Saint Michael's Medical Center Newark, NJ, United States
Raed Atiyat, MD1, Hannah Beachwood, 2, Kok Hoe Chan, MD1, Kassidy R. Veasaw, 3, Samir Elias, MPH4, Theodore Dacosta, MD1, Yatinder Bains, MD1, Mehul Shah, MD1 1Saint Michael's Medical Center, Newark, NJ; 2University of New England College of Osteopathic Medicine, Newark, NJ; 3University of New England College of Osteopathic Medicine, Owego, NY; 4St. George's University, Clifton, NJ
Introduction: COVID-19 is a systemic disease that causes multiple organ failure. Abnormal liver chemistries are commonly seen in patients with COVID-19. We aimed to investigate the relationship of abnormal liver chemistries with clinical outcome in these cohort of patients.
Methods: A retrospective hospital cohort study was conducted on patients ≥ 18 years old with COVID-19 who were admitted to our hospital between March 2020 and May 2020. Patients that do not have complete laboratory parameters and no clear clinical outcome were excluded from the study.Continuous data was expressed as percentages or mean. The chi-square (χ) test was used to identify the associations between categorical variables. Logistic regression model was performed to identify the logistic correlation between liver enzyme parameters and clinical outcomes. PRISM statistical software was used for all data analysis.
Results: After excluding patients with no complete laboratory, total number of study participants was 458. The upper normal limit (ULN) of liver enzyme aspartate transaminase (AST) and alanine transaminase (ALT) was 36 and 29 respectively. The average of AST and ALT in the study participants were 242.4 ± 63.76 and 137.5 ± 24.45.
Number of patients with >3 times ULN of AST was 123 with an incidence of 26.9%. As for ALT, number of patients with >3 times the ULN was 117, with an incidence of 25.5%. When combined, the total number of patients with >3 times the ULN was 93, with an incidence of 20%. We dissected the potential of AST/ALT ratio in predicting the liver disease in patients with COVID-19, number of patients with AST/ALT ratio of >2 was 74.
There is statistically difference in liver enzyme parameters between the survival and expired cohorts. AST, ALT and AST/ALT ratio tends to be higher in the expired groups with p-value of < 0.0001 for all three parameters. Nonetheless, there is significant correlation between the elevation of liver enzyme with clinical outcome. The correlation index (R squared) for AST, ALT and AST/ALT ratio was 0.042, 0.042 and 0.08 respectively.
Discussion: While there was no strong statistical correlation between liver enzymes and mortality, there was a noticeable significance in elevated liver enzymes in expired patients versus patients that survived. There may be a role of using AST, ALT and AST/ALT ratio as a prognosis indicator in patients with COVID-19. Larger studies are required to establish the relationship between liver chemistry abnormalities and morality in COVID 19 patients.
Figure: AST vs ALT vs Ratios
Raed Atiyat indicated no relevant financial relationships.
Hannah Beachwood indicated no relevant financial relationships.
Kok Hoe Chan indicated no relevant financial relationships.
Kassidy Veasaw indicated no relevant financial relationships.
Samir Elias indicated no relevant financial relationships.
Theodore Dacosta indicated no relevant financial relationships.
Yatinder Bains indicated no relevant financial relationships.
Mehul Shah indicated no relevant financial relationships.
Raed Atiyat, MD1, Hannah Beachwood, 2, Kok Hoe Chan, MD1, Kassidy R. Veasaw, 3, Samir Elias, MPH4, Theodore Dacosta, MD1, Yatinder Bains, MD1, Mehul Shah, MD1. P1791 - Interplay of COVID-19 Associated Transaminase and Clinical Outcome: A Retrospective Cohort Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.