Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19 (original) (raw)

Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19

http://orcid.org/0000-0002-1819-2464Terry Cheuk-Fung Yip1,
Grace Chung-Yan Lui2,
http://orcid.org/0000-0003-2215-9410Vincent Wai-Sun Wong1,
Viola Chi-Ying Chow3,
Tracy Hang-Yee Ho4,
Timothy Chun-Man Li4,
Yee-Kit Tse1,
David Shu-Cheong Hui2,
Henry Lik-Yuen Chan1,
http://orcid.org/0000-0002-2863-9389Grace Lai-Hung Wong1
1 Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
2 Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
3 Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
4 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Correspondence to Dr Grace Lai-Hung Wong, Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong; wonglaihung{at}cuhk.edu.hk

Abstract

Objective Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear.

Design This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death.

Results We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir–ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation.

Conclusion ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir–ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.

cholestasis
hepatitis
liver function test

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