Abnormal Liver Tests in COVID‐19: A Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network

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Source: https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.31487

Abnormal Liver Tests in COVID‐19: A Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network
Melanie A. Hundt
Yanhong Deng
Maria M. Ciarleglio
Michael H. Nathanson
Joseph K. Lim
First published: 29 July 2020
https://doi.org/10.1002/hep.31487

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1002/hep.31487


The COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, is associated with significant morbidity and mortality due to pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Liver injury has been reported as a non‐pulmonary manifestation of COVID‐19 but characterization of liver test abnormalities and their association with clinical outcomes is incomplete. We conducted a retrospective cohort study of 1827 patients with confirmed COVID‐19 who were hospitalized within the Yale‐New Haven Health System (YNHHS) between March 14, 2020 and April 23, 2020. Clinical characteristics, liver tests (AST, ALT, ALP, TBIL, albumin) at three time points (pre‐infection baseline, admission, peak hospitalization), and hospitalization outcomes (severe COVID‐19, ICU admission, mechanical ventilation, death) were analyzed. Abnormal liver tests were commonly observed in hospitalized patients with COVID‐19, both at admission (AST 66.9%, ALT 41.6%, ALP 13.5%, TBIL 4.3%) and peak hospitalization (AST 83.4%, ALT 61.6%, ALP 22.7%, TBIL 16.1%). Most patients with abnormal liver tests at admission had minimal elevations 1‐2x ULN (AST 63.7%, ALT 63.5%, ALP 80.0%, TBIL 75.7%). A significant proportion of these patients had abnormal liver tests pre‐hospitalization (AST 25.9%, ALT 38.0%, ALP 56.8%, TBIL 44.4%). Multivariate analysis revealed an association between abnormal liver tests and severe COVID‐19, including ICU admission, mechanical ventilation, and death; associations with age, male gender, BMI, and diabetes mellitus were also observed. Medications used in COVID‐19 treatment (lopinavir/ritonavir, hydroxychloroquine, remdesivir, and tocilizumab) were associated with peak hospitalization liver transaminase elevations >5x ULN. Conclusion: Abnormal liver tests occur in most hospitalized patients with COVID‐19 and may be associated with poorer clinical outcomes.

 

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Source: https://scienceblog.com/517806/stro...ormal-liver-tests-and-poor-covid-19-outcomes/

Strong link found between abnormal liver tests and poor COVID-19 outcomes
August 8, 2020 Yale University

Researchers at the Yale Liver Center found that patients with COVID-19 presented with abnormal liver tests at much higher rates than suggested by earlier studies. They also discovered that higher levels of liver enzymes — proteins released when the liver is damaged — were associated with poorer outcomes for these patients, including ICU admission, mechanical ventilation, and death.

The study appeared online on July 29 in Hepatology.

Previous studies in China found that approximately 15% of patients with COVID-19 had abnormal liver tests. The Yale study, which looked retrospectively at 1,827 COVID-19 patients who were hospitalized in the Yale New Haven Health system between March and April, found that the incidence of abnormal liver tests was much higher — between 41.6% and 83.4% of patients, depending on the specific test.

In all, the Yale researchers examined five liver tests, looking at factors such as elevations in aspartate aminotransferase (AST) and alanine transaminase (ALT), which indicate liver cell inflammation; an increase in bilirubin, which indicates liver dysfunction; and increased levels of alkaline phosphatase (ALP), which may indicate inflammation of bile ducts.

Although the researchers do not know why the incidence of abnormal liver tests was so much higher than in previous studies from China, senior author Dr. Joseph Lim, professor of medicine and director of the Yale Viral Hepatitis Program, said other health differences between the Chinese and U.S. populations could account for it.

“We can speculate that U.S. patients may have an increased rate of other risk factors such as alcoholic or non-alcoholic fatty liver disease,” he said.
In the U.S., close to one-third of people have fatty liver disease, and several million people have chronic hepatitis B or C....