tetano
Editor, Senior Moderator
Hepatol Int
. 2021 Feb 3.
doi: 10.1007/s12072-021-10141-6. Online ahead of print.
Liver injury predicts overall mortality in severe COVID-19: a prospective multicenter study in Brazil
Fernanda Manh?es Pozzobon[SUP] 1 2 [/SUP], Hugo Perazzo[SUP] 3 [/SUP], Fernando Augusto Bozza[SUP] 3 4 [/SUP], Rosana Souza Rodrigues[SUP] 4 [/SUP], Renata de Mello Perez[SUP] 4 5 [/SUP], Maria Chiara Chindamo[SUP] 6 5 [/SUP]
Affiliations
Abstract
Background/purpose: The relationship between liver injury and mortality remains unclear in patients with COVID-19. We aimed to evaluate the prognostic value of aminotransferases levels at hospital admission to predict mortality in patients with COVID-19.
Methods and results: This prospective study included 406 patients [57% male, aged 56 years] with COVID-19 hospitalized in 26 centers in Brazil. Overall, 36.7% (95% CI 32.1-41.5) presented at admission with severe disease requiring respiratory support. The prevalence of elevated ALT and AST levels at admission [> 2 ? ULN] was 14.0% (95% CI 11.0-17.8) and 12.9% (95% CI 10.0-16.6), respectively. Sixty-two patients [15.3% (95% CI 12.1-19.1)] died during hospitalization and the overall mortality rate was 13.4 (10.5-17.2) deaths per 1000 persons-years. The 15-day-overall survival (95% CI) was significantly lower in patients with ALT levels ≥ 2 ? ULN compared to those with ALT < 2 ? ULN [67.1% (48.4-80.2) vs 83.4% (76.1-88.6), p = 0.001] and in those with AST levels ≥ 2 ? ULN compared to those with AST < 2 ? ULN [61.5% (44.7-74.6) vs 84.2% (76.5-89.5), p < 0.001]. The presence of elevated aminotransferases levels at hospital admission significantly increased the risk of in-hospital all-cause mortality adjusted for age-and-sex. Those findings were present in the subgroup of critically ill patients already admitted in need of respiratory support (n = 149), but not in patients without that requirement at admission (n = 257).
Conclusions: Elevated aminotransferases at hospital admission predicted in-hospital all-cause mortality in patients with COVID-19, especially in those with severe disease. Measurement of transaminases levels at hospital admission should be integrated to the care of patients with COVID-19 as an auxiliary strategy to identify patients at higher death risk.
Keywords: Aminotransferases; Coronavirus; Death; Hepatic; Hospital admission; Hospitalization; Prognostic value; Respiratory support; SARS-CoV-2 infection; Severe disease.
. 2021 Feb 3.
doi: 10.1007/s12072-021-10141-6. Online ahead of print.
Liver injury predicts overall mortality in severe COVID-19: a prospective multicenter study in Brazil
Fernanda Manh?es Pozzobon[SUP] 1 2 [/SUP], Hugo Perazzo[SUP] 3 [/SUP], Fernando Augusto Bozza[SUP] 3 4 [/SUP], Rosana Souza Rodrigues[SUP] 4 [/SUP], Renata de Mello Perez[SUP] 4 5 [/SUP], Maria Chiara Chindamo[SUP] 6 5 [/SUP]
Affiliations
- PMID: 33534084
- DOI: 10.1007/s12072-021-10141-6
Abstract
Background/purpose: The relationship between liver injury and mortality remains unclear in patients with COVID-19. We aimed to evaluate the prognostic value of aminotransferases levels at hospital admission to predict mortality in patients with COVID-19.
Methods and results: This prospective study included 406 patients [57% male, aged 56 years] with COVID-19 hospitalized in 26 centers in Brazil. Overall, 36.7% (95% CI 32.1-41.5) presented at admission with severe disease requiring respiratory support. The prevalence of elevated ALT and AST levels at admission [> 2 ? ULN] was 14.0% (95% CI 11.0-17.8) and 12.9% (95% CI 10.0-16.6), respectively. Sixty-two patients [15.3% (95% CI 12.1-19.1)] died during hospitalization and the overall mortality rate was 13.4 (10.5-17.2) deaths per 1000 persons-years. The 15-day-overall survival (95% CI) was significantly lower in patients with ALT levels ≥ 2 ? ULN compared to those with ALT < 2 ? ULN [67.1% (48.4-80.2) vs 83.4% (76.1-88.6), p = 0.001] and in those with AST levels ≥ 2 ? ULN compared to those with AST < 2 ? ULN [61.5% (44.7-74.6) vs 84.2% (76.5-89.5), p < 0.001]. The presence of elevated aminotransferases levels at hospital admission significantly increased the risk of in-hospital all-cause mortality adjusted for age-and-sex. Those findings were present in the subgroup of critically ill patients already admitted in need of respiratory support (n = 149), but not in patients without that requirement at admission (n = 257).
Conclusions: Elevated aminotransferases at hospital admission predicted in-hospital all-cause mortality in patients with COVID-19, especially in those with severe disease. Measurement of transaminases levels at hospital admission should be integrated to the care of patients with COVID-19 as an auxiliary strategy to identify patients at higher death risk.
Keywords: Aminotransferases; Coronavirus; Death; Hepatic; Hospital admission; Hospitalization; Prognostic value; Respiratory support; SARS-CoV-2 infection; Severe disease.