Predictors and Outcomes of Hospitalized COVID-19 Patients with Liver Injury

Henry Winston C. Li; Janus P. Ong; Maria Sonia S. Salamat; Anna Flor G.  Malundo; Cybele Lara R. Abad

doi:10.47895/amp.vi0.4651

Henry Winston C. Li, MD Division of Gastroenterology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila https://orcid.org/0000-0001-6408-191X
Janus P. Ong, MD Division of Gastroenterology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
Maria Sonia S. Salamat, MD, MPH Division of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
Anna Flor G. Malundo, MD Division of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
Cybele Lara R. Abad, MD Division of Infectious Diseases, Department of Medicine; Philippine General Hospital, University of the Philippines Manila

DOI: https://doi.org/10.47895/amp.vi0.4651

Keywords: Liver injury, Coronavirus disease-19, Severe Acute Respiratory Syndrome Coronavirus-2, Clinical outcomes, Alanine aminotransferase elevation

Abstract

Objective. To determine incidence, predictors, and impact of liver injury among hospitalized COVID-19 patients

Methods. This is a retrospective cohort study of hospitalized COVID-19 patients at the University of the PhilippinesPhilippine General Hospital. Liver injury (LI) was defined as ALT elevation above institutional cut-off (>50 u/L) and was classified as mild (>1x to 3x ULN), moderate (>3x to 5x ULN), or severe (>5x ULN). Significant liver injury (SLI) was defined as moderate to severe LI. Univariate analysis of SLI predictors was performed. The impact of LI on clinical outcomes was determined and adjusted for known predictors -age, sex, and comorbidities.

Results. Of the 1,131 patients, 565 (50.04%) developed LI. SLI was associated with male sex, alcohol use, chronic
liver disease, increasing COVID-19 severity, high bilirubin, AST, LDH, CRP, and low lymphocyte count and albumin. An increasing degree of LI correlated with ICU admission. Only severe LI was associated with the risk of invasive ventilation (OR: 3.54, p=0.01) and mortality (OR: 2.76, p=0.01). Severe LI, male sex, cardiovascular disease, and malignancy were associated with longer hospital stay among survivors.

Conclusion. The liver injury occurred commonly among COVID-19 patients and was associated with important clinicodemographic characteristics. Severe liver injury increases the risk of adverse outcomes among hospitalized patients.