COVID-19 AND MODERATE INCREASED LIVER ENZYMES: MORE THAN A SIMPLE SUBSET OF COVID-19 WITH HIGH MORTALITY
Authors: L. Fass, S. A. Tamkus, K. Alharshawi, J. Mitchell, S. L. Eswaran, N. Shah, S. Janardhan, D. M. Jensen, C. A. Q. Santos, Y. Rhee, N. Reau, C. Aloman
Journal: Hepatology (2020)

Background: Abnormal liver enzymes are frequently seen in the course of the COVID-19 in patients with no prior liver disease and has been frequent reason to consult Hepatology services during COVID-19 pandemic So far there is a relatively very poor characterization of this special population and we do not know whether mortality, severity of disease and health care burden is the same as described in the general population with COVID-19 Methods: We performed a retrospective, single-center study of 35 COVID-19 patients with no prior liver disease who developed significant liver enzymes elevation from April 1 to May 31, 2020 Inclusion criteria was nucleic acidconfirmed COVID-19 infection, no known history of prior liver disease, AST and/or ALT values at least 5 times the upper limit of normal and request for Hepatology Consult We recorded demographics (age, sex, BMI, race, ethnicity) comorbidities, laboratory values (CRP (C Reactive Protein), Procalcitonin, Fibrinogen, chemistry data), and clinical characteristics (hospital length of stay, Intensive Care Unit (ICU) admission, and mortality) for these patients The primary outcome was mortality Secondary outcomes were severity of disease defined as need for ICU admission and health care burden defined as an extended hospital stay beyond the average length of stay for the general COVID 19 population (14 days) Comparisons between the groups who reached primary and secondary end points were performed using unpaired t tests with Welch's correction and chi squared analysis (p-values <0 05) via the Prism statistical analysis software Results: Striking, from all the multiple variables analyzed, only the CRP was confirmed to be statistically significantly higher in deceased patients, ICU-admitted patients, and patients with extended hospital stay The mean CRP for deceased patients was 352 1+/-79 55 mg/L (p 0026) while the mean CRP for patients who lived was 277 7+/-133 8 mg/L (p 0026) Patients with ICU admissions had CRP mean of 309 9+/-105 5 mg/L (p 0016) versus 126 2 +/-111 4 mg/L (p 0016) without ICU admission Extended hospital stay patients had a CRP mean of 318 9+/-97 55 mg/L (p-value: 012) versus 201 2+/- 142 3 mg/L (p-value 012) for non-extended hospital stay patients As expected, patients requiring ICU admission or prolonged hospital stay had higher use of vasopressors, higher Alkaline Phosphatase peak and longer time interval to reach the ALT and Alkaline Phosphatase peak No other demographics, clinical or laboratory data were identified more frequent in patients who reached the end points in this specific COVID-19 group Conclusion: Patients with COVID-19 and moderate hepatocellular liver enzymes elevation and not known prior chronic liver disease is a specific subset of patients with risk factors for mortality, severity and length of stay different than the general population  These findings support the need for additional studies and prognostic modeling