P- 17 LIVER TESTS ABNORMALITIES AS PROGNOSTIC MARKERS OF DEATH IN PATIENTS HOSPITALISED BY COVID-19. A COHORT STUDY

Abstract

Introduction and Objectives

In COVID-19, liver alterations has multiple mechanisms. The objective of this study is to evaluate if raise in transaminases and bilirubin predicts death in COVID-19.

Materials and Methods

Retrospective cohort study of adults hospitalized with COVID-19 and hypoxemia. The primary outcome was death of any cause with a multivariate independent model for ALT, AST and total bilirubin adjusted by age, diabetes mellitus, presence of fever, lymphocyte count, D dimer and lactate dehydrogenase.

Results

Data from 702 patients was collected. The mortality rate was 38%. In admission, 64% of patients had elevated ALT, 64% elevated AST and 8.3% elevated total bilirubin. AST rise level was independently associated with death (OR=1.06, 95% CI: 1.02-1.11 by every rise of 40 U/L, p-value=0.009). Total bilirubin also was independently associated with death (OR = 1.26, 95% CI: 1.08-1.47 for every rise in 1 mg/dl, p-value=0.003). Total bilirubin was also associated with ICU admission, mechanical ventilation and length of hospital stay. Results for ALT did not allow us to conclude an independent association with death. Age, fever and lymphocyte count nadir also was associated with death.

Conclusions

In patients with COVID-19 and hypoxemia, a rise in transaminases and bilirubin is frequent. AST and bilirubin predict mortality, so it is reasonable to measure them in admission. Progress must be made in including these markers in predictive models of mortality and clinical decision rules.