Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission

Abstract

Introduction & objectives: The independent effect of liver biochemistries as a prognostic factor in patientswith COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnor-mal liver tests on admission of hospitalized patients with COVID-19.Materials & methods: We performed a prospective cohort study including 1611 hospitalized patients withconfirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from11 Latin American countries. We registered clinical and laboratory parameters, including liver functiontests, on admission and during hospitalization. All patients were followed until discharge or death. Wefit multivariable logistic regression models, further post-estimation effect through margins and inverseprobability weighting.Results: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liverdisease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7–47.7)of the cohort (n = 726). Overall, 15.1% (CI 13.4–16.9) of patients died (n = 244). Patients with abnormalliver tests on admission presented higher mortality 18.7% (CI 15.9–21.7), compared to those with normalliver biochemistries 12.2% (CI 10.1–14.6); P < .0001). After excluding patients with history of chronicliver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI1.1–2.0); P = 0.01], and severe COVID-19 (2.6 [2.0–3.3], P < .0001), both adjusted by age, gender, diabetes,pneumonia and body mass index >30.Conclusions: The presence of abnormal liver tests on admission is independently associated with mortalityand severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogatemarker of inflammation.