Elevated Transaminases and Hypoalbuminemia in COVID-19 Are Prognostic Factors for Disease Severity

INTRODUCTION: Prognostic markers are needed to understand the disease course and severity in patients with Covid-19, a respiratory viral illness. There is evidence that Covid-19 causes gastrointestinal symptoms and abnormalities in liver enzymes. We aimed to determine if hepatobiliary laboratory data could predict disease severity in patients with Covid-19. METHODS: This is an IRB approved, retrospective, single institution, cohort study that analyzed patients admitted to a community academic hospital with the diagnosis of Covid-19 between March, 1st 2020 and May 5th, 2020. The primary outcome was the need for Intensive Care Unit (ICU) admission based on elevations in transaminases, Alkaline Phosphatase (AP) and Total Bilirubin (TB). Secondary outcomes included mortality, development of Acute Kidney Injury (AKI) or hypotension and need for supplemental oxygen. RESULTS: Sixty patients were included in the analysis. Elevation of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Alkaline Phosphatase (AP) increased the odds of ICU admission by 5.12 (95% CI: 1.55,16.89; P = 0.007), 4.71 (95% CI: 1.51,14.69; P = 0.01) and 4.12 (95% CI: 1.21,14.06, P = 0.02), respectively. Hypoalbuminemia was associated with increased mortality by an odds ratio of 6.79 (CI: 1.27–36.34, P = 0.02). Additionally, there was evidence of liver injury: the change in AST during admission above baseline was significantly higher in patients admitted to the ICU (54.2 ± 15.70 U/L) relative to those who were not (9.2 ± 4.89 U/L; P = 0.01). CONCLUSION: This study found that hypoalbuminemia and abnormalities in hepatobiliary laboratory data are prognostic factors for disease severity in patients admitted to the hospital with Covid-19. Additionally, there may be evidence of liver injury in Covid-19 patients that is more severe in those admitted to the ICU.

Duke Scholars

Author Ahmad Farooq Medicine, Gastroenterology