Liver damage at admission is an independent prognostic factor for COVID-19.

Chen, Liu Ying; Chu, Hui Kuan; Bai, Tao; Tu, Sheng Jin; Wei, Yuan; Li, Zhong Lin; Hu, Li Ling; Zhu, Rui; Zhang, Lei; Han, Chao Qun; Xiao, Li; He, Qi; Song, Jun; Liu, Wei Hua; Zhu, Qing Jing; Chen, Hua; Yang, Ling; Hou, Xiao Hua

OBJECTIVE Abnormal liver function has been noticed as common extra pulmonary organ damage of the coronavirus disease 2019 (COVID-19). Severe patients had a higher probability and progression of liver injury compared with non-severe patients. We aimed to investigate the prognostic value of liver injury in COVID-19 patients. METHODS We retrospectively included 502 patients with laboratory-confirmed SARS CoV-2 infection. Clinical features and survival of patients with and without liver injury were compared. Cox proportional hazard ratio models were used to find the variables that have an effect on survival. RESULTS Among enrolled 502 patients, 301 patients had abnormal liver function with increased neutrophil count, C-reactive protein (CRP), creatinine, troponin (TnI), D-dimer, lactose dehydrogenase (LDH) and creatine kinase (CK). Compared to patients with normal liver functions, those with abnormal liver functions had higher mortality rate (28.9% vs 9.0%, P<0.001), higher ratio of male patients (65.1% vs 40.8%, P<0.001) and higher chance of SIRS development (53.5% vs 41.3%, P=0.007). Among patients with abnormal liver functions, liver damage grade 2 patients (both ALT/AST and ALP/GGT abnormal) had higher ratio of male patients, neutrophil count, PCT, D-dimer and mortality rate. Multivariate Cox regression analyses suggested that grade of liver damage (HR:1.377, 95%CI:1.000-1.896, P=0.049) was an independent predictor of death. CONCLUSIONS COVID-19 patients with abnormal liver functions have a higher mortality. Liver damage is an independent prognostic factor of COVID-19. This article is protected by copyright. All rights reserved.