Liver injury in hospitalized patients with COVID-19: An International observational cohort study

Bharath Kumar Tirupakuzhi Vijayaraghavan; Saptarshi Bishnu; Joaquin Baruch; Barbara Wanjiru Citarella; Christiana Kartsonaki; Aronrag Meeyai; Zubair Mohamed; Shinichiro Ohshimo; Benjamin Lefèvre; Abdulrahman Al-Fares; Jose Andres Calvache; Fabio Silvio Taccone; Piero Olliaro; Laura Merson; Neill K.J. Adhikari; ISARIC Clinical Characterisation Group

doi:10.1371/journal.pone.0277859

Liver injury in hospitalized patients with COVID-19: An International observational cohort study

Bharath Kumar Tirupakuzhi Vijayaraghavan, Saptarshi Bishnu, Joaquin Baruch, Barbara Wanjiru Citarella, Christiana Kartsonaki, Aronrag Meeyai, Zubair Mohamed, Shinichiro Ohshimo, Benjamin Lefèvre, Abdulrahman Al-Fares, Jose Andres Calvache, Fabio Silvio Taccone, Piero Olliaro, Laura Merson, Neill K.J. Adhikari, ISARIC Clinical Characterisation Group

Research output: Contribution to journal › Article › Research › peer-review

1 Citation (Scopus)

Abstract

Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.

Original language	English
Article number	e0277859
Number of pages	17
Journal	PLoS ONE
Volume	18
Issue number	9
DOIs	https://doi.org/10.1371/journal.pone.0277859
Publication status	Published - Sept 2023
Externally published	Yes

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Vijayaraghavan, B. K. T., Bishnu, S., Baruch, J., Citarella, B. W., Kartsonaki, C., Meeyai, A., Mohamed, Z., Ohshimo, S., Lefèvre, B., Al-Fares, A., Calvache, J. A., Taccone, F. S., Olliaro, P., Merson, L., Adhikari, N. K. J., & ISARIC Clinical Characterisation Group (2023). Liver injury in hospitalized patients with COVID-19: An International observational cohort study. PLoS ONE, 18(9), Article e0277859. https://doi.org/10.1371/journal.pone.0277859

@article{948344e279db43669eb224b715125bca,

title = "Liver injury in hospitalized patients with COVID-19: An International observational cohort study",

abstract = "Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.",

author = "Vijayaraghavan, {Bharath Kumar Tirupakuzhi} and Saptarshi Bishnu and Joaquin Baruch and Citarella, {Barbara Wanjiru} and Christiana Kartsonaki and Aronrag Meeyai and Zubair Mohamed and Shinichiro Ohshimo and Benjamin Lef{\`e}vre and Abdulrahman Al-Fares and Calvache, {Jose Andres} and Taccone, {Fabio Silvio} and Piero Olliaro and Laura Merson and Adhikari, {Neill K.J.} and Abdukahil, {Sheryl Ann} and Abdulkadir, {Nurul Najmee} and Ryuzo Abe and Laurent Abel and Amal Abrous and Lara Absil and Andrew Acker and Elisabeth Adam and Diana Adri{\~a}o and {Al Ageel}, Saleh and Kate Ainscough and Hssain, {Ali Ait} and Tamlihat, {Younes Ait} and Takako Akimoto and Ernita Akmal and {Al Qasim}, Eman and Angela Alberti and Tala Al-Dabbous and Senthilkumar Alegesan and Marta Alessi and Beatrice Alex and K{\'e}vin Alexandre and Huda Alfoudri and Imran Ali and Alidjnou, {Kazali Enagnon} and Jeffrey Aliudin and Clotilde Allavena and Nathalie Allou and Alves, {Jo{\~a}o Melo} and Rita Alves and Cabrita, {Joana Alves} and Maria Amaral and Nur Amira and Phoebe Ampaw and Claire Andrejak and Andrea Angheben and Fran{\c c}ois Angoulvant and S{\'e}verine Ansart and Sivanesen Anthonidass and {de Brito}, {Carlos Alexandre Antunes} and Ardiyan Apriyana and Yaseen Arabi and Irene Aragao and Francisco Arancibia and Carolline Araujo and Antonio Arcadipane and Patrick Archambault and Lukas Arenz and Arlet, {Jean Beno{\^i}t} and Christel Arnold-Day and Lovkesh Arora and Rakesh Arora and Elise Artaud-Macari and Diptesh Aryal and Muhammad Ashraf and Namra Asif and Assie, {Jean Baptiste} and Amirul Asyraf and Minahel Atif and Anika Atique and Johann Auchabie and Hugues Aumaitre and Adrien Auvet and Laur{\`e}ne Azemar and Cecile Azoulay and Benjamin Bach and Delphine Bachelet and Claudine Badr and Nadia Baig and Baillie, {J. Kenneth} and Erica Bak and Bakar, {Nazreen Abu} and Andriy Bal and Mohanaprasanth Balakrishnan and Valeria Balan and Firouz{\'e} Bani-Sadr and Renata Barbalho and Barbosa, {Nicholas Yuri} and Barclay, {Wendy S.} and Barnett, {Saef Umar} and Michaela Barnikel and Audrey Barrelet and Cleide Barrigoto and Marie Bartoli and Joaqu{\'i}n Baruch and Romain Basmaci and Basri, {Muhammad Fadhli Hassin} and Jules Bauer and Rincon, {Diego Fernando Bautista} and Abigail Beane and Alexandra Bedossa and Bee, {Ker Hong} and Husna Begum and Sylvie Behilill and Albertus Beishuizen and Aleksandr Beljantsev and David Bellemare and Anna Beltrame and Beltr{\~a}o, {Beatriz Amorim} and Marine Beluze and Nicolas Benech and Benjiman, {Lionel Eric} and Dehbia Benkerrou and Suzanne Bennett and Lu{\'i}s Bento and Berdal, {Jan Erik} and Delphine Bergeaud and Hazel Bergin and Giulia Bertoli and Simon Bessis and Sybille Bevilcaqua and Karine Bezulier and Amar Bhatt and Krishna Bhavsar and Claudia Bianco and Bidin, {Farah Nadiah} and Singh, {Moirangthem Bikram} and Humaid, {Felwa Bin} and Kamarudin, {Mohd Nazlin Bin} and Fran{\c c}ois Bissuel and Patrick Biston and Laurent Bitker and Catherine Blier and Mathieu Blot and Lucille Blumberg and Laetitia Bodenes and Debby Bogaert and Boivin, {Anne H{\'e}l{\`e}ne} and Isabela Bola{\~n}os and Bolze, {Pierre Adrien} and Fran{\c c}ois Bompart and Diogo Borges and Rapha{\"e}l Borie and Elisabeth Botelho-Nevers and Lila Bouadma and Olivier Bouchaud and Sabelline Bouchez and Dounia Bouhmani and Damien Bouhour and K{\'e}vin Bouiller and Laurence Bouillet and Camile Bouisse and Boureau, {Anne Sophie} and John Bourke and Maude Bouscambert and Aurore Bousquet and Jason Bouziotis and Bianca Boxma and Marielle Boyer-Besseyre and Maria Boylan and Bozza, {Fernando Augusto} and Axelle Braconnier and Cynthia Braga and Monteiro, {Filipa Br{\'a}s} and Luca Brazzi and Dorothy Breen and Kathy Brickell and Shaunagh Browne and Marjolein Brusse-Keizer and Petra Bryda and Nina Buchtele and Polina Bugaeva and Marielle Buisson and Erlina Burhan and Aidan Burrell and Bustos, {Ingrid G.} and Denis Butnaru and Andr{\'e} Cabie and Eder Caceres and Cyril Cadoz and Garc{\^e}s, {Rui Caetano} and Calvache, {Jose Andres} and Jo{\~a}o Cam{\~o}es and Valentine Campana and Paul Campbell and Cecilia Canepa and Pauline Caraux-Paz and Cardellino, {Chiara Simona} and Filipa Cardoso and Filipe Cardoso and Nelson Cardoso and Sofia Cardoso and Nicolas Carlier and Thierry Carmoi and Gayle Carney and In{\^e}s Carqueja and Carret, {Marie Christine} and Carrier, {Fran{\c c}ois Martin} and Gail Carson and Casanova, {Maire Laure} and Mariana Casc{\~a}o and Siobhan Casey and Jos{\'e} Casimiro and Bailey Cassandra and Silvia Casta{\~n}eda and Nidyanara Castanheira and Guylaine Castor-Alexandre and Ivo Castro and Catherine, {Fran{\c c}ois Xavier} and Paolo Cattaneo and Roberta Cavalin and Alexandros Cavayas and Minerva Cervantes-Gonzalez and Anissa Chair and Catherine Chakveatze and Adrienne Chan and Meera Chand and Auger, {Christelle Chantalat} and Chapplain, {Jean Marc} and Charlotte Charpentier and Julie Chas and Anjellica Chen and Chen, {Yih Sharng} and L{\'e}o Chenard and Cheng, {Matthew Pellan} and Antoine Cheret and Thibault Chiarabini and Julian Chica and Chidambaram, {Suresh Kumar} and Tho, {Leong Chin} and Catherine Chirouze and Davide Chiumello and Bernard Cholley and Chopin, {Marie Charlotte} and Chow, {Ting Soo} and Chua, {Hiu Jian} and Jonathan Chua and Cidade, {Jose Pedro} and Colin McArthur and Alistair Nichol and Liadain Reid and Neto, {Ary Serpa} and Tony Trapani and Andrew Udy and Steve Webb and {ISARIC Clinical Characterisation Group}",

note = "Funding Information: “This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z]; and the Bill & Melinda Gates Foundation [OPP1209135]. The funders had no role in the design, analysis, manuscript preparation or decision to submit for publication.” Publisher Copyright: {\textcopyright} 2023 Vijayaraghavan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2023",

month = sep,

doi = "10.1371/journal.pone.0277859",

language = "English",

volume = "18",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science (PLoS)",

number = "9",

}

Vijayaraghavan, BKT, Bishnu, S, Baruch, J, Citarella, BW, Kartsonaki, C, Meeyai, A, Mohamed, Z, Ohshimo, S, Lefèvre, B, Al-Fares, A, Calvache, JA, Taccone, FS, Olliaro, P, Merson, L, Adhikari, NKJ & ISARIC Clinical Characterisation Group 2023, 'Liver injury in hospitalized patients with COVID-19: An International observational cohort study', PLoS ONE, vol. 18, no. 9, e0277859. https://doi.org/10.1371/journal.pone.0277859

TY - JOUR

T1 - Liver injury in hospitalized patients with COVID-19

T2 - An International observational cohort study

AU - Vijayaraghavan, Bharath Kumar Tirupakuzhi

AU - Bishnu, Saptarshi

AU - Baruch, Joaquin

AU - Citarella, Barbara Wanjiru

AU - Kartsonaki, Christiana

AU - Meeyai, Aronrag

AU - Mohamed, Zubair

AU - Ohshimo, Shinichiro

AU - Lefèvre, Benjamin

AU - Al-Fares, Abdulrahman

AU - Calvache, Jose Andres

AU - Taccone, Fabio Silvio

AU - Olliaro, Piero

AU - Merson, Laura

AU - Adhikari, Neill K.J.

AU - Abdukahil, Sheryl Ann

AU - Abdulkadir, Nurul Najmee

AU - Abe, Ryuzo

AU - Abel, Laurent

AU - Abrous, Amal

AU - Absil, Lara

AU - Acker, Andrew

AU - Adam, Elisabeth

AU - Adrião, Diana

AU - Al Ageel, Saleh

AU - Ainscough, Kate

AU - Hssain, Ali Ait

AU - Tamlihat, Younes Ait

AU - Akimoto, Takako

AU - Akmal, Ernita

AU - Al Qasim, Eman

AU - Alberti, Angela

AU - Al-Dabbous, Tala

AU - Alegesan, Senthilkumar

AU - Alessi, Marta

AU - Alex, Beatrice

AU - Alexandre, Kévin

AU - Alfoudri, Huda

AU - Ali, Imran

AU - Alidjnou, Kazali Enagnon

AU - Aliudin, Jeffrey

AU - Allavena, Clotilde

AU - Allou, Nathalie

AU - Alves, João Melo

AU - Alves, Rita

AU - Cabrita, Joana Alves

AU - Amaral, Maria

AU - Amira, Nur

AU - Ampaw, Phoebe

AU - Andrejak, Claire

AU - Angheben, Andrea

AU - Angoulvant, François

AU - Ansart, Séverine

AU - Anthonidass, Sivanesen

AU - de Brito, Carlos Alexandre Antunes

AU - Apriyana, Ardiyan

AU - Arabi, Yaseen

AU - Aragao, Irene

AU - Arancibia, Francisco

AU - Araujo, Carolline

AU - Arcadipane, Antonio

AU - Archambault, Patrick

AU - Arenz, Lukas

AU - Arlet, Jean Benoît

AU - Arnold-Day, Christel

AU - Arora, Lovkesh

AU - Arora, Rakesh

AU - Artaud-Macari, Elise

AU - Aryal, Diptesh

AU - Ashraf, Muhammad

AU - Asif, Namra

AU - Assie, Jean Baptiste

AU - Asyraf, Amirul

AU - Atif, Minahel

AU - Atique, Anika

AU - Auchabie, Johann

AU - Aumaitre, Hugues

AU - Auvet, Adrien

AU - Azemar, Laurène

AU - Azoulay, Cecile

AU - Bach, Benjamin

AU - Bachelet, Delphine

AU - Badr, Claudine

AU - Baig, Nadia

AU - Baillie, J. Kenneth

AU - Bak, Erica

AU - Bakar, Nazreen Abu

AU - Bal, Andriy

AU - Balakrishnan, Mohanaprasanth

AU - Balan, Valeria

AU - Bani-Sadr, Firouzé

AU - Barbalho, Renata

AU - Barbosa, Nicholas Yuri

AU - Barclay, Wendy S.

AU - Barnett, Saef Umar

AU - Barnikel, Michaela

AU - Barrelet, Audrey

AU - Barrigoto, Cleide

AU - Bartoli, Marie

AU - Baruch, Joaquín

AU - Basmaci, Romain

AU - Basri, Muhammad Fadhli Hassin

AU - Bauer, Jules

AU - Rincon, Diego Fernando Bautista

AU - Beane, Abigail

AU - Bedossa, Alexandra

AU - Bee, Ker Hong

AU - Begum, Husna

AU - Behilill, Sylvie

AU - Beishuizen, Albertus

AU - Beljantsev, Aleksandr

AU - Bellemare, David

AU - Beltrame, Anna

AU - Beltrão, Beatriz Amorim

AU - Beluze, Marine

AU - Benech, Nicolas

AU - Benjiman, Lionel Eric

AU - Benkerrou, Dehbia

AU - Bennett, Suzanne

AU - Bento, Luís

AU - Berdal, Jan Erik

AU - Bergeaud, Delphine

AU - Bergin, Hazel

AU - Bertoli, Giulia

AU - Bessis, Simon

AU - Bevilcaqua, Sybille

AU - Bezulier, Karine

AU - Bhatt, Amar

AU - Bhavsar, Krishna

AU - Bianco, Claudia

AU - Bidin, Farah Nadiah

AU - Singh, Moirangthem Bikram

AU - Humaid, Felwa Bin

AU - Kamarudin, Mohd Nazlin Bin

AU - Bissuel, François

AU - Biston, Patrick

AU - Bitker, Laurent

AU - Blier, Catherine

AU - Blot, Mathieu

AU - Blumberg, Lucille

AU - Bodenes, Laetitia

AU - Bogaert, Debby

AU - Boivin, Anne Hélène

AU - Bolaños, Isabela

AU - Bolze, Pierre Adrien

AU - Bompart, François

AU - Borges, Diogo

AU - Borie, Raphaël

AU - Botelho-Nevers, Elisabeth

AU - Bouadma, Lila

AU - Bouchaud, Olivier

AU - Bouchez, Sabelline

AU - Bouhmani, Dounia

AU - Bouhour, Damien

AU - Bouiller, Kévin

AU - Bouillet, Laurence

AU - Bouisse, Camile

AU - Boureau, Anne Sophie

AU - Bourke, John

AU - Bouscambert, Maude

AU - Bousquet, Aurore

AU - Bouziotis, Jason

AU - Boxma, Bianca

AU - Boyer-Besseyre, Marielle

AU - Boylan, Maria

AU - Bozza, Fernando Augusto

AU - Braconnier, Axelle

AU - Braga, Cynthia

AU - Monteiro, Filipa Brás

AU - Brazzi, Luca

AU - Breen, Dorothy

AU - Brickell, Kathy

AU - Browne, Shaunagh

AU - Brusse-Keizer, Marjolein

AU - Bryda, Petra

AU - Buchtele, Nina

AU - Bugaeva, Polina

AU - Buisson, Marielle

AU - Burhan, Erlina

AU - Burrell, Aidan

AU - Bustos, Ingrid G.

AU - Butnaru, Denis

AU - Cabie, André

AU - Caceres, Eder

AU - Cadoz, Cyril

AU - Garcês, Rui Caetano

AU - Calvache, Jose Andres

AU - Camões, João

AU - Campana, Valentine

AU - Campbell, Paul

AU - Canepa, Cecilia

AU - Caraux-Paz, Pauline

AU - Cardellino, Chiara Simona

AU - Cardoso, Filipa

AU - Cardoso, Filipe

AU - Cardoso, Nelson

AU - Cardoso, Sofia

AU - Carlier, Nicolas

AU - Carmoi, Thierry

AU - Carney, Gayle

AU - Carqueja, Inês

AU - Carret, Marie Christine

AU - Carrier, François Martin

AU - Carson, Gail

AU - Casanova, Maire Laure

AU - Cascão, Mariana

AU - Casey, Siobhan

AU - Casimiro, José

AU - Cassandra, Bailey

AU - Castañeda, Silvia

AU - Castanheira, Nidyanara

AU - Castor-Alexandre, Guylaine

AU - Castro, Ivo

AU - Catherine, François Xavier

AU - Cattaneo, Paolo

AU - Cavalin, Roberta

AU - Cavayas, Alexandros

AU - Cervantes-Gonzalez, Minerva

AU - Chair, Anissa

AU - Chakveatze, Catherine

AU - Chan, Adrienne

AU - Chand, Meera

AU - Auger, Christelle Chantalat

AU - Chapplain, Jean Marc

AU - Charpentier, Charlotte

AU - Chas, Julie

AU - Chen, Anjellica

AU - Chen, Yih Sharng

AU - Chenard, Léo

AU - Cheng, Matthew Pellan

AU - Cheret, Antoine

AU - Chiarabini, Thibault

AU - Chica, Julian

AU - Chidambaram, Suresh Kumar

AU - Tho, Leong Chin

AU - Chirouze, Catherine

AU - Chiumello, Davide

AU - Cholley, Bernard

AU - Chopin, Marie Charlotte

AU - Chow, Ting Soo

AU - Chua, Hiu Jian

AU - Chua, Jonathan

AU - Cidade, Jose Pedro

AU - McArthur, Colin

AU - Nichol, Alistair

AU - Reid, Liadain

AU - Neto, Ary Serpa

AU - Trapani, Tony

AU - Udy, Andrew

AU - Webb, Steve

AU - ISARIC Clinical Characterisation Group

N1 - Funding Information: “This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z]; and the Bill & Melinda Gates Foundation [OPP1209135]. The funders had no role in the design, analysis, manuscript preparation or decision to submit for publication.” Publisher Copyright: © 2023 Vijayaraghavan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2023/9

Y1 - 2023/9

N2 - Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.

AB - Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85171238933&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0277859

DO - 10.1371/journal.pone.0277859

M3 - Article

C2 - 37703268

AN - SCOPUS:85171238933

SN - 1932-6203

VL - 18

JO - PLoS ONE

JF - PLoS ONE

IS - 9

M1 - e0277859

ER -

Liver injury in hospitalized patients with COVID-19: An International observational cohort study

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