tetano
Editor, Senior Moderator
Liver Int
. 2020 Jun 11.
doi: 10.1111/liv.14565. Online ahead of print.
Abnormal Liver Function Tests Predict Transfer to Intensive Care Unit and Death in COVID-19
Salvatore Piano[SUP] 1 [/SUP], Andrea Dalbeni[SUP] 2 [/SUP], Elia Vettore[SUP] 3 [/SUP], Devis Benfaremo[SUP] 4 [/SUP], Massimo Mattioli[SUP] 5 [/SUP], Carmine Gabriele Gambino[SUP] 1 [/SUP], Viviana Framba[SUP] 1 [/SUP], Lorenzo Cerruti[SUP] 1 [/SUP], Anna Mantovani[SUP] 2 [/SUP], Andrea Martini[SUP] 1 3 [/SUP], Michele Maria Luchetti[SUP] 4 [/SUP], Roberto Serra[SUP] 1 [/SUP], Annamaria Cattelan[SUP] 6 [/SUP], Roberto Vettor[SUP] 1 [/SUP], Paolo Angeli[SUP] 1 [/SUP], COVID-LIVER study group
Collaborators, Affiliations
Abstract
Background: The pandemic of coronavirus disease 2019 (COVID-19) has emerged as a relevant threat for humans worldwide. Abnormality in liver function tests (LFTs) has been commonly observed in patients with COVID-19, but there is controversy on its clinical significance. The aim of this study was to assess the prevalence, the characteristics and the clinical impact of abnormal LFTs in hospitalized, non-critically ill patients with COVID-19.
Methods: In this multicenter, retrospective study, we collected data about 565 inpatients with COVID-19. Data on LFTs were collected at admission and every 7?2 days during the hospitalization. The primary outcome was a composite endpoint of death or transfer to intensive care unit (ICU).
Results: Upon admission 329 patients (58%) had LFTs abnormality. Patients with abnormal LFTs had more severe inflammation and higher degree of organ dysfunction than those without. During hospitalization, patients with abnormal LFTs had a higher rate of transfer to ICU (20vs8%; p<0.001), acute kidney injury (22vs13%, p=0.009), need for mechanical ventilation (14vs6%; p=0.005), and mortality (21vs11%; p=0.004) than those without. In multivariate analysis, patients with abnormal LFTs had a higher risk of the composite endpoint of death or transfer to ICU (OR=3.53; p<0.001). During the hospitalization, 86 patients developed de novo LFTs abnormality, which was associated with the use of tocilizumab, lopinavir/ritonavir and acetaminophen and not clearly associated with the composite endpoint.
Conclusions: LFTs abnormality is common at admission in patients with COVID-19, is associated with systemic inflammation, organ dysfunction and is an independent predictor of transfer to ICU or death.
Keywords: SARS-CoV-2; liver injury; nCOV-19; sepsis.
. 2020 Jun 11.
doi: 10.1111/liv.14565. Online ahead of print.
Abnormal Liver Function Tests Predict Transfer to Intensive Care Unit and Death in COVID-19
Salvatore Piano[SUP] 1 [/SUP], Andrea Dalbeni[SUP] 2 [/SUP], Elia Vettore[SUP] 3 [/SUP], Devis Benfaremo[SUP] 4 [/SUP], Massimo Mattioli[SUP] 5 [/SUP], Carmine Gabriele Gambino[SUP] 1 [/SUP], Viviana Framba[SUP] 1 [/SUP], Lorenzo Cerruti[SUP] 1 [/SUP], Anna Mantovani[SUP] 2 [/SUP], Andrea Martini[SUP] 1 3 [/SUP], Michele Maria Luchetti[SUP] 4 [/SUP], Roberto Serra[SUP] 1 [/SUP], Annamaria Cattelan[SUP] 6 [/SUP], Roberto Vettor[SUP] 1 [/SUP], Paolo Angeli[SUP] 1 [/SUP], COVID-LIVER study group
Collaborators, Affiliations
- PMID: 32526083
- DOI: 10.1111/liv.14565
Abstract
Background: The pandemic of coronavirus disease 2019 (COVID-19) has emerged as a relevant threat for humans worldwide. Abnormality in liver function tests (LFTs) has been commonly observed in patients with COVID-19, but there is controversy on its clinical significance. The aim of this study was to assess the prevalence, the characteristics and the clinical impact of abnormal LFTs in hospitalized, non-critically ill patients with COVID-19.
Methods: In this multicenter, retrospective study, we collected data about 565 inpatients with COVID-19. Data on LFTs were collected at admission and every 7?2 days during the hospitalization. The primary outcome was a composite endpoint of death or transfer to intensive care unit (ICU).
Results: Upon admission 329 patients (58%) had LFTs abnormality. Patients with abnormal LFTs had more severe inflammation and higher degree of organ dysfunction than those without. During hospitalization, patients with abnormal LFTs had a higher rate of transfer to ICU (20vs8%; p<0.001), acute kidney injury (22vs13%, p=0.009), need for mechanical ventilation (14vs6%; p=0.005), and mortality (21vs11%; p=0.004) than those without. In multivariate analysis, patients with abnormal LFTs had a higher risk of the composite endpoint of death or transfer to ICU (OR=3.53; p<0.001). During the hospitalization, 86 patients developed de novo LFTs abnormality, which was associated with the use of tocilizumab, lopinavir/ritonavir and acetaminophen and not clearly associated with the composite endpoint.
Conclusions: LFTs abnormality is common at admission in patients with COVID-19, is associated with systemic inflammation, organ dysfunction and is an independent predictor of transfer to ICU or death.
Keywords: SARS-CoV-2; liver injury; nCOV-19; sepsis.