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Liver injury predicts overall mortality in severe COVID-19: a prospective multicenter study in Brazil
Fernanda Manhães Pozzobon1,2, Hugo Perazzo3, Fernando Augusto Bozza3,4
1Barra D'Or Hospital, Rede D'Or São Luiz, Ayrton Senna Avenue, 3079, Rio de Janeiro, Brazil. nandamanhaes@gmail.com.
Insights
Elevated aminotransferase levels upon hospital admission for COVID-19 indicate a higher risk of in-hospital mortality, particularly in severe cases. This finding suggests using transaminase measurements to identify high-risk patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- The prognostic significance of liver injury, indicated by elevated aminotransferases, in COVID-19 patients is not fully understood.
- Liver injury may contribute to increased mortality risk in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Purpose of the Study:
- To investigate the predictive value of aminotransferase levels at hospital admission for in-hospital mortality in COVID-19 patients.
- To assess whether elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels can serve as prognostic markers for COVID-19 outcomes.
Main Methods:
- A prospective study involving 406 hospitalized COVID-19 patients across 26 centers in Brazil.
- Analysis of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at hospital admission, with a threshold of >2 times the upper limit of normal (ULN).
- Evaluation of in-hospital mortality rates and survival analysis, stratified by aminotransferase levels and disease severity.
Main Results:
- 14.0% of patients had elevated ALT and 12.9% had elevated AST at admission.
- In-hospital mortality was significantly higher in patients with elevated ALT or AST levels compared to those with normal levels (p < 0.001).
- Elevated aminotransferases at admission independently predicted in-hospital mortality, especially in critically ill patients requiring respiratory support.
Conclusions:
- Elevated aminotransferase levels at hospital admission are a significant predictor of in-hospital mortality in COVID-19 patients.
- This marker is particularly relevant for identifying high-risk individuals among those with severe COVID-19.
- Measuring transaminases at admission can aid in risk stratification and patient management for COVID-19.
Background/Purpose:
The relationship between liver injury and mortality remains unclear in patients with COVID-19. We aimed to evaluate the prognostic value of aminotransferases levels at hospital admission to predict mortality in patients with COVID-19.
Methods And Results:
This prospective study included 406 patients [57% male, aged 56 years] with COVID-19 hospitalized in 26 centers in Brazil. Overall, 36.7% (95% CI 32.1-41.5) presented at admission with severe disease requiring respiratory support. The prevalence of elevated ALT and AST levels at admission [> 2 × ULN] was 14.0% (95% CI 11.0-17.8) and 12.9% (95% CI 10.0-16.6), respectively. Sixty-two patients [15.3% (95% CI 12.1-19.1)] died during hospitalization and the overall mortality rate was 13.4 (10.5-17.2) deaths per 1000 persons-years. The 15-day-overall survival (95% CI) was significantly lower in patients with ALT levels ≥ 2 × ULN compared to those with ALT < 2 × ULN [67.1% (48.4-80.2) vs 83.4% (76.1-88.6), p = 0.001] and in those with AST levels ≥ 2 × ULN compared to those with AST < 2 × ULN [61.5% (44.7-74.6) vs 84.2% (76.5-89.5), p < 0.001]. The presence of elevated aminotransferases levels at hospital admission significantly increased the risk of in-hospital all-cause mortality adjusted for age-and-sex. Those findings were present in the subgroup of critically ill patients already admitted in need of respiratory support (n = 149), but not in patients without that requirement at admission (n = 257).
Conclusions:
Elevated aminotransferases at hospital admission predicted in-hospital all-cause mortality in patients with COVID-19, especially in those with severe disease. Measurement of transaminases levels at hospital admission should be integrated to the care of patients with COVID-19 as an auxiliary strategy to identify patients at higher death risk.
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