Liver function test (LFT) abnormalities at the time of hospital admission, such as hypoalbuminemia combined with elevated aminotransferases or gammaglutamyltransferase (GGT), are highly significant, independent risk factors for a severe course of SARS-CoV-2 infection, according to a study published in Gut.

A total of 275 patients with a diagnosis or suspicion of COVID-19 were prospectively enrolled from a university hospital in Germany from March 2020 to July 2020. Participants had a median age of 63 years and 66% were male. Arterial hypertension, diabetes mellitus type 2, coronary artery disease, and chronic kidney disease were the most common underlying medical conditions.

Of the 217 patients with SARS-CoV-2 infection that were included in the analysis, 36% required treatment in the intensive care unit (ICU) and 32% needed mechanical ventilation. The overall fatality rate was 14.7%, primarily related to COVID-19.


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A total of 125 patients (58%) had liver biochemistry abnormalities at hospital admission, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), GGT, alkaline phosphatase (ALP), and total bilirubin (TBIL). Increased levels of ALT and AST at hospital admission were observed in 27% and 42% of patients, respectively.

Patients with COVID-19 who needed ICU treatment had significantly higher baseline levels of AST, ALT, GGT, and TBIL (P <.05), as well as higher peak levels of AST, ALT, TBIL, GGT, and ALP (P <.001). They also had significantly lower albumin levels at baseline and respective nadir (P <.001).

When albumin deficiency and increased levels of AST, ALT, GGT, or any liver parameter at admission were combined, the study authors observed a more than 20-fold risk increase in ICU admission, with the highest odds ratio (OR) found for the combination of hypoalbuminemia and AST (OR, 46.22; P <.001) and of hypoalbuminemia and GGT (OR, 38.82; P <.001). Hypoalbuminemia combined with TBIL elevation at hospital admission was associated with an almost 10-fold risk increase for COVID-19-related death.

GGT elevation combined with hypoalbuminemia was associated with an increase in ICU admission or the composite endpoint for severe COVID-19 (OR, 38.82 and 26.85, respectively). “The same applied for AST elevation in combination with hypoalbuminemia, for which an OR of 46.22 and 42.04, respectively, was observed for ICU admission or the composite endpoint of ICU admission and/or COVID-19-related death,” according to the investigators.

The researchers noted that their study included only patients who presented or were referred to their university hospital, and thus there may be a potential bias towards more severe COVID-19 cases. It is possible that LFT elevation at admission might represent a more severe course of SARS-CoV-2 infection.

“[B]aseline hypoalbuminaemia when combined with other abnormal LFT in particular with abnormal AST or GGT should be regarded as a red flag indicating a more severe course of the disease and could support clinical decisions regarding closer monitoring and intensive care of patients with COVID-19,” the study authors concluded.

Reference

Weber S, Hellmuth JC, Scherer C, et al. Liver function test abnormalities at hospital admission are associated with severe course of SARS-CoV-2 infection: a prospective cohort study. Gut. Published online January 29, 2021. doi: 10.1136/gutjnl-2020-323800