Higher Mortality and Intensive Care Unit Admissions in COVID-19 Patients with Liver Enzyme Elevations

Area of Science:

• Hepatology
• Infectious Diseases
• Critical Care Medicine

Background:

• COVID-19 can affect multiple organ systems, including the liver.
• Liver enzyme elevations (LEE) are observed in some COVID-19 patients, but their prognostic significance requires further investigation.

Purpose of the Study:

• To determine if liver enzyme elevations (LEE) are independently associated with mortality or intensive care unit (ICU) admission in COVID-19 patients.
• To identify clinical, laboratory, and treatment factors associated with the development of LEE in COVID-19.

Main Methods:

• Single-center observational study of 799 adult COVID-19 patients.
• Categorization of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevations using a standardized toxicity grade scale.
• Analysis of association between LEE (grade ≥2) and outcomes (mortality, ICU admission) using adjusted hazard ratios (aHR).

Main Results:

• 28.1% of patients developed LEE (grade ≥2) within three days of diagnosis.
• LEE (grade ≥2) were associated with a higher hazard of death or ICU admission (aHR: 1.46, 95% CI: 1.14-1.88).
• Factors associated with LEE included male sex, higher respiratory rate, higher gamma-glutamyl transpeptidase (GGT), and lower baseline albumin. Steroids, tocilizumab, and darunavir/ritonavir correlated with LEE.

Conclusions:

• Liver enzyme elevations (LEE) are associated with increased mortality and ICU admission risk in COVID-19 patients.
• LEE evaluation may provide additional prognostic value alongside standard clinical and laboratory parameters.
• The multifactorial origin of LEE in COVID-19 warrants further research.