The role of liver steatosis as measured with transient elastographyand transaminases on hard clinical outcomes in patients withCOVID-19

摘要

Liver injury has been widely described in patients with Coronavirus disease 2019(COVID-19). We aimed to study the effect of liver biochemistry alterations,previous liver disease, and the value of liver elastography on hard clinicaloutcomes in COVID-19 patients. We conducted a single-center prospectiveobservational study in 370 consecutive patients admitted for polymerase chainreaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data werecollected at baseline and liver parameters and clinical events recorded duringfollow-up. Transient elastography [with Controlled Attenuation Parameter (CAP)measurements] was performed at admission in 98 patients. All patients werefollowed up until day 28 or death. The two main outcomes of the study were28-day mortality and the occurrence of the composite endpoint intensive careunit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartateaminotransferase (AST) levels were elevated at admission in 130 patients (35%)and 167 (45%) patients, respectively. Overall, 14.6% of patients presented thecomposite endpoint ICU and/or death. Neither ALT elevations, prior liverdisease, liver stiffness nor liver steatosis (assessed with CAP) had any effecton outcomes. However, patients with abnormal baseline AST had a higheroccurrence of the composite ICU/death (21% versus 9.5%,p = 0.002). Patients ⩾65 years and with an ASTlevel > 50 U/ml at admission had a significantly higher risk of ICU and/ordeath than those with AST ⩽ 50 U/ml (50% versus 13.3%,p < 0.001). In conclusion, mild liver damage isprevalent in COVID-19 patients, but neither ALT elevation nor liver steatosisinfluenced hard clinical outcomes. Elevated baseline AST is a strong predictorof hard outcomes, especially in patients ⩾65 years.