier survival analyses, patients with any abnormal AST had an increase in both the primary and secondary outcome as compared to patients with normal values. Compared to patients with normal AST, patients with AST >10x the upper limits of normal were three times as likely to have both the primary (adjusted HR 2.64, 95% CI: 1.73-4.04, P < 0.001) and secondary outcome (adjusted HR 3.38, 95% CI: 1.78-6.40, P < 0.001). CONCLUSION: Our study found that abnormal AST levels on presentation in COVID-19 patients without known chronic liver disease was predictive of increased in-hospital mortality and the need for mechanical ventilation in this large cohort. The degree of AST elevation correlates with worse outcomes even when adjusted for baseline demographics and the presence of comorbidities. Based upon this large study, AST may be used to predict outcomes in COVID-19 infection and is an important parameter to be considered in the initial assessment of these patients.