S1129 Prevalence of Liver Manifestations in Coronavirus Infection: A Population-Based Study

Abstract

INTRODUCTION: Along with newly identified SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) other coronaviruses, i.e. SARS-CoV and Middle Eastern respiratory syndrome coronavirus (MERS-CoV) were associated with severe respiratory illnesses and significant mortality. Gastrointestinal symptoms were frequently reported in COVID-19 patients, however, limited data have been published on the liver manifestations associated with coronavirus infection. Our objective is to study the epidemiology of hepatic manifestations and associated mortality in patients infected with the coronavirus. METHODS: We performed a retrospective cohort study using IBM EXPLORYS, HIPPA-enabled web platform that includes over 65 million patient data, pooled from multiple healthcare systems using electronic medical records. All patients with coronavirus infection were included in the study and were categorized into two groups; abnormal and normal liver enzymes. Abnormal liver enzyme group included patients with elevated levels of either aspartate aminotransferase (AST) or alanine aminotransferase (ALT) or both. Patient characteristics, symptoms, medications, and mortality was compared between the groups. Data were analyzed with R statistical software (RStudio, Inc. Boston, MA). RESULTS: A total of 4210 patients were infected with coronavirus of which 1740 (41%) had abnormal liver enzymes. Abnormal liver enzymes were mostly noted in elderly females with age > 65 (P < 0.0001). Abdominal pain, nausea, and vomiting were the most common presentation (P < 0.0001). Immunosuppressants or steroids were significantly associated with elevated liver enzymes (P = 0.024). Pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and mortality was significantly high in abnormal liver enzyme group. There was no association with race, body mass index, hepatitis, and liver transplantation (Table). CONCLUSION: Elderly patients infected with coronavirus are at higher risk to have worse outcomes. Patients with abnormal liver enzymes were at increased risk to develop pneumonia, ARDS, and septic shock. The mortality rate in this group was significantly high. Our findings suggest that elderly patients infected with coronavirus who are on immunosuppressants or steroids are at higher risk for clinical deterioration. Further multi-center studies are needed to evaluate if hepatic function panel on the day of admission, in conjunction with other risk factors, could be used to identify high-risk patients for clinical deterioration.Table 1.: Characteristics of Patients with Coronavirus InfectionTable 2.: Characteristics of Patients with Coronavirus Infection