Liver injury on admission linked to worse outcomes in COVID-19: an analysis of 14,138 patients

Harleen Kaur Chela; Erin M Tallon; William Baskett; Karthik Gangu; Veysel Tahan; Chi-Ren Shyu; Ebubekir Daglilar

doi:10.21037/tgh-21-94

Liver injury on admission linked to worse outcomes in COVID-19: an analysis of 14,138 patients

Transl Gastroenterol Hepatol. 2023 Jan 25:8:4. doi: 10.21037/tgh-21-94. eCollection 2023.

Authors

Harleen Kaur Chela^#¹, Erin M Tallon^#², William Baskett², Karthik Gangu³, Veysel Tahan¹, Chi-Ren Shyu^{2

4}, Ebubekir Daglilar¹

Affiliations

¹ Division of Gastroenterology, Department of Medicine, University of Missouri-Columbia, Columbia, MO, USA.
² Institute for Data Science and Informatics, University of Missouri-Columbia, Columbia, MO, USA.
³ Division of Hospital Medicine, Department of Medicine, University of Missouri-Columbia, Columbia, MO, USA.
⁴ Electrical Engineering and Computer Science Department, University of Missouri-Columbia, Columbia, MO, USA.

^# Contributed equally.

Abstract

Background: Infection with the SARS-CoV-2 virus, which can result in hepatic inflammation and injury that varies from mild to severe and potentially acute fulminant liver injury, may be associated with poor outcomes. Our aims were to: (I) assess baseline clinical and demographic characteristics in patients with coronavirus disease 2019 (COVID-19) who did and did not have abnormalities in liver chemistries [alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (Tbili)] and (II) evaluate associations between abnormalities in liver chemistries and the primary outcomes of in-hospital death, intubation, and hospital length of stay (LOS).

Methods: In this nationwide retrospective cohort study of 14,138 patients, we analyzed associations between abnormalities in liver chemistries (ALT, AST, ALP, and Tbili) and mortality, intubation, and prolonged hospital LOS in patients with laboratory-confirmed COVID-19. We used Pearson's chi-squared tests to detect significant differences in categorical variables for patients with and without abnormal liver chemistries. Welch's two-sample t-tests were used to make comparisons of liver chemistry (ALT, AST, ALP, Tbili) and serum albumin results. All other continuous variables were analyzed using independent samples t-tests. A P value of <0.05 was considered significant.

Results: Propensity score matching demonstrated that abnormalities in liver chemistries at admission are significantly associated with increased risk for mortality (RR 1.70) and intubation (RR 1.44) in patients with COVID-19. Elevated AST is the liver chemistry abnormality associated with the highest risk for mortality (RR 2.27), intubation (RR 2.12), and prolonged hospitalization (RR 1.19). Male gender, pre-existing liver disease, and decreased serum albumin are also significantly associated with severe outcomes and death in COVID-19.

Conclusions: Routine liver chemistry testing should be implemented and used for risk stratification at the time of COVID-19 diagnosis.

Keywords: Health outcomes; SARS-CoV-2; coronavirus disease 2019 (COVID-19); liver disease; liver injury.