Mohammad Siddiqui, MD1, Suraj Suresh, MD1, Mouhanna Abu Ghanimeh, MD1, Megan Karrick, MD1, Faisal Nimri, MD1, Maher Musleh, MD1, Vivek Mediratta, MD1, Mustafa Al-Shammari, MD2, Stephen Simmer, MD3, Jessica Jou, MD1, Sarah Russell, MD1, Duyen Dang, MD1, Reena Salgia, MD1, Tobias Zuchelli, MD1; 1Henry Ford Hospital, Detroit, MI; 2Henry Ford Health System, Detroit, MI; 3Henry Ford Hospital/Wayne State University, Detroit, MI
Introduction: Based on current literature there appears to be a high prevalence of liver injury (LI) in patients with COVID-19. However, there are limited large scale studies on risk factors, morbidity, and mortality associated with LI in these patients. We aim to determine risk factors and outcomes of patients hospitalized with COVID-19 and LI. Methods: We performed a retrospective single-center study at a large tertiary care hospital. All index admissions of adult patients with confirmed COVID19 between 3/1 to 4/30/2020 were included. Data on baseline characteristics and clinical outcomes was collected during manual chart review. Mild elevation in LFTs (MEL), defined as peak levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TB) above upper limit of normal (ULN) but lower than the threshold for LI. LI was defined as peak ALT/AST three times ULN and/or peak ALP/TB two times ULN. ULN threshold values of ALT 52, AST 35, TB 1.2, ALP 140 were used. Both cohorts were compared with our control group, who had normal LFTs at presentation and throughout the hospitalization. SAS 9.4 was used for analysis. Results: A total of 1935 patients were included of which 507 (26.2%) had normal LFTs, 1030 (53.2%) had MEL, and 397 (20.5%) had LI. Males were more commonly found in the MEL (p=0.0004) and LI groups compared to control (p< .0001). Patients in the MEL cohort were older (p=0.0005). African Americans were more likely to develop LI (p=0.0318). There was no difference in comorbidities between all groups (Table 1). Among patients with LI, 241 (61%) had a hepatocellular pattern, 20 (5%) had a cholestatic pattern, and 135 (34%) had a mixed pattern. Patients with LI had an increased risk of mortality (RR 4.26 [95% CI 3.12, 5.81; p< .0001]), ICU admission (RR 5.52 [95% CI 4.07, 7.49; p< .0001]), intubation (RR 11.01 [95% CI 6.97, 17.34]); p< .0001) and 30-day readmission (1.81 [95% CI 1.17, 2.80; p< .0076]) (Table 2, Figure 1) compared to the control group. Discussion: Our study demonstrates that patients with COVID-19 who present with LI have a significantly increased risk of mortality, mechanical ventilation, ICU admission, and 30-day re-admission compared to patients with MEL and normal LFTs. This information is important to appropriately manage COVID-19 patients. Further research looking at risk prediction models and pooling multi-center data should include liver injury as a key variable.
Table 1. Comparison of baseline patient characteristics (MEL vs. control and LI vs. control)
Table 2. Comparison of relative risk of outcomes (MEL vs control and LI vs control)
Figure 1. Incidence of adverse outcomes in patients with normal LFTs vs. MEL vs. LI
Disclosures: Mohammad Siddiqui indicated no relevant financial relationships. Suraj Suresh indicated no relevant financial relationships. Mouhanna Abu Ghanimeh indicated no relevant financial relationships. Megan Karrick indicated no relevant financial relationships. Faisal Nimri indicated no relevant financial relationships. Maher Musleh indicated no relevant financial relationships. Vivek Mediratta indicated no relevant financial relationships. Mustafa Al-Shammari indicated no relevant financial relationships. Stephen Simmer indicated no relevant financial relationships. Jessica Jou indicated no relevant financial relationships. Sarah Russell indicated no relevant financial relationships. Duyen Dang indicated no relevant financial relationships. Reena Salgia indicated no relevant financial relationships. Tobias Zuchelli indicated no relevant financial relationships.