The Elevation of LIVER Enzymes in Patients with Atrial Fibrillation and COVID-19 Is a Marker of Bad Evolution and Mortality
Authors: Cerezo Manchado Juan Jose , Olivera Pável E , Lopez Abellan María Dolores , Campoy Castaño Desiree , Velasquez César A , Rodriguez Rojas Carlos , Ramos Arenas Veronica , Flores Katia , Cárdenas Gámez Rubén , García de Guadiana Romualdo Luis , Iturbe Hernandez Teodoro , Sierra Jorge , Salinas Ramón 
Published: November 2020

Introduction: The COVID-19 pandemic reflects liver damage. A study carried out in China (Guan WJ et al. N Engl J Med. 2020) reported that in more than 21% of cases there was an elevation of liver enzymes (ELE), with only 2.1% of them having previous liver disease. ELE is frequent in anticoagulated patients and is associated with an increased cardiovascular risk and bleeding complications2,3. It is necessary to evaluate the impact of ELE in patients with atrial fibrillation (AF) and COVID-19 Methods: Multicenter, retrospective and observational study that consecutively included patients admitted with COVID-19 during the months of March and April 2020. The patients were followed were followed up until 30 days after discharge or death. termino en inglés ¿??Anticoagulation was chosen at the clinical discretion. The main variables investigated were the value of liver enzymes (AST, ALT, GGT) at admission, during the first week (peak value) and at hospital discharge. Patients who achieved a 3-fold higher level of ELE(&gt; 120UI) were described as high-risk transaminasemia (HRT). The number of bleedings, thromboembolic events, as well as all-cause mortality were evaluated. Statistical analysis was performed with SPSS 21.0 (SPSS Inc., Chicago, IL). Results: A total of 235 patients were included. The mean age was 79 years [standard deviation (SD) 7.9. years]. The demographic characteristics of the patients with and without HRT are summarized in Table 1. The median follow-up was 59 days (SD 29 days). In AF patients, ELE values rose significantly on admission with respect to discharge p &lt;0.05. No significant difference in the value of ELE was found between those who received LMWH versus ACODS. In patients with AF, there were 30 admissions to intensive care, these had higher ELE values at admission and at discharge, awith ALT at admission and ALT, AST and GGT at discharge being significant, p &lt;0.05. They also presented 24 (10%) bleeding events, which had a significantly higher AST level in the first week (42-60UI). There were 45 (19.1%) patients who died during de follow-up, ELE values were significantly higher on admission. Finally, if we analyze the events in the 48 HRTpatients (21%) compared to the non-TAR 187 patients (79%), they had significantly more hemorrhagic events, and death from all causes, p &lt;0.05, events was resume in Table 2. If we perform a logistic regresión for TAR as a predictor variable of bleddings events, TAR was a risk marker ,independly OR 3,6(1,39-9,33), table 3 Conclusion: In our cohort, AF patients who suffered events had a higher ELE than those who did not suffer significantly. Furthermore, the patients classified as HRT presented an increase in mortality, bleedings events compared to non-HRT (Table 2 and 3). No significant differences were observed in the elevation of the ELE according to the antithrombotic treatment, the patients treated with DOACs did not experience a significant increase in the ELE during the follow-up.

Disclosures
Olivera: Daiichi Sankyo:Consultancy, Speakers Bureau;BAYER:Consultancy;Boehringer Ingelheim:Consultancy, Speakers Bureau;Pfizer:Consultancy, Speakers Bureau.Campoy Castaño:Boehringer Ingelheim:Consultancy;Daiichi Sankyo:Speakers Bureau.Sierra:Astellas:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Novartis:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals:Research Funding;Pfizer:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Daiichi Sankyo:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Roche:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Gilead-Kite:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.