Abstract
The Association Between Liver Enzyme Elevation and Coronavirus Disease 2019 Outcome: A Single Center Retrospective Cohort Study
Jose Maria Gonzalez1, Maxine Andrea Garcia1, Madalinee Eternity Labio2
1Department of Internal Medicine, Makati Medical Center , 2Section of Gastroenterology and Liver Unit, Makati Medical Center
Significance: Liver injury in COVID-19 patients lacks sufficient data. This study aims to evaluate the association between liver enzyme elevation with mortality, ICU admission and mortality among COVID-19 patients.
Methodology: A retrospective cohort study of COVID-19 patients admitted in Makati Medical Center. Outcomes of interest were in- hospital mortality, ICU admission and mortality.
Results: 654 COVID-19 patients were analyzed, 517 (79%) presented with liver enzyme elevation and 70 (11%) expired. Among non-survivors, 40% presented with mild, 44% with moderate and 11% with severe enzyme elevation (p<0.001). In univariate analysis, levels >5x ULN had higher odds for mortality (OR 12.32, 95% CI 3.08–49.29), ICU admission (OR 9.82, 95% CI 3.70– 26.03) and severe disease (OR 8.02, 95% CI 3.59–18.18). When correcting for confounders, mild elevation (<2x ULN) was found to have higher odds for mortality (aOR 6.99, 95% CI 1.33 – 36.92) while moderate elevation (2-5x ULN) had higher odds for critical disease (aOR 3.44, 95% CI 1.57–7.52).
Conclusion: COVID-19 patients with elevated baseline liver enzymes may be at higher risk of mortality, ICU admission and disease severity. Pre-existing liver disease was not found to increase the odds for a poor outcome in this study, though this may be due to under reporting of liver disease and lack of routine screening. COVID-19 disease severity, lower hemoglobin and elevated Troponin were found to increase the odds for in-hospital mortality.
Keywords: COVID-19 liver enzyme elevation, mortality, disease severity, ICU admission
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |