Patterns of liver injury among COVID-19 infected patients in East Avenue Medical Center

Background and Aim: SARS-COV-2 resulted to a pandemic leading to millions of deaths worldwide. Though studies are continuously published describing liver injury in COVID-19, local studies are lacking. We aimed to provide local data and validate relationship between severity of COVID-19 infection with alteration of liver biochemistries. Furthermore, we aimed to investigate if COVID-19 infection predisposes to drug-induced alterations of aminotransferases. Methods: In this retrospective cohort study, 322 admitted patients with suspected COVID-19 infection from March 2020 to August 2020 were included. Association between liver biochemistries with disease severity and clinical outcomes (intubation, ICU admission, and mortality), comparing COVID positive and negative cases, was studied. Changes in AST, ALT from baseline, and after administration of potentially hepatotoxic medications were analyzed. Correlation of liver biochemistries with inflammatory biomarkers (LDH, CRP) was also determined. Results: Comparing COVID positive and negative cases, parameters that were significantly different were baseline AST (p = 0.002), ALT (p = 0.001), and CRP (p = 0.018). Higher AST and ALT are significantly associated with disease severity (AST: p = 0.027, ALT: p = 0.028) and ICU admission (AST: p = 0.001, ALT: p = 0.011). Higher AST, ALT, and TBIL are significantly associated with intubation (AST: p = 0.023, ALT: p = 0.048, TBIL: p = 0.035) while AST and TBIL are significantly associated with mortality (AST: p = 0.019, TBIL: p = 0.049) (Table). There was no sufficient statistical evidence found to conclude that COVID-19 infection predisposes to drug-induced elevations of AST and ALT. Statistically significant positive correlations were observed between AST, ALT, TBIL, INR, and LDH (AST: r = 0.574, p = <0.001;ALT: r = 0.498, p = <0.001;TBIL: r = 0.315, p = 0.001;INR: r = 0.219, p = 0.029). Significant positive correlation also applies between AST, ALT, TBIL, and CRP (AST: r = 0.427, p = <0.001;ALT: r = 0.348, p = <0.001;TBIL: r = 0.249, p = 0.012). Conclusion: Hepatocellular type of liver injury is commonly observed in COVID-19 infection. Elevation of AST, ALT, and TBIL are associated with disease severity and poor clinical outcomes-serving as predictors of severity and prognosis.