Longitudinal analysis of the utility of liver biochemistry in hospitalised COVID-19 patients as prognostic markers

ABSTRACT

Background: COVID-19, the clinical syndrome caused by infection with SARS-CoV-2, has been associated with deranged liver biochemistry in studies from China, Italy and the USA. However, the clinical utility of liver biochemistry as a prognostic marker of outcome for COVID-19 is currently debated. Methods: We extracted routinely collected clinical data from a large teaching hospital in the UK, matching 585 hospitalised SARS-CoV-2 RT-PCR-positive patients to 1165 hospitalised SARS-CoV-2 RT-PCR-negative patients for age, gender, ethnicity and pre-existing comorbidities. Liver biochemistry was compared between groups over time to determine whether derangement was associated with outcome. Results: 26.8% (157/585) of COVID-19 patients died, compared to 11.9% (139/1165) in the non-COVID-19 group (p<0.001). At presentation, a significantly higher proportion of the COVID-19 group had elevated alanine aminotransferase (20.7% vs. 14.6%, p=0.004) and hypoalbuminaemia (58.7% vs. 35.0%, p<0.001), compared to the non-COVID-19 group. Within the COVID-19 group, those with hypoalbuminaemia at presentation had 1.83-fold increased hazards of death compared to those with normal albumin (adjusted hazard ratio [HR] 1.83, 95% CI 1.25-2.67), whilst the hazard of death was ~4-fold higher in those aged [≥]75 years (adjusted HR 3.96, 95% CI 2.59-6.04) and ~3-fold higher in those with pre-existing liver disease (adjusted HR 3.37, 95% CI 1.58-7.16). In the COVID-19 group, alkaline phosphatase increased (R=0.192, p<0.0001) and albumin declined (R=-0.123, p=0.0004) over time in patients who died. We did not find a significant association between other liver biochemistry and death. Conclusion: In this UK population, liver biochemistry is commonly deranged in patients with COVID-19 but only baseline low albumin and a rising alkaline phosphatase over time are prognostic markers for death.