Liver injury in hospitalized patients with COVID-19: An International observational cohort study

Background: Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods: We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results: Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37–1.71]; OR 2.50 [2.10–2.96]), ICU admission (OR 1.63 [1.48–1.79]; OR 1.90 [1.62–2.23]), and invasive mechanical ventilation (OR 1.43 [1.27–1.70]; OR 1.95 (1.55–2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27–1.50]; OR 1.46 [1.25–1.70]), acute kidney injury (OR 1.13 [1.00–1.27]; OR 1.59 [1.32–1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22–1.55]; OR 1.80 [1.49–2.17]). Conclusions: Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.