Abnormal liver biochemistry constitutes an independent prognostic factor of a less favorable clinical course in patients with COVID-19.

Alventosa Mateu, Carlos; Urquijo Ponce, Juan José; Puchades Gimeno, Francesc; Benlloch Pérez, Salvador; Sanz Herrero, Francisco; Latorre Sánchez, Mercedes; García Deltoro, Miguel; Gimeno Cardona, Concepción; Ocete Mochón, María Dolores; Diago Madrid, Moisés

INTRODUCTION Abnormal liver biochemistry (ALB) is correlated with increased clinical involvement or severity in COVID-19, but its prognostic implications have not been studied extensively. Our aim is to determine whether ALB is a risk factor for an unfavorable clinical outcome and involvement. MATERIALS AND METHODS Retrospective, single-center study of confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as the elevation of total bilirubin, AST, ALT, alkaline phosphatase and/or GGT above the upper limit of normal. An assessment was first made of the correlation between ALB and the need for hospitalization. This was followed by an assessment of the correlation of hospitalized patients with demographic variables, comorbidities and treatment for COVID-19 and with clinical involvement and outcome. Statistical analysis was performed using age-adjusted multiple logistic regression with a p-value of <0.05 RESULTS: Of 1,277 confirmed cases, 346 required hospitalization, and 302 were included. The prevalence of ALB was higher in hospitalized patients compared to non-hospitalized patients (60.9% vs. 10.3%, p Ë‚0.001). Among the hospitalized patients, there was no correlation between ALB and demographic variables, comorbidities or treatment for COVID-19, except for low molecular weight heparin. We found a significant correlation between ALB and moderate/severe COVID-19 involvement and between unfavorable clinical outcomes and elevated total bilirubin. The period of greatest clinical worsening and deterioration of liver biochemistry parameters occurred during the first seven days. There was a significant correlation between ALB and a longer hospital stay and admission to the Intensive Care Unit, but this did not imply higher mortality. CONCLUSIONS ALB is correlated with greater clinical involvement and worse clinical outcomes in hospitalized patients with COVID-19.