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Multicenter Study
. 2020 Oct;40(10):2394-2406.
doi: 10.1111/liv.14565. Epub 2020 Jul 5.

Abnormal liver function tests predict transfer to intensive care unit and death in COVID-19

Salvatore Piano  1 , Andrea Dalbeni  2 , Elia Vettore  3 , Devis Benfaremo  4 , Massimo Mattioli  5 , Carmine G Gambino  1 , Viviana Framba  1 , Lorenzo Cerruti  1 , Anna Mantovani  2 , Andrea Martini  1   3 , Michele M Luchetti  4 , Roberto Serra  1 , Annamaria Cattelan  6 , Roberto Vettor  1 , Paolo Angeli  1 ; COVID-LIVER study group
Affiliations
Multicenter Study

Abnormal liver function tests predict transfer to intensive care unit and death in COVID-19

Salvatore Piano et al. Liver Int. 2020 Oct.

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 multicentre, 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 (20% vs 8%; P < .001), acute kidney injury (22% vs 13%, P = .009), need for mechanical ventilation (14% vs 6%; P = .005) and mortality (21% vs 11%; P = .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 < .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.

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Conflict of interest statement

The authors states that they have no conflicts of interest regarding the content of this manuscript.

Figures

Figure 1
Figure 1
Flow chart of the study Legend: COVID‐19, coronavirus disease 2019; LFTs, liver function tests
Figure 2
Figure 2
Composite outcome of transfer to intensive care unit or death according to abnormality of liver function tests and the baseline respiratory component of SOFA score. Legend: ICU, intensive care unit; LFTs, liver function tests; SOFA, sequential organ failure assessment
Figure 3
Figure 3
Probability of the composite outcome of transfer to intensive care unit or death according to abnormality of liver function tests. Legend: ICU, intensive care unit; LFTs, liver function tests
See this image and copyright information in PMC

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