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Liver damage at admission is an independent prognostic factor for COVID-19
Liu Ying Chen1, Hui Kuan Chu1, Tao Bai1
1Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Insights
Patients with COVID-19 experiencing liver injury face significantly higher mortality rates. This liver damage is an independent predictor of death in coronavirus disease 2019 patients, highlighting its prognostic importance.
Area of Science:
- Infectious Diseases
- Hepatology
- Critical Care Medicine
Background:
- Abnormal liver function is a frequent extra-pulmonary manifestation of coronavirus disease 2019 (COVID-19).
- Severe COVID-19 cases exhibit a greater likelihood and progression of liver injury compared to non-severe cases.
- Understanding the prognostic implications of liver injury in COVID-19 is crucial for patient management.
Purpose of the Study:
- To investigate the prognostic significance of liver injury in patients diagnosed with COVID-19.
- To compare the clinical characteristics and survival outcomes of COVID-19 patients with and without liver injury.
- To identify independent predictors of mortality in COVID-19 patients with liver damage.
Main Methods:
- Retrospective analysis of 502 patients with laboratory-confirmed SARS-CoV-2 infection.
- Comparison of clinical features and survival rates between patients with and without liver injury.
- Application of Cox proportional hazards models to determine factors influencing survival.
Main Results:
- 301 out of 502 patients presented with abnormal liver function, often accompanied by elevated inflammatory markers and organ damage indicators.
- Patients with abnormal liver function exhibited a significantly higher mortality rate (28.9% vs 9.0%) and increased risk of systemic inflammatory response syndrome.
- Grade 2 liver damage was associated with higher mortality, and multivariate analysis identified the grade of liver damage as an independent predictor of death (HR: 1.377).
Conclusions:
- COVID-19 patients with abnormal liver function experience a substantially increased risk of mortality.
- Liver damage serves as an independent prognostic factor for mortality in coronavirus disease 2019.
- Early identification and management of liver injury in COVID-19 patients are critical for improving survival outcomes.
Objective:
Abnormal liver function is a common form of extra-pulmonary organ damage in patients with coronavirus disease 2019 (COVID-19). Patients with severe COVID-19 have a higher probability and progression of liver injury than those without severe disease. We aimed to evaluate the prognosis of liver injury in patients with COVID-19.
Methods:
We retrospectively included 502 patients with laboratory-confirmed SARS-CoV-2 infection. Clinical features and survival of patients with and without liver injury were compared. Cox proportional hazards models were used to determine the variables that might have an effect on survival.
Results:
Among the 502 patients enrolled, 301 patients had abnormal liver function with increased neutrophil count, C-reactive protein, creatinine, troponin I (TnI), D-dimer, lactose dehydrogenase and creatine kinase. Patients with abnormal liver functions had a higher mortality rate (28.9% vs 9.0%, P < 0.001), a higher ratio of male sex (65.1% vs 40.8%, P < 0.001) and a higher chance of developing systemic inflammatory response syndrome (53.5% vs 41.3%, P = 0.007). Among patients with abnormal liver functions, patients with grade 2 liver damage (with both abnormal alanine aminotransferase or aspartate aminotransferase levels and abnormal alkaline phosphatase or gamma-glutamyl transpeptidase levels) had a higher ratio of male patients, elevated neutrophil count, procalcitonin, D-dimer levels and mortality rate. Multivariate Cox regression analyses suggested that the grade of liver damage (hazard ratio: 1.377, 95% confidence interval: 1.000-1.896, P = 0.049) was an independent predictor of death.
Conclusions:
Patients with COVID-19 and abnormal liver functions have a higher mortality than those with normal liver functions. Liver damage is an independent prognostic factor of COVID-19.
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