Gut . Liver Injury Is Independently Associated With Adverse Clinical Outcomes in Patients With COVID-19

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Gut


. 2020 Jul 8;gutjnl-2020-321726.
doi: 10.1136/gutjnl-2020-321726. Online ahead of print.
Liver Injury Is Independently Associated With Adverse Clinical Outcomes in Patients With COVID-19


Terry Cheuk-Fung Yip ¹ , Grace Chung-Yan Lui ² , Vincent Wai-Sun Wong ¹ , Viola Chi-Ying Chow ³ , Tracy Hang-Yee Ho ⁴ , Timothy Chun-Man Li ⁴ , Yee-Kit Tse ¹ , David Shu-Cheong Hui ² , Henry Lik-Yuen Chan ¹ , Grace Lai-**** Wong ⁵



Affiliations

• PMID: 32641471
• DOI: 10.1136/gutjnl-2020-321726

Abstract

Objective: Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear.
Design: This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 ? upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death.
Results: We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ?ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation.
Conclusion: ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.

Keywords: cholestasis; hepatitis; liver function test.