Acute liver injury and survival in patients with SARS-Cov-2 from the Hospital Central Militar

Background and aim: Recent studies on SARS-CoV-2 have shown that the incidence of liver injury varies between 14.8% and 53%, mainly demonstrable by abnormal ALT / AST levels accompanied by slightly elevated bilirubin levels. Reports of autopsies around the word of patients that death from COVID-19 shows severe liver damage ranging from 58.06% to 78% of the cases.

There is evidence that the elevation of transaminases (ALT / AST) translates into a more serious clinical profile. Besides, the elevation of AST is related with a high risk of mortality, so it must be monitored during hospitalization. Thus, it is important to know the behavior of liver injury and mortality in our population. Aim: To determine transaminase levels in patients with SARS-Cov-2 and its relationship with mortality.

Methods. All the patients admitted with a positive SARS-Cov-2 PCR test were analyzed, the mean and standard deviation of AST, ALT, and other variables of the liver biochemistry, hemoglobin, leukocyte, fibrinogen, and TP were obtained. A Kapplan Meier curve was made for survival to compare patients with and without transaminases elevation.

Results: We studied a total of 92 patients: 79 (86%) were male, age 56.62 ± 13.70 years, weight 72.5 ± 14.30 kg, height 1.63 ± 0.10 m, BMI 27.09 ± 5.04 kg / m2. Of the 92 patients, 68 (73%) had an elevation of transaminases at admission.

Patient's whit elevation of transaminases (68): 63 (93%) were males, the mean values at admission of AST and ALT were 74.91 ± 5.83 and 72.75 ± 5.74, respectively. The average hospital stay was 6.1 ± 4.1 days in de group with no elevation of transaminases and 7.25 ± 5.3 days for the group with elevation. Other variables of liver biochemistry, hemoglobin, leukocyte, fibrinogen, and TP are presented in Table 1. The data referring to the probability of requiring ICU income. And probability of requiring mechanical ventilation are presented in Table 2.

Table 1.

Variables determined in the total of SARS-Cov-2 positive patients.

Table 2.

Risk of admission to the ICU. And the risk of requiring mechanical ventilation in patients with elevated transaminases.

The group without and with elevated transaminases were compared to observe if elevation of transaminases could influence mortality, obtaining a non-statistically significant p. (x2 = 0.087, p = 0.782).

Conclusions: In the studied population, the predominant gender was male, the population with elevated transaminases had a 3.82 risk of entering the ICU and 2.02 times more of requiring mechanical ventilation. The elevation of transaminases does not influence survival. The analysis of the entire database will have to be done, since this is a preliminary study (Fig. 1).

Figure 1.

Kaplan Meier curve. The group of patients with and without transaminase elevation is displayed. Elevation of transaminases does not influence in survival.

Conflicts of interest: The authors have no conflicts of interest to declare.