Impact of abnormal liver tests and chronic liver disease in hospitalized COVID-19 patients' outcomes-a still growing understanding

Background: The impact of SARS-CoV-2 infection on the liver and the possibility of chronic liver disease (CLD) as a risk factor for COVID-19 severity is not fully understood Our goal was to describe clinical outcomes of COVID-19 patients regarding the presence of abnormal liver tests (LTs) and CLD Methods: Retrospective analysis of clinical, analytical and imaging features of patients with SARS-CoV-2 infection, hospitalized in a tertiary care center in Portugal from March 2nd to May 4th, 2020 Studied outcomes were disease and hospitalization duration, COVID-19 severity, admission to intensive care unit (ICU) and mortality, analyzed by the presence of abnormal liver enzymes and CLD Results: We included 317 inpatients with a mean age of 70 4 years, 50 5% males COVID-19 severity was moderate to severe in 57 4% and critical in 12 9% Mean disease duration was 37 8 days, median hospitalization duration 10 0 days and overall mortality 28 6% At admission, 50 3% of the patients showed abnormal LTs and 41 5% showed elevated transaminase levels, from which the majority (75 4%) were mild (up to 2x the ULN) Male gender (62 3% vs 37 3%, p= 001) and age >65 years (71 3% vs 28 7%, p= 006) were associated with elevated transaminase levels Also, elevated transaminases at admission were associated with COVID-19 severity (34 4% vs 18 38%, p= 001), ICU admission (13 1% vs 5 92%, p= 034) and increased mortality (25 8% vs 13 3%, p= 007) In our cohort, 14 patients had baseline CLD (4 42%), 3 of them with cirrhosis Alcohol (n=6) and non-alcoholic fatty liver disease (n=6) were the most frequent etiologies CLD patients presented increased frequency of critical COVID-19 (21 4% vs 12 5%, p= 237), longer disease duration (36 6 vs 31 4 days, p= 291), hospitalization duration (11 5 vs 10 0 days, p= 447) and increased mortality (28 6% vs 22 5%, p= 595) Cirrhotic patients had longer inpatient duration (15 0 vs 10 0 days, p= 639), increased COVID-19 severity (66 6% vs 54 6%, p= 844) and higher mortality (66 7% vs 18 2%, p= 176) Conclusion: LTs abnormalities in COVID-19 patients were frequent but most commonly mild They were associated with worse clinical outcomes, such as COVID-19 severity, ICU admission and mortality Also, 4 41% of our COVID-19 patients presented CLD and a trend towards worse clinical outcomes