S1118 Gender Disparities of Liver Injury at Presentation in COVID-19 Patients

Abstract

INTRODUCTION: There are several reports suggesting abnormal liver enzymes occur in as many as 50% of patients infected by the novel coronavirus-19 (COVID-19). The purpose of our study was to examine the gender disparities in the prevalence of abnormal liver enzymes at initial presentation in COVID-19 patients. METHODS: We reviewed the charts of 11,265 adult patients with confirmed COVID-19 infection admitted to any of the 12 hospitals in our health system from March 1 to April 30, 2020. COVID-19 status was confirmed by polymerase chain reaction of a nasopharyngeal swab specimen. Labs drawn within 24 hours of presentation were considered baseline. Patients that had an age less than 18 or missing baseline data were excluded. Abnormalities in liver chemistries for AST (Aspartate Amino Transferase) and ALT (Alanine Amino Transferase) were grouped as follows: (1) within normal limits; (2) mild: greater than the upper limit of normal (ULN) to less than or equal to 4 times the ULN; (3) moderate: greater than 4 times the ULN to less than or equal to 10 times the ULN; and (4) severe: greater than 10 times the ULN. RESULTS: After exclusions, 10,856 patients were included in our study. There was a significant difference of the prevalence of liver injury between men and women (Table 1). Liver injury was present in 61% male and 40% female (P < 0.001). On univariate analysis, men (OR: 1.77 [95% CI: 1.64–1.92] and OR: 2.56 [95% CI: 2.06–3.17]) were more likely to have mild or moderate increases in AST but the difference was not apparent with ALT levels. These results were confirmed using the adjusted analysis after adjusting for baseline demographics and comorbidities (Table 2). CONCLUSION: Males presenting with COVID-19 infection are more likely to have elevated AST levels than females. There were no significant differences in ALT levels based upon gender. Elevated AST levels have been associated with a poor prognosis in hospitalized COVID-19 patients. Further research is needed to understand the mechanism of these gender-based differences in liver enzyme elevations, and their relationship to outcomes in COVID-19 infected patients.Table 1.: Frequencies of liver injuries in patients admitted with COVID-19 infectionTable 2.: Multinomial Logistic Regression Analysis showing the relative risk of Liver injury in Male patients With COVID-19 Compared to Female patients