Abnormal Liver Function Tests Were Associated Adverse Clinical Outcomes: An Observational Cohort Study of 2912 Patients with COVID-19

Background: The impact of liver function test (LFTs) abnormality on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains controversial. We aim to assess the impact of abnormal LFTs on clinical outcomes in a large cohort of hospitalized patients with COVID-19.Methods: We retrospectively collected data on 2912 consecutive hospitalized patients with COVID-19 between 5 February and 23 March 2020. The association between LFTs abnormalities (baseline and peak values) and clinical outcomes was measured by using Cox regression models.Findings: On admission 1414 patients (48.6%) had abnormal LFTs, with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP), and glutamyl transferase (GGT) elevation in 662 (22.7%), 221 (7.6%), 52 (1.8%), 135 (4.6%) and 536 (18.5%) patients, respectively and hypoalbuminemia in 737 (25.3%) patients. During a median 13 (IQR: 8-19) days of hospitalization, 61 patients (2.1%) died, 106 (3.6%) admitted to intensive care unit (ICU) and 75 (2.6%) required mechanical ventilation. After adjustment for confounders, baseline abnormal LFTs were independently associated with increased risks of mortality (adjusted HR 3.66, 95%CI 1.64-8.19, p=0.002), ICU admission (adjusted HR 3.12 95%CI 1.86-5.23, p<0.001) and mechanical ventilation (adjusted HR 3.00, 95%CI 1.63-5.52, p<0.001). Among the parameters of LTFs, the associations with outcomes were more pronounced for AST and albumin abnormality. In contrast, ALT elevation was not significantly associated with those outcomes. Similar results were observed for peak values of LFTs during hospitalization.Interpretation: Abnormality of AST, albumin, TBIL, ALP and GGT but not ALT were independently associated with adverse outcomes.Funding: Boost program of Xijing Hospital, Clinical Applied Research Subject of Military Medicine and China Postdoctoral Science Foundation.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the National Health Commission of China and the institutional review board at Huoshenshan hospital. Written informed consent was waived by the ethics committee of the Huoshenshan hospital for patients with emerging infectious diseases.