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

Piano, Salvatore; Dalbeni, Andrea; Vettore, Elia; Benfaremo, Devis; Mattioli, Massimo; Gambino, Carmine Gabriele; Framba, Viviana; Cerruti, Lorenzo; Mantovani, Anna; Martini, Andrea; Luchetti, Michele Maria; Serra, Roberto; Cattelan, Annamaria; Vettor, Roberto; Angeli, Paolo

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 multicenter, 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 (20vs8%; p<0.001), acute kidney injury (22vs13%, p=0.009), need for mechanical ventilation (14vs6%; p=0.005), and mortality (21vs11%; p=0.004) 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<0.001). 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.