Elevation of Aminotransferases and Total Bilirubin Levels as Prognostic Markers of Mortality in Adults Hospitalized for COVID-19. A Cohort Study
DOI:
https://doi.org/10.52787/agl.v54i1.390Keywords:
COVID-19, mortality, liver function tests, transaminases, bilirubin, prognosisAbstract
Introduction. The liver is an organ that is affected by multiple mechanisms in the presence of COVID-19. The aim of this study was to determine whether elevated alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels are predictors of mortality in adults with COVID-19.
Materials and methods. A retrospective cohort study of adults hospitalized between 2020 and 2022 at a university hospital in Bogotá for COVID-19 and hypoxemia. All-cause mortality was the primary outcome. An independent multivariate model was built for each of the following markers of liver injury: alanine aminotransferase, aspartate aminotransferase, and total bilirubin. Each model was adjusted by age, presence of diabetes mellitus, presence of fever during hospitalization, lymphocyte count, D-dimer, and lactate dehydrogenase.
Results. A total of 704 patients were included. The mortality rate was 38%. Elevated alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels on admission were reported in 64%, 64%, and 8.3% of patients, respectively. According to the multivariate analysis, the elevation of both aspartate aminotransferase (OR = 1.06,
95% CI: 1.02-1.11 for each 40 U/L increase, p - value = 0.009) and total bilirubin levels (OR = 1.26, 95% CI: 1.08 -1.47 for every rise in 1mg/dl, p - value = 0.003) were independently associated with death. Total bilirubin level was also associated with intensive care unit admission, need for invasive mechanical ventilation and length of hospital stay. The results for alanine aminotransferase did not allow us to conclude an independent association with death. Age, fever, and lowest lymphocyte count during hospitalization were also associated with death.
Conclusion. Elevated transaminases and total bilirubin levels are frequent findings in patients with COVID-19 and hypoxemia. Aspartate aminotransferase and total bilirubin were predictive of mortality in these patients, so their measurement on admission is a reasonable practice. Progress needs to be made in incorporating these markers into predictive models of mortality and clinical decision rules.
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