Prevalence of abnormal liver biochemistry and its impact on COVID-19 patients' outcomes: a single-center Greek study

Evangelos Cholongitas; Triada Bali; Vasiliki E Georgakopoulou; Alexios Giannakodimos; Argyrios Gyftopoulos; Vasiliki Georgilaki; Dimitrios Gerogiannis; Dimitrios Basoulis; Irene Eliadi; Georgios Karamanakos; Konstantinos Mimidis; Nikolaos V Sipsas; Michael Samarkos

doi:10.20524/aog.2022.0709

Prevalence of abnormal liver biochemistry and its impact on COVID-19 patients' outcomes: a single-center Greek study

Ann Gastroenterol. 2022 May-Jun;35(3):290-296. doi: 10.20524/aog.2022.0709. Epub 2022 Mar 25.

Authors

Evangelos Cholongitas¹, Triada Bali¹, Vasiliki E Georgakopoulou^{2

3}, Alexios Giannakodimos¹, Argyrios Gyftopoulos¹, Vasiliki Georgilaki¹, Dimitrios Gerogiannis¹, Dimitrios Basoulis^{1

3}, Irene Eliadi³, Georgios Karamanakos³, Konstantinos Mimidis⁴, Nikolaos V Sipsas^{5

3}, Michael Samarkos^{1

3}

Affiliations

¹ First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos).
² Pulmonology Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Vasiliki E. Georgakopoulou).
³ Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Nikolaos V. Sipsas, Michael Samarkos).
⁴ First Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece (Konstantinos Mimidis).
⁵ Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and Laiko General Hospital of Athens, Athens, Greece (Nikolaos V. Sipsas).

Abstract

Background: Abnormalities in aminotransferases are frequently observed in hospitalized COVID-19 patients, but their clinical impact is poorly characterized.

Methods: A total of 1046 patients hospitalized to the non-intensive care unit ward with documented COVID-19 were included retrospectively. Demographic, clinical and laboratory characteristics on admission and during hospital stay, including the presence of liver injury (LI), defined as aspartate aminotransferase (AST) >200 IU/L, were recorded.

Results: On admission, 363 (34.7%) and 269 (25.7%) patients had abnormal AST and ALT values (i.e., >40 IU/L), respectively, while during hospitalization 53 (5%) patients fulfilled the criteria for LI. In multivariate logistic regression analysis, AST (odds ratio [OR] 1.023, 95% confidence interval [CI] 1.016-1.029; P<0.001), and ferritin (OR 1.01, 95%CI 1.001-1.02; P<0.001) were the baseline factors independently associated with the development of LI during hospital stay. One hundred twenty-three (11.7%) patients died during hospitalization. The independent variables associated with mortality were: age (hazard ratio [HR] 1.043, 95%CI 1.029-1.056; P<0.001), ferritin (HR 1.1, 95%CI 1.05-1.2; P<0.001), platelets (HR 0.996, 95%CI 0.994-0.999; P=0.003), and administration of remdesivir (HR 0.50, 95%CI 0.30-0.85; P=0.009). The patients with abnormal baseline AST (i.e., >40 IU/L), compared to those with normal AST values, had worse outcomes (log rank test: 8.8, P=0.003).

Conclusions: Elevated aminotransferases are commonly seen in COVID-19 patients. They possibly reflect disease severity and may be associated with in-hospital mortality.

Keywords: COVID-19; disease severity; liver function tests; liver injury; mortality.