Presenter: Aleksandr Kalabin MD ;Columbia University at Harlem Hospital Background: Direct viral damage of organs/systems with subsequent inflammatory cascade is considered to be a major contributor to the pathogenesis of SARS-CoV-2 infection. Although lung is contemplated to be the primary organ targeted by the virus, recent reports predominantly from China and Europe provided evidence of affinity of COVID-19 to Angiotensin-converting enzyme 2(ACE 2) receptors expressed on gastrointestinal tract and liver parenchymal cells. The goal of our study was to investigate if SARS-CoV-2 virus affects liver function of Northern American population and if liver injury correlates with the disease severity in COVID-19 patients. Methods: Retrospective analysis of patients admitted with SARS-CoV-2 infection between March – April 2020 and liver function tests done within first 24h of admission. The primary outcome of interest was to determine if liver function is affected by COVOD-19 and assess the correlation with the disease severity. Patients were grouped into Non-intubated(NI-T) vs Intubated(I-T) patients and Survived(S) vs Deceased(D). Patients defined as survived were alive at the time of data accrual. Unpaired Student’s t-test was used for continues variables, Pearson Chi-square(χ2) test for categorical. P value < 0.05 was considered to represent statistically significant difference. Results: 183 patients were included, 73 Females(39.89%) and 110 males(60.11%). 114(62.30%) patients were African-Americans, 58(31.69%) Hispanics and 11 Asians(6.01%). Mean age was 64.77(SD 14.09), mean BMI 29.03(SD 7.36), mean body temperature 100.89(SD 1.68). 93 patients(50.82%) had GI complaints on presentation: most common symptoms were anorexia(54 patients, 29.51%), diarrhea(more than 3 loose stools per day, 41 patients, 22.40%), nausea/vomiting(33 patients, 18.03%) and abdominal pain(18 patients, 9.84%). Evaluation of LFTs on admission revealed mean aspartate aminotransferase(AST) of 63.83(SD 115.87), mean alanine transaminase(ALT) – 47.08(SD 85.64). Total bilirubin for the cohort was 0.64(SD 0.51), mean albumin 3.60(SD 0.52), mean Prothrombin time(PT) 14.38(SD 3.46), mean platelet count 220.94(83.59). Intubated patients tended to have significantly higher levels of AST(109.17 vs 53.97, P = 0.018), ALT(79.53 vs 40.03, P = 0.02) and total bilirubin(0.82 vs 0.60, P = 0.03) compared to non-intubated patents. This correlated with body temperature that was higher(101.38) for Intubated vs Non-intubated patients(100.70) (p = 0.0006), and acute phase reactants CRP(24.06 v 15.96, P = 0.019) and lactate(3.28 vs 2.13, P = 0.009). No difference between groups was observed for PT, platelets and albumin. Mean AST for Survived patients was 66.40 vs 50.41 for Deceased group(P = 0.51), mean ALT 48.89 vs 37.63(P = 0.53) and mean bilirubin 0.65 vs 0.60(P = 0.65) respectively. No difference between groups was observed for PT, platelets and albumin. CRP and lactate were higher in Deceased group compared to the Survived group:(27.09 vs 16.39, P = 0.008) and (3.33 vs 2.10 P = 0.005) respectively. Conclusion: Our study suggests direct viral injury to the liver parenchymal and biliary cells in Northern American patients with COVID-19 infection. Moreover, patients with elevated liver enzymes tended to have severe disease course, but no correlation with mortality was observed. Interestingly enough liver synthetic function of patients with SARS-CoV-2 infection was not significantly affected. While exact mechanisms of direct damage to the liver currently remain unclear and other explanations of elevated liver enzymes have been offered, more studies are needed to prove unambiguous interrelation between liver dysfunction and SARS-CoV-2 virus. [Formula presented]