S1112 Single Center Assessment of Liver Injury, Proton Pump Inhibitor Intake, and Mortality Based on Race and Ethnicity in Individuals With COVID-19

Abstract

INTRODUCTION: A significant number of subjects infected with COVID-19 present with gastrointestinal-related manifestations, particularly acute liver injury. Most data originate from China, and it is unclear that similar patterns hold in different ethno-social contexts. METHODS: A retrospective assessment of individuals diagnosed with COVID-19 in a county hospital in Minnesota was performed. Individuals with a positive COVID-19 test between 3/1/20 and 5/25/20 were included. We evaluated the role of race, ethnicity, co-morbidities, and proton-pump inhibitor (PPI) use on liver injury, hospital admission and mortality. Logistic regressions were performed using SAS 9.4. Statistical significance was reported at a 0.05 level. Census variables were sourced from the 2015 American Community Survey 5 year estimates. Results: 2164 individuals diagnosed with COVID-19 were identified. Median age was 39 years (IQR 28–51) and 52.4% were males. 12.5% were classified as white, 38.6% as African American, 34.6% as Hispanic, and 14.2% as other/unknown. Of those admitted to the hospital (N = 323), the median lab values were a follows: ALT 26 IU/L (IQR 18–45), AST 40 IU/L (IQR 27–63), total bilirubin 0.5 mg/dl (IQR 0.3–0.6) and alkaline phosphatase 74 IU/L (IQR 59–100). Only 2.6% and 3.7% of individuals without liver disease presented with elevated ALT or AST, respectively. In those with chronic liver disease (N = 71), 9.9% and 14.1% presented with elevated ALT or AST, respectively. Men were more likely to have abnormal ALT and AST (P = 0.002 and P = 0.005 respectively). Race was associated with an elevated AST on admission (P = 0.03) in those without chronic liver disease. We found no association between degree of abnormal liver enzymes and mortality. Surprisingly, being Hispanic or African American was inversely associated with mortality (P = 0.03 and P = 0.001, respectively). PPI use was associated with a 2.75 higher risk of mortality upon admission (P = 0.003) during bivariate analysis. However, this association became weak after correcting for age as well as renal, pulmonary and cardiovascular co-morbidities, suggesting that PPI-associated mortality could be related to other factors the lead to PPI use. CONCLUSION: Our findings suggest minimal hepatic injury inflicted by COVID-19 in those with no concurrent liver disease, regardless of race or ethnicity. Use of PPI was significantly associated to mortality, but further studies are needed to confirm this effect as the presence of co-morbidities significantly impacted this association.