Do low levels of alanine aminotransferase, a baseline marker of sarcopenia and frailty, associate with worse clinical outcomes among hospitalized COVID-19 patients? A Retrospective Cohort Study

Ehud Raz Gatt; Eyal Zilber; Max Perelman; Nitsan Landau; Maya Yakir; Noam Glick; Liat Negru; Gad Segal; Edward Itelman

doi:10.22540/JFSF-08-148

Do low levels of alanine aminotransferase, a baseline marker of sarcopenia and frailty, associate with worse clinical outcomes among hospitalized COVID-19 patients? A Retrospective Cohort Study

J Frailty Sarcopenia Falls. 2023 Sep 1;8(3):148-154. doi: 10.22540/JFSF-08-148. eCollection 2023 Sep.

Authors

Ehud Raz Gatt¹, Eyal Zilber^{1

2}, Max Perelman^{1

2}, Nitsan Landau^{1

2}, Maya Yakir^{1

2}, Noam Glick^{1

2}, Liat Negru^{1

2}, Gad Segal^{1

2}, Edward Itelman^{1

2}

Affiliations

¹ Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
² Internal Department "T", Tel Hashomer Hospital, Ramat Gan, Israel.

Abstract

Objectives: COVID-19 geoperdize lives. Not all the risk factors for negative outcomes are known. Sarcopenia and frailty are common, negatively affecting clinical outcomes. Studies have shown that sarcopenia and frailty are associated with worse outcomes. Our objective was to examine whether low ALT (Alanine-aminotranferase), a surrogate marker for sarcopenia, is associated with worse clinical outcomes among hospitalized COVID-19 patients.

Methods: We reviewed cases of COVID-19 in a tertiary hospital, during three COVID-19 waves and examined correlations between ALT and mortality using crude, univariate and multivariate analysis for age, gender, hypertension, Chronic obstructive pulmonary disease and Congestive heart failure.

Results: 357 patients were included in this analysis. Median age was 69, 54% were males. Median ALT was 19 IU/L. During follow-up, 73 (20%) died. Patients with low ALT were more likely to die (HR 1.82, 95% CI 1.06-3.09, P=0.028). Other predictors for mortality were low albumin, background COPD, dyslipidemia, dementia, and malignancy. The multivariate analysis showed that low ALT was still an independent predictor of poor prognosis (HR 1.7, 95% CI 1.0-2.9, P=0.049).

Conclusions: In our analysis of COVID-19 patients, low ALT levels were independently associated with increased risk of mortality, both as standalone and when incorporated into a multivariate analysis.

Keywords: ALT; Clinical outcomes; Corona virus; Frailty; Sacrcopenia.