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Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network.
Hepatology. 2020 Jul 29 [Online ahead of print]Hep

Abstract

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, is associated with significant morbidity and mortality due to pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Liver injury has been reported as a non-pulmonary manifestation of COVID-19 but characterization of liver test abnormalities and their association with clinical outcomes is incomplete. We conducted a retrospective cohort study of 1827 patients with confirmed COVID-19 who were hospitalized within the Yale-New Haven Health System (YNHHS) between March 14, 2020 and April 23, 2020. Clinical characteristics, liver tests (AST, ALT, ALP, TBIL, albumin) at three time points (pre-infection baseline, admission, peak hospitalization), and hospitalization outcomes (severe COVID-19, ICU admission, mechanical ventilation, death) were analyzed. Abnormal liver tests were commonly observed in hospitalized patients with COVID-19, both at admission (AST 66.9%, ALT 41.6%, ALP 13.5%, TBIL 4.3%) and peak hospitalization (AST 83.4%, ALT 61.6%, ALP 22.7%, TBIL 16.1%). Most patients with abnormal liver tests at admission had minimal elevations 1-2x ULN (AST 63.7%, ALT 63.5%, ALP 80.0%, TBIL 75.7%). A significant proportion of these patients had abnormal liver tests pre-hospitalization (AST 25.9%, ALT 38.0%, ALP 56.8%, TBIL 44.4%). Multivariate analysis revealed an association between abnormal liver tests and severe COVID-19, including ICU admission, mechanical ventilation, and death; associations with age, male gender, BMI, and diabetes mellitus were also observed. Medications used in COVID-19 treatment (lopinavir/ritonavir, hydroxychloroquine, remdesivir, and tocilizumab) were associated with peak hospitalization liver transaminase elevations >5x ULN.

Conclusion:

Abnormal liver tests occur in most hospitalized patients with COVID-19 and may be associated with poorer clinical outcomes.

Authors+Show Affiliations

Department of Medicine, Yale School of Medicine, New Haven, CT, United States.Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, United States.Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, United States.Department of Medicine, Yale School of Medicine, New Haven, CT, United States. Yale Liver Center and Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, United States.Department of Medicine, Yale School of Medicine, New Haven, CT, United States. Yale Liver Center and Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32725890

Citation

Hundt, Melanie A., et al. "Abnormal Liver Tests in COVID-19: a Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network." Hepatology (Baltimore, Md.), 2020.
Hundt MA, Deng Y, Ciarleglio MM, et al. Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network. Hepatology. 2020.
Hundt, M. A., Deng, Y., Ciarleglio, M. M., Nathanson, M. H., & Lim, J. K. (2020). Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network. Hepatology (Baltimore, Md.). https://doi.org/10.1002/hep.31487
Hundt MA, et al. Abnormal Liver Tests in COVID-19: a Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network. Hepatology. 2020 Jul 29; PubMed PMID: 32725890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1827 Patients in a Major U.S. Hospital Network. AU - Hundt,Melanie A, AU - Deng,Yanhong, AU - Ciarleglio,Maria M, AU - Nathanson,Michael H, AU - Lim,Joseph K, Y1 - 2020/07/29/ PY - 2020/7/30/entrez KW - SARS-CoV-2 KW - coronavirus KW - hepatitis KW - liver function tests KW - liver injury JF - Hepatology (Baltimore, Md.) JO - Hepatology N2 - The COVID-19 pandemic, caused by the SARS-CoV-2 virus, is associated with significant morbidity and mortality due to pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Liver injury has been reported as a non-pulmonary manifestation of COVID-19 but characterization of liver test abnormalities and their association with clinical outcomes is incomplete. We conducted a retrospective cohort study of 1827 patients with confirmed COVID-19 who were hospitalized within the Yale-New Haven Health System (YNHHS) between March 14, 2020 and April 23, 2020. Clinical characteristics, liver tests (AST, ALT, ALP, TBIL, albumin) at three time points (pre-infection baseline, admission, peak hospitalization), and hospitalization outcomes (severe COVID-19, ICU admission, mechanical ventilation, death) were analyzed. Abnormal liver tests were commonly observed in hospitalized patients with COVID-19, both at admission (AST 66.9%, ALT 41.6%, ALP 13.5%, TBIL 4.3%) and peak hospitalization (AST 83.4%, ALT 61.6%, ALP 22.7%, TBIL 16.1%). Most patients with abnormal liver tests at admission had minimal elevations 1-2x ULN (AST 63.7%, ALT 63.5%, ALP 80.0%, TBIL 75.7%). A significant proportion of these patients had abnormal liver tests pre-hospitalization (AST 25.9%, ALT 38.0%, ALP 56.8%, TBIL 44.4%). Multivariate analysis revealed an association between abnormal liver tests and severe COVID-19, including ICU admission, mechanical ventilation, and death; associations with age, male gender, BMI, and diabetes mellitus were also observed. Medications used in COVID-19 treatment (lopinavir/ritonavir, hydroxychloroquine, remdesivir, and tocilizumab) were associated with peak hospitalization liver transaminase elevations >5x ULN. Conclusion: Abnormal liver tests occur in most hospitalized patients with COVID-19 and may be associated with poorer clinical outcomes. SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/32725890/Abnormal_Liver_Tests_in_COVID-19:_A_Retrospective_Observational_Cohort_Study_of_1827_Patients_in_a_Major_U.S._Hospital_Network L2 - https://doi.org/10.1002/hep.31487 DB - PRIME DP - Unbound Medicine ER -
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