Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19?
J Clin Exp Hepatol
; 12(4): 1114-1123, 2022.
Article
en En
| MEDLINE
| ID: mdl-35125781
ABSTRACT
Background:
The most dreaded pandemic grappling world now, the Coronavirus Disease 2019 (COVID-19), chiefly involves the respiratory system; nevertheless, it is a multisystem disorder. Its involvement of the hepatic system is considerable; however, still emerging are its clinical implications and the effects on morbidity and mortality.Aim:
The aim of this study is to report on the various aspects of its hepatic involvement by describing the alterations in tests of liver function and its significance in the disease outcome in a cohort of hospitalized COVID-19 patients at a tertiary center in northern India.Methods:
This is a retrospective cohort study conducted in a tertiary-care hospital in northern India. All confirmed hospitalized COVID-19 cases aged 15 and above from Apr to Oct 2020 with no pre-existing liver disease were included. The primary endpoint was death at 28 days. Statistical analysis included descriptive analysis, sensitivity-specificity, and univariable and multivariable regression analysis as well as survival analysis.Results:
A total of 708 patients with COVID-19 fulfilled the inclusion criteria included 561 (79.2%) males and 147 (20.8%) females. The median age was 49 (IQR = 25) years. Mild and moderate/severe disease were seen in 508 (71.8%) and 200 (28.2) patients, respectively. Serum bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were elevated in 6.92%, 69.91%, and 80.22% of patients, respectively. In univariable logistic regression, AST [odds ratio; OR 1.008 95% CI (1.005-1.012) per 1 IU/L increase] and ALT [OR 1.005 95% CI (1.002-1.007) per 1 IU/L increase] were significantly associated with the odds of moderate to severe disease but only AST was significant after adjustment to age, sex, and comorbidity [adjusted odds ratio; aOR 1.007 95% CI (1.003-1.011) per 1 IU/L increase]. Serum albumin was negatively associated with the odds of moderate to severe disease and remained significant in the adjusted model [aOR 0.217 95%CI (0.149-0.316) per 1 g/dL increase].Ninety-six patients succumbed to illness [case fatality rate; CFR 13.6%). In adjusted Cox Proportional-Hazards Model for mortality, AST [adjusted hazard ratio; aHR 1.002 95% CI (1.000-1.003) per 1 IU/L increase] and serum albumin [aHR 0.396 95% CI (0.285-0.549) per 1 g/dL increase] showed significant association with mortality.Conclusion:
Liver function abnormalities are common in patients with COVID-19. In particular, AST and serum albumin levels are effective predictors of disease severity and mortality and can be used as markers of fatal disease in the management as well as prognostication of COVID-19.
ACG, American College of Gastroenterology; ALC, Absolute Lymphocyte Count; ALP, Alkaline Phosphatase; ALT, Alanine Aminotransferase/Alanine Transaminase; ANC, Absolute Neutrophil Count; AST, Aspartate Aminotransferase/Aspartate Transaminase; AUC, Area Under the Curve; COVID-19; COVID-19, Coronavirus Disease 2019; CRP, C Reactive Protein; GGT, Gamma Glutamyl Transferase; Hb, Hemoglobin; IQR, Interquartile Range; NLR, Neutrophil to Lymphocyte Ratio; OR, Odds Ratio; PLT, Platelet; PT, Prothrombin Time; ROC, Receiver Operating characteristic Curve; RT PCR, Real Time Transcription Polymerase chain reaction; SpO2, Saturation of oxygen by pulse oximetry; TLC, Total Leukocyte Count; ULN, Upper Limit of Normal; liver functions; mortality; serum albumin; severe disease
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Banco de datos:
MEDLINE
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
J Clin Exp Hepatol
Año:
2022
Tipo del documento:
Article
País de afiliación:
India