MO369ACUTE KIDNEY INJURY IS ASSOCIATED WITH ELEVATED AMINOTRANSFERASES AT ADMISSION IN HOSPITALIZED PATIENTS WITH COVID-19
Authors: Khruleva Yulia , Arisheva Olga , Troitskaya Elena , Efremovtseva Marina , Kobalava Zhanna 
Published: May 2021

Abstract

Background and Aims
Initial reports indicate a high incidence of abnormal liver tests and acute kidney injury (AKI) in the novel coronavirus infection (COVID-19). However, outcomes in hospitalized patients with COVID-19 and elevated aspartate transaminase (AST) and alanine transaminase (ALT) levels at admission and their associations with AKI are not well understood.
The aim of the study was to investigate the incidence of cytolysis at admission and its contribution to the development of AKI, severity of COVID-19 and outcomes.

Method
A retrospective analysis of the register of patients hospitalized with COVID-19 was performed (n=481). COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical computer tomography (CT) picture. We excluded patients with previously known liver disease, re-hospitalization, acute surgical pathology, single serum creatinine measurement during hospitalization. Abnormality in aminotransferases was deﬁned as ALT and/or AST &gt;40 U/L. Definition of AKI was based on KDIGO criteria. P value &lt;0.05 was considered statistically significant.

Results
462 patients were included (50.4% males, mean age 63±16 years, mean Charlson index 3±2.4, 67% with hypertension, 48% with obesity, 25% with diabetes mellitus). 26,4% (122) of patients were hospitalized in the intensive care unit (ICU), 71,3% (87) of them were treated with mechanical ventilation. The median length of stay was 11 [9;15] days, in the ICU – 4 [2;9] days. 20% (92) of patients died.
At admission 43% (200) of the patients had abnormal level of aminotransferases. Elevated AST was more common than ALT, (39% (178) vs 29% (132)). The median levels of AST and ALT at admission were 54.5[44;72] and 45.9[34;66] U/L in the group with cytolysis and 26[19;33] and 19[11;27] U/L in the group without it, respectively. The AKI incidence in the register was 24.8%. The 1st stage of AKI was observed in the majority of the patients (46% - 1st stage, 36% - 2nd stage, 18% - 3rd stage. Patients in ICU compared to non-ICU patients more often had AKI (50% vs 13%, p&lt;0.001). In-hospital mortality was significantly higher in the group with AKI (54% vs 10% for patients with and without AKI development, respectively, p&lt;0.001).
Groups with and without aminotransferases elevation were similar in age, gender, presence of comorbidities, coagulation status, statins and frequency of antibiotic intake before admission. Increase in AST and/or ALT levels at admission showed no association with AKI severity. The higher incidence of elevated ALT or/and AST was observed in ICU compared with non-ICU patients (59% vs 37%, p&lt;0.001). Patients with elevation of aminotransferases at admission compared to patients without it had more severe lung injury by CT scan (22.4% vs 18.6%, with 50-75% lung injury; 5.5% vs 0.4% with 75-90% lung injury, p=0.008 for the trend), higher ferritin (598[404;715] vs 391[189;587] µkg/l, p=0.03) and serum creatinine levels (91[78;118] vs 86[74;109] µmol/l, p=0.008), higher rate of AKI development (29% vs 18%, p=0.005) and in-hospital mortality (26% vs 15,4%, p=0.005). Elevated ALT and/or AST at admission were the independent predictors for the development of AKI (OR 1.87 95%CI 1.17-2.92, p=0.005) and in-hospital mortality (OR 1.89 95%CI 1.17-3.08, p=0.006).

Conclusion
Syndrome of cytolysis is common among hospitalized patients with COVID-19. Development of AKI and disease severity were associated with elevated levels of aminotransferases at admission, and are predictors for AKI development and in-hospital mortality in this population.