Abstract

C.G. Sridhar*, Anabhra Sharma, Soundappan Somasundaram, Shikha Sharma, Mohd. Juned Khan, Raghunath D., Dhivahar G. and Aravinth S.

ABSTRACT

Background: The pandemic of coronavirus (COVID-19) has rapidly emerged as a relevant threat for humans worldwide. The main clinical feature is pneumonia characterized by a high mortality rate, however, increasing data suggest that COVID-19 is a systemic disease affecting other organs/systems including liver, kidney and coagulation system and heart.[2-5] An increase in liver function tests (LFTs) (14%-75% of hospitalized patients in the world) has been found in patients with COVID-19.[2,3,6-11] Aim of this study was to assess the prevalence and the clinical impact of abnormal LFTs in hospitalized COVID-19 patients to predict mortality. Methodology: Patients hospitalized between 1/5/21 to 25/5/21 in COVID-Unit of GEM Hospital and research centre were retrospectively identified. Inclusion criteria were as follows: (a) patients hospitalized with a SARS-CoV-2 infection confirmed by real-time reverse transcription polymerase chain reaction method; (b) age >12 years old. Exclusion criterion involve patients admitted to ICU within 6 hours of admission as they were likely to be critically ill at admission with other unknown comorbidities and we wanted to target patients managed in regular wards so that a prediction model can be studied for future admissions. Verbal or written informed consent was taken and study approval permission given by local Ethics Committee. The study was performed according to the Institutional ethical guidelines and according to the principles of Declaration of Helsinki (Seventh edition). Results: Median age was 52 years with more prevalence in men (58.5%). All patients reported flu-like symptoms: fever (137 [77.8%]), cough (116 [65.9%]), fatigue (55 [31.3%]) and muscle pain (15 [8.5%]); gastrointestinal symptoms were observed in 39 patients (22.2%). Dyspnoea was present in 73 (41.5%) patients. At least one co-morbidity was recognised in about 43% of positive patients. Among the total admitted patients, 44 (25%) patients were shifted to ICU in need for either ventilatory support or hemodynamic instability and this was significantly associated with patients having SIRS, high CRP & D-Dimer values (p-value =0.001). The final outcome in any form was seen to be significantly associated with COVID profile of the patient (raised CRP with p-value =0.002) and no significant association was seen between in hospital mortality and LFT derangement of a patient. Conclusion: LFT abnormalities are common at admission in patients with COVID-19, but it cannot be used as an independent predictor of transfer to ICU or death unlike other markers of systemic inflammation and multi-organ dysfunction. Lay summary: Liver test abnormalities (in particular elevations in the levels of aspartate aminotransferase [AST], alanine aminotransferase [ALT] and total bilirubin [T-Bil]) were observed commonly after symptom onset in patients who were admitted with coronavirus disease 2019 (COVID-19). Abnormal levels of these liver function tests cannot be used as an independent predictors of COVID-19 related mortality and morbidity.