The role of liver steatosis as measured with transient elastography and transaminases on hard clinical outcomes in patients with COVID-19

Isabel Campos-Varela, Ares Villagrasa, Macarena Simon-Talero, Mar Riveiro-Barciela, Meritxell Ventura-Cots, Lara Aguilera-Castro, Patricia Alvarez-Lopez, Emilie A Nordahl, Adrian Anton, Juan Bañares, Claudia Barber, Ana Barreira-Diaz, Betina Biagetti, Laura Camps-Relats, Andrea Ciudin, Raul Cocera, Cristina Dopazo, Andrea Fernandez, Cesar Jimenez, Maria M JimenezMariona Jofra, Clara Gil, Concepción Gomez-Gavara, Danila Guanozzi, Jorge A Guevara, Beatriz Lobo, Carolina Malagelada, Joan Martinez-Camprecios, Luis Mayorga, Enric Miret, Elizabeth Pando, Ana Pérez-Lopez, Marc Pigrau, Alba Prio, Jesus M Rivera-Esteban, Alba Romero, Stephanie Tasayco, Judit Vidal-Gonzalez, Laura Vidal, Beatriz Minguez, Salvador Augustin, Joan Genesca

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2 Citations (Scopus)


Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years.

Original languageEnglish
Pages (from-to)17562848211016567
JournalTherap Adv Gastroenterol.
Publication statusPublished - 2021


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