Liver injury predicts overall mortality in severe COVID-19: a prospective multicenter study in Brazil.

Autor: Pozzobon FM; Barra D'Or Hospital, Rede D'Or São Luiz, Ayrton Senna Avenue, 3079, Rio de Janeiro, Brazil. nandamanhaes@gmail.com.; Health Assistance Division, Fluminense Federal University (UFF), Niteroi, RJ, Brazil. nandamanhaes@gmail.com., Perazzo H; Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil., Bozza FA; Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil., Rodrigues RS; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil., de Mello Perez R; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.; Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil., Chindamo MC; Barra D'Or Hospital, Rede D'Or São Luiz, Ayrton Senna Avenue, 3079, Rio de Janeiro, Brazil.; Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Jazyk: angličtina
Zdroj: Hepatology international [Hepatol Int] 2021 Apr; Vol. 15 (2), pp. 493-501. Date of Electronic Publication: 2021 Feb 03.
DOI: 10.1007/s12072-021-10141-6
Abstrakt: Background/purpose: The relationship between liver injury and mortality remains unclear in patients with COVID-19. We aimed to evaluate the prognostic value of aminotransferases levels at hospital admission to predict mortality in patients with COVID-19.
Methods and Results: This prospective study included 406 patients [57% male, aged 56 years] with COVID-19 hospitalized in 26 centers in Brazil. Overall, 36.7% (95% CI 32.1-41.5) presented at admission with severe disease requiring respiratory support. The prevalence of elevated ALT and AST levels at admission [> 2 × ULN] was 14.0% (95% CI 11.0-17.8) and 12.9% (95% CI 10.0-16.6), respectively. Sixty-two patients [15.3% (95% CI 12.1-19.1)] died during hospitalization and the overall mortality rate was 13.4 (10.5-17.2) deaths per 1000 persons-years. The 15-day-overall survival (95% CI) was significantly lower in patients with ALT levels ≥ 2 × ULN compared to those with ALT < 2 × ULN [67.1% (48.4-80.2) vs 83.4% (76.1-88.6), p = 0.001] and in those with AST levels ≥ 2 × ULN compared to those with AST < 2 × ULN [61.5% (44.7-74.6) vs 84.2% (76.5-89.5), p < 0.001]. The presence of elevated aminotransferases levels at hospital admission significantly increased the risk of in-hospital all-cause mortality adjusted for age-and-sex. Those findings were present in the subgroup of critically ill patients already admitted in need of respiratory support (n = 149), but not in patients without that requirement at admission (n = 257).
Conclusions: Elevated aminotransferases at hospital admission predicted in-hospital all-cause mortality in patients with COVID-19, especially in those with severe disease. Measurement of transaminases levels at hospital admission should be integrated to the care of patients with COVID-19 as an auxiliary strategy to identify patients at higher death risk.
Databáze: MEDLINE
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