ISSN: 2574-8009
Authors: Ilaria L*, Andrea A, Vincenzo M, Marco I, Elisabetta T, Andrea Di L, Loredana S, Mario A and Massimo A
1.1. Background: Liver injury (LI) occurring in patients with COVID-19 has been reported, yet its prognostic significance remains unexplored. 1.2. Aim: To investigate whether the onset, type and severity of virus-associated LI predicts the clinical outcomes of the disease 1.3. Methods: All consecutive patients with COVID-19 admitted to the Infectious Disease Unit of the University Hospital of Rome “Tor Vergata†from February to May 2020, were enrolled. LI was defined as the presence of an elevation of aminotransferases, gamma-glutamyl transferase or alkaline phosphatase greater than 1.5 times above the upper limit of normality (ULN), and/or a total bilirubin greater than 2.0 mg/dl. Death was considered as the primary endpoint. 1.4. Results: Among 151 hospitalized patients (mean age, 64 ± 18 years; 62.9% males) 41 (27.1%) died. LI was found in 57.6% of cases and in 23.8% was already present at admission. LI was associated with older age (p=0.006), longer hospital stay (p<0.0001), ICU admission (p=0.002), obesity (p=0.019) and cardiovascular diseases (p=0.029). Patients who died were older (p<0.0001), were more frequently admitted in ICU (p<0.0001) and had more comorbidities (40/41 patients; p<0.0001). Among 41 patients who died, 32 (78%) had LI (p=0.002) and the presence of this condition at admission was a significant predictor of lower survival (35 vs 49 days; p=0.030). At multivariate analysis, low albumin (p<0.0001), low ALT (p=0.0002), high AST (p=0.0250), high LDH (p=0.0014), low platelet count (p=0.0056) and high white blood cell count (p=0.0001) were independently associated with a greater risk of death. 1.5. Conclusion: LI occurs frequently in COVID-19 and its early emergence is an unfavourable prognostic marker of disease and clinical outcomes.
Keywords: SARS-Cov-2; COVID-19; Liver Injury; Survival
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