Table 4.
Association Between Liver Test Abnormalities and Outcomes in Hospitalized Patients with COVID-19
| Unadjusted | Model 1 (demographic variables) * | Model 2 (model 1 + comorbidity Variables) ** | Model 3 (models 1 and 2 + severe illness variables) *** | |||||
|---|---|---|---|---|---|---|---|---|
| OR (95% CI) | p-value | OR (95% CI) | p-value | OR (95% CI) | p-value | OR (95% CI) | p-value | |
| A. Association with in-hospital mortality | ||||||||
| Peak ALT | ||||||||
| Normal | Reference | Reference | Reference | Reference | ||||
| 1–3 × ULN | 0.9 (0.6–1.2) | 0.305 | 0.9 (0.7–1.3) | 0.730 | 1.1 (0.7–1.5) | 0.736 | 0.8 (0.5–1.2) | 0.213 |
| 3–10 × ULN | 1.0 (0.7–1.4) | 0.912 | 1.3 (0.9–1.9) | 0.222 | 1.7 (1.1–2.5) | 0.014 | 0.6 (0.4–1.01) | 0.055 |
| 10–20 × ULN | 1.0 (0.4–2.1) | 0.911 | 1.3 (0.6–3.1) | 0.537 | 1.5 (0.6–4.0) | 0.432 | 0.4 (0.2–1.3) | 0.132 |
| > 20 × ULN | 6.0 (3.1–11.5) | < 0.001 | 7.1 (3.1–14.2) | < 0.001 | 7.8 (3.7–16.3) | < 0.001 | 2.2 (0.9–5.4) | 0.075 |
| Peak ALP | ||||||||
| Normal | Reference | Reference | Reference | Reference | ||||
| 1–2 × ULN | 2.4 (1.8–3.2) | < 0.001 | 2.7 (2.0–3.7) | < 0.001 | 2.8 (2.0–3.8) | < 0.001 | 1.4 (0.9–2.1) | 0.064 |
| 2–3 × ULN | 3.8 (2.2–6.4) | < 0.001 | 4.2 (2.4–7.4) | < 0.001 | 4.7 (2.6–8.6) | < 0.001 | 1.6 (0.8–3.1) | 0.149 |
| > 3 × ULN | 4.4 (2.5–7.7) | < 0.001 | 5.1 (2.8–9.3) | < 0.001 | 4.8 (2.5–9.4) | < 0.001 | 2.0 (0.9–4.2) | 0.067 |
| Severe ALI | 6.8 (3.0–15.3) | < 0.001 | 7.4 (3.1–17.7) | < 0.001 | 7.3 (3.0–17.8) | < 0.001 | 2.8 (1.01–7.9) | 0.047 |
| B. Association with hospital LOS | ||||||||
| Peak ALT | ||||||||
| Normal | Reference | Reference | Reference | Reference | ||||
| 1–3 × ULN | 2.4 (0.9–3.8) | 0.001 | 2.7 (1.3–4.2) | < 0.001 | 2.6 (1.2–4.1) | < 0.001 | 1.6 (0.4–2.9) | 0.012 |
| 3–10 × ULN | 7.7 (6.0–9.4) | < 0.001 | 8.3 (6.6–10.0) | < 0.001 | 8.6 (7.0–10.3) | < 0.001 | 4.3 (2.8–5.9) | < 0.001 |
| 10–20 × ULN | 11.1 (7.4–14.8) | < 0.001 | 11.7 (8.0–15.4) | < 0.001 | 11.3 (7.5–15.1) | < 0.001 | 5.0 (1.6–8.4) | 0.004 |
| > 20 × ULN | 10.2 (6.4–14.0) | < 0.001 | 10.1 (6.4–13.9) | < 0.001 | 9.9 (6.2–13.5) | < 0.001 | 2.8 (-0.6–6.1) | 0.107 |
| Peak ALP | ||||||||
| Normal | Reference | Reference | Reference | Reference | ||||
| 1–2 × ULN | 7.5 (6.2–8.8) | < 0.001 | 7.7 (6.3–9.1) | < 0.001 | 7.2 (5.8–8.6) | < 0.001 | 3.8 (2.4–5.1) | < 0.001 |
| 2–3 × ULN | 13.9 (11.2–16.6) | < 0.001 | 13.7 (10.9–16.6) | < 0.001 | 11.7 (8.8–14.6) | < 0.001 | 5.3 (2.6–7.9) | < 0.001 |
| > 3 × ULN | 11.8 (8.8–14.8) | < 0.001 | 11.9 (8.8–15.0) | < 0.001 | 11.7 (8.5–14.9) | < 0.001 | 6.4 (3.5–9.3) | < 0.001 |
| Severe ALI | 3.3 (-1.6–8.2) | 0.185 | 2.8 (-2.1–7.7) | 0.259 | 3.3 (-1.5–8.1) | 0.180 | -3.8 (-8.0–0.4) | 0.073 |
Abbreviations:ALI =acute liver injury, ALP = alkaline phosphatase, ALT = alanine aminotransferase, CI = confidence interval, OR = odds ratio, ULN = upper limit of normal
*Model 1 adjusted for age (per 10 years), sex, race, Hispanic ethnicity, smoking, and alcohol use
**Model 2 adjusted for model 1 variables plus body mass index (per 5 units), hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, end-stage liver disease, cancer, dementia, connective tissue disease, HIV infection, and chronic liver disease
***Model 3 adjusted for models 1 and 2 variables plus acute kidney injury, need for vasopressors, need for mechanical ventilation, and need for ECMO