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Presentation, patterns and predictive value of baseline liver tests on outcomes in COVID-19 patients without chronic
David Bernstein1, Nitzan Roth2, Angela Kim3
1Department of Medicine/Hepatology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States. dbernste@northwell.edu.
Insights
Abnormal liver enzymes in COVID-19 patients without chronic liver disease indicate a higher risk of in-hospital death and need for mechanical ventilation. Cholestasis poses the greatest danger.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) infection frequently causes abnormal liver enzymes.
- The long-term impact of these hepatic enzyme elevations remains unclear.
Purpose of the Study:
- To determine the prevalence and prognostic significance of initial liver enzyme levels in a large cohort of COVID-19 patients.
- To assess the association between liver enzyme abnormalities and clinical outcomes in COVID-19 survivors and non-survivors.
Main Methods:
- Retrospective analysis of electronic medical records for 10,614 COVID-19 patients admitted between March 1, 2020, and April 30, 2020.
- Analysis of baseline demographics and liver chemistries.
- Primary outcome: in-hospital mortality. Secondary outcome: composite of in-hospital mortality or mechanical ventilation.
Main Results:
- Patients with abnormal liver tests exhibited increased risks of mortality and the composite outcome compared to those with normal liver enzymes.
- These associations persisted after adjusting for demographic factors.
Conclusions:
- Liver enzyme abnormalities are linked to increased mortality and mechanical ventilation needs in COVID-19 patients without pre-existing liver disease.
- Cholestasis in COVID-19 patients is associated with the highest risk of adverse outcomes.
Background:
Coronavirus disease 2019 (COVID-19) infection is known to cause abnormal hepatic enzymes. The long term consequences of such elevations are uncertain.
Aim:
To assessed the prevalence and prognostic value of initial liver enzymes in a large cohort of COVID-19 patients.
Methods:
We reviewed electronic medical records of 10614 COVID-19 patients without known chronic liver disease who were admitted to our health system from March 1, 2020, to April 30, 2020. We analyzed baseline demographics and liver chemistries. The primary outcome was in-hospital mortality, and the secondary outcome was a composite of in-hospital mortality or need for mechanical ventilation.
Results:
Subjects with abnormal liver tests had increased risks of mortality and composite outcome when compared to patients with normal measurements on unadjusted analysis and after adjustment for demographic factors.
Conclusion:
In our diverse patient population, liver enzyme abnormalities are associated with increased mortality and the need for mechanical ventilation in subjects without chronic liver disease. Cholestasis patients are at the greatest risk for poor outcomes.
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