The effect of liver test abnormalities on the prognosis of covid-19

Medetalibeyoglu, Alpay; Catma, Yunus; Senkal, Naci; Ormeci, Asli; Cavus, Bilger; Kose, Murat; Bayramlar, Osman Faruk; Yildiz, Gulcan; Akyuz, Filiz; Kaymakoglu, Sabahattin; Tukek, Tufan

INTRODUCTION: COVID-19 caused by the SARS-CoV-2 continues to spread rapidly across the world. In our study, we aim to investigate the relationship between the liver enzymes on admission (AST, ALT, ALP, GGT) and severity of COVID-19. We evaluated course of disease, hospital stay, liver damage and mortality. MATERIALS AND METHODS: Our study included 614 patients who were hospitalized with the diagnosis of COVID-19 between 03.16.20-05.12.20. Patients with liver disease, hematological and solid organ malignancy with liver metastases were excluded, resulting in 554 patients who met our inclusion criteria. We retrospectively evaluated liver transaminase levels, AST/ALT ratio, cholestatic enzyme levels and R ratio during hospital admission and these were compared in terms of morbidity, mortality and clinical course. RESULTS: Mean age of 554 subjects were 66.21 ± 15.45 years, 328 (59.2%) were men. The mean values of liver enzymes on admission were AST(36.2 ± 33.6 U/L), ALT(34.01 ± 49.34 U/L), ALP(78.8 ± 46.86 U/L), GGT(46.25 ± 60.05 U/L). Mortality rate and need for intensive care unit were statistically significant in subjects that had high ALT-AST levels during their admission to the hospital(p = 0.001). According to the ROC analysis AST/ALT ratio was a good marker of mortality risk (AUC = 0.713:p = 0.001) and expected probability of intensive care unit admission (AUC = 0.636:p = 0.001). R ratio, which was used to evaluate prognosis, showed a poor prognosis rate of 26.5% in the cholestatic injury group, 36.1% in the mixed pattern group and 30% in the hepato-cellular injury group(p 0.001). CONCLUSIONS: ALT-AST elevation and AST/ALT ratio>1 was associated with more severe course and increased mortality in COVID-19.