S1203 Predictors of Elevated Liver Tests During COVID-19 Shelter in Place in Those Without Known Liver Disease

Abstract

Introduction: Elevated liver tests(LT) are associated with reduced liver related health. The AIM of our study was to determine the prevalence and predictors of new-onset elevated LT during COVID-19 shelter in place(SIP) in those without chronic liver disease(CLD). Methods: Retrospective cohort study examining LT in patients ³18 years at one month after SIP from 4/19/2020 until 12/31/2020(2020). We excluded patients with CLD and those hospitalized. We extracted LT, serum low density lipoprotein(LDL), serum triglyceride(TG) and demographic data. We compared LT obtained during the same time period for the same patients from 4/19/2019 to 12/31/2019(2019). Elevated LT were defined as ALT >35U/L in males, >25U/L in females, AST >40U/L, or total bilirubin (TB) >1.1 mg/dL. Among patients with normal LT in 2019, we evaluated predictors of elevated LT in 2020 using multivariate analysis. Results: We evaluated 44021 patients: median age 56 years (IQR 54-75), median weight 173.9 lb(IQR 149.2-202.9), 51.8% males, and 48.2%females. Higher rates of new onset ALT elevation were observed in females than males(18.9% vs9 .4%, p < 0.001) and was predicted by higher weight, serum TG level. Younger age was associated with lower odds of ALT elevation. We observed new onset AST elevation in 2.8% and was predicted by higher TG, systolic blood pressure, and male gender. Younger age was also associated with lower odds of AST elevation. New onset elevated TB was observed in 2.6% and was predicted by Asian or Black race compared to White race, and male gender. Lower serum TG was associated with lower odds of TB elevation. Significantly more patients had FIB-4 >3.25 in 2020(5.3%) compared to(3.8%) patients with FIB-4 >3.25 in 2019(P< 0.001). Predictors of FIB-4 >3.25 in 2020 included age(OR 1.0032, 95% CI 1.0030-1.0034,P< 0.001), male gender(OR 1.03, 95% CI 1.02-1.04) and language barrier (non-English speaking) (OR1.07,95%CI1.05-1.08, P < 0.001). Conclusion: During SIP, in patients without history of CLD or hospitalization, we observed a higher rate of new onset abnormal ALT levels in females than males which were associated with features of metabolic syndrome and older age. Higher AST levels were associated with male gender, metabolic syndrome features and older age suggesting higher rates of alcohol use. We also observed higher rates of FIB-4 >3.25 in 2020 indicating worsening patterns of liver disease. Further follow-up will be required to determine the long-term effects of these changes.Table 1.: Association of patient and hospital characteristics on mortality outcomes of individuals hospitalized for venous thromboembolism and comorbid nonalcoholic fatty liver disease. REF = reference; Median household income for patient's ZIP Code (based on current year): Q1 = 0-25th percentile; Q2 = 26th to 50th percentile; Q3 = 51st to 75th percentile; Q4 = 76th to 100th percentile.