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Observational Study
. 2020 Oct;72(4):1169-1176.
doi: 10.1002/hep.31487.

Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network

Melanie A Hundt  1 , Yanhong Deng  2 , Maria M Ciarleglio  2 , Michael H Nathanson  1   3 , Joseph K Lim  1   3
Affiliations
Observational Study

Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network

Melanie A Hundt et al. Hepatology. 2020 Oct.

Abstract

Background and aims: The coronavirus-19 disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 virus, is associated with significant morbidity and mortality attributable to pneumonia, acute respiratory distress syndrome, and multiorgan failure. Liver injury has been reported as a nonpulmonary manifestation of COVID-19, but characterization of liver test abnormalities and their association with clinical outcomes is incomplete.

Approach and results: We conducted a retrospective cohort study of 1,827 patients with confirmed COVID-19 who were hospitalized within the Yale-New Haven Health System between March 14, 2020 and April 23, 2020. Clinical characteristics, liver tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP], total bilirubin [TBIL], and albumin) at three time points (preinfection baseline, admission, and peak hospitalization), and hospitalization outcomes (severe COVID-19, intensive care unit [ICU] admission, mechanical ventilation, and death) were analyzed. Abnormal liver tests were commonly observed in hospitalized patients with COVID-19, both at admission (AST 66.9%, ALT 41.6%, ALP 13.5%, and TBIL 4.3%) and peak hospitalization (AST 83.4%, ALT 61.6%, ALP 22.7%, and TBIL 16.1%). Most patients with abnormal liver tests at admission had minimal elevations 1-2× the upper limit of normal (ULN; AST 63.7%, ALT 63.5%, ALP 80.0%, and TBIL 75.7%). A significant proportion of these patients had abnormal liver tests prehospitalization (AST 25.9%, ALT 38.0%, ALP 56.8%, and TBIL 44.4%). Multivariate analysis revealed an association between abnormal liver tests and severe COVID-19, including ICU admission, mechanical ventilation, and death; associations with age, male sex, body mass index, and diabetes mellitus were also observed. Medications used in COVID-19 treatment (lopinavir/ritonavir, hydroxychloroquine, remdesivir, and tocilizumab) were associated with peak hospitalization liver transaminase elevations >5× ULN.

Conclusions: Abnormal liver tests occur in most hospitalized patients with COVID-19 and may be associated with poorer clinical outcomes.

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Conflict of interest statement

Conflict of interest disclosure: MAH, YD, MMC, and MHN report no disclosures. JKL reports research contracts (to Yale University) from Allergan, Conatus, Genfit, Gilead, and Intercept.

Figures

Figure 1:
Figure 1:
Liver test abnormality by COVID-19 severity (pre-hospital vs. admission liver tests) AST = aspartate aminotransferase; ALT = alanine aminotransferase; ALP = alkaline phosphatase; TBIL = total bilirubin
Figure 1:
Figure 1:
Liver test abnormality by COVID-19 severity (pre-hospital vs. admission liver tests) AST = aspartate aminotransferase; ALT = alanine aminotransferase; ALP = alkaline phosphatase; TBIL = total bilirubin
Figure 1:
Figure 1:
Liver test abnormality by COVID-19 severity (pre-hospital vs. admission liver tests) AST = aspartate aminotransferase; ALT = alanine aminotransferase; ALP = alkaline phosphatase; TBIL = total bilirubin
See this image and copyright information in PMC

Comment in

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