Introduction: Abnormal liver function tests at hospital admission are frequently reported in patients with coronavirus disease 2019 (COVID-19), but their prognostic significance deserves further investigation.
Aim: To assess whether aspartate aminotransferase (AST) and alanine aminotransferase (ALT) abnormalities at admission predict disease course in patients hospitalized for COVID-19.
Methods: In this single-center retrospective study, data of 188 patients admitted to the Infectious Disease Unit of the Padova University Hospital between February and May 2020 were collected. Patients were considered to have transaminases abnormalities when AST, ALT or both were above the upper limit of normal (ULN). The disease was considered as severe in case of intensive care unit (ICU) patient admission or death.
Results: At admission, 98 patients (52.1%) had abnormal transaminases, but only 12 patients (6.4%) showed levels above 3 x ULN. Patients with severe disease showed higher AST (50 [IQR, 37-77] vs. 30 [IQR, 24-43] U/L, p<0.0001) and a trend to higher ALT (32 [IQR, 20-56] vs. 25 [IQR, 18-39] U/L, p=0.07) levels. Altered transaminases at baseline were associated with a higher probability of ICU transfer (40.8% vs. 15.6%, p=0.0002), mechanical ventilation (19.4% vs. 3.3%, p=0.0005), non-invasive ventilation (12.2% vs. 4.4%, p=0.07), and longer hospital stay (9 vs. 7 days, p=0.002). The risk of severe disease (transfer to ICU or death) was remarkably higher in patients with altered transaminases at admission (46.9% vs. 15.6%; p<0.0001) (Figure), and this was confirmed on multivariable logistic regression analysis after adjusting for sex, age, comorbidities, circulating inflammatory markers (neutrophil-to-lymphocyte ratio and C-reactive protein) and albumin levels with a five-fold higher risk (OR=5.17, 95% CI 1.81-14.70; p=0.002).
Conclusion: Hospitalized COVID-19 patients have frequently transaminases abnormalities at admission, and these alterations are able to independently predict a severe disease course.
