Therap Adv Gastroenterol
. 2021 May 30;14:17562848211016567.
doi: 10.1177/17562848211016567. eCollection 2021.
The role of liver steatosis as measured with transient elastography and transaminases on hard clinical outcomes in patients with COVID-19
Isabel Campos-Varela 1 , Ares Villagrasa 2 , Macarena Simon-Talero 2 , Mar Riveiro-Barciela 2 , Meritxell Ventura-Cots 2 , Lara Aguilera-Castro 3 , Patricia Alvarez-Lopez 2 , Emilie A Nordahl 4 , Adrian Anton 2 , Juan Bañares 2 , Claudia Barber 3 , Ana Barreira-Diaz 2 , Betina Biagetti 5 , Laura Camps-Relats 2 , Andrea Ciudin 5 , Raul Cocera 6 , Cristina Dopazo 7 , Andrea Fernandez 7 , Cesar Jimenez 2 , Maria M Jimenez 8 , Mariona Jofra 7 , Clara Gil 2 , Concepción Gomez-Gavara 7 , Danila Guanozzi 3 , Jorge A Guevara 9 , Beatriz Lobo 3 , Carolina Malagelada 3 , Joan Martinez-Camprecios 2 , Luis Mayorga 3 , Enric Miret 6 , Elizabeth Pando 7 , Ana Pérez-Lopez 8 , Marc Pigrau 9 , Alba Prio 2 , Jesus M Rivera-Esteban 2 , Alba Romero 2 , Stephanie Tasayco 3 , Judit Vidal-Gonzalez 2 , Laura Vidal 7 , Beatriz Minguez 2 , Salvador Augustin 1 , Joan Genesca 2
Affiliations
- PMID: 34104210
- PMCID: PMC8170328
- DOI: 10.1177/17562848211016567
Abstract
Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years.
Keywords: ALT; AST; CAP; controlled attenuation parameter; liver injury.