tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Ares Villagrasa[SUP] 2 [/SUP], Macarena Simon-Talero[SUP] 2 [/SUP], Mar Riveiro-Barciela[SUP] 2 [/SUP], Meritxell Ventura-Cots[SUP] 2 [/SUP], Lara Aguilera-Castro[SUP] 3 [/SUP], Patricia Alvarez-Lopez[SUP] 2 [/SUP], Emilie A Nordahl[SUP] 4 [/SUP], Adrian Anton[SUP] 2 [/SUP], Juan Bañares[SUP] 2 [/SUP], Claudia Barber[SUP] 3 [/SUP], Ana Barreira-Diaz[SUP] 2 [/SUP], Betina Biagetti[SUP] 5 [/SUP], Laura Camps-Relats[SUP] 2 [/SUP], Andrea Ciudin[SUP] 5 [/SUP], Raul Cocera[SUP] 6 [/SUP], Cristina Dopazo[SUP] 7 [/SUP], Andrea Fernandez[SUP] 7 [/SUP], Cesar Jimenez[SUP] 2 [/SUP], Maria M Jimenez[SUP] 8 [/SUP], Mariona Jofra[SUP] 7 [/SUP], Clara Gil[SUP] 2 [/SUP], Concepción Gomez-Gavara[SUP] 7 [/SUP], Danila Guanozzi[SUP] 3 [/SUP], Jorge A Guevara[SUP] 9 [/SUP], Beatriz Lobo[SUP] 3 [/SUP], Carolina Malagelada[SUP] 3 [/SUP], Joan Martinez-Camprecios[SUP] 2 [/SUP], Luis Mayorga[SUP] 3 [/SUP], Enric Miret[SUP] 6 [/SUP], Elizabeth Pando[SUP] 7 [/SUP], Ana Pérez-Lopez[SUP] 8 [/SUP], Marc Pigrau[SUP] 9 [/SUP], Alba Prio[SUP] 2 [/SUP], Jesus M Rivera-Esteban[SUP] 2 [/SUP], Alba Romero[SUP] 2 [/SUP], Stephanie Tasayco[SUP] 3 [/SUP], Judit Vidal-Gonzalez[SUP] 2 [/SUP], Laura Vidal[SUP] 7 [/SUP], Beatriz Minguez[SUP] 2 [/SUP], Salvador Augustin[SUP] 1 [/SUP], Joan Genesca[SUP] 2 [/SUP]
Affiliations
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.
. 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[SUP] 1 [/SUP], Ares Villagrasa[SUP] 2 [/SUP], Macarena Simon-Talero[SUP] 2 [/SUP], Mar Riveiro-Barciela[SUP] 2 [/SUP], Meritxell Ventura-Cots[SUP] 2 [/SUP], Lara Aguilera-Castro[SUP] 3 [/SUP], Patricia Alvarez-Lopez[SUP] 2 [/SUP], Emilie A Nordahl[SUP] 4 [/SUP], Adrian Anton[SUP] 2 [/SUP], Juan Bañares[SUP] 2 [/SUP], Claudia Barber[SUP] 3 [/SUP], Ana Barreira-Diaz[SUP] 2 [/SUP], Betina Biagetti[SUP] 5 [/SUP], Laura Camps-Relats[SUP] 2 [/SUP], Andrea Ciudin[SUP] 5 [/SUP], Raul Cocera[SUP] 6 [/SUP], Cristina Dopazo[SUP] 7 [/SUP], Andrea Fernandez[SUP] 7 [/SUP], Cesar Jimenez[SUP] 2 [/SUP], Maria M Jimenez[SUP] 8 [/SUP], Mariona Jofra[SUP] 7 [/SUP], Clara Gil[SUP] 2 [/SUP], Concepción Gomez-Gavara[SUP] 7 [/SUP], Danila Guanozzi[SUP] 3 [/SUP], Jorge A Guevara[SUP] 9 [/SUP], Beatriz Lobo[SUP] 3 [/SUP], Carolina Malagelada[SUP] 3 [/SUP], Joan Martinez-Camprecios[SUP] 2 [/SUP], Luis Mayorga[SUP] 3 [/SUP], Enric Miret[SUP] 6 [/SUP], Elizabeth Pando[SUP] 7 [/SUP], Ana Pérez-Lopez[SUP] 8 [/SUP], Marc Pigrau[SUP] 9 [/SUP], Alba Prio[SUP] 2 [/SUP], Jesus M Rivera-Esteban[SUP] 2 [/SUP], Alba Romero[SUP] 2 [/SUP], Stephanie Tasayco[SUP] 3 [/SUP], Judit Vidal-Gonzalez[SUP] 2 [/SUP], Laura Vidal[SUP] 7 [/SUP], Beatriz Minguez[SUP] 2 [/SUP], Salvador Augustin[SUP] 1 [/SUP], Joan Genesca[SUP] 2 [/SUP]
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.