Liver function test abnormalities a risk factor for severe SARS-CoV-2 infection

Patients with liver function test (LFT) abnormalities at hospital admission, particularly gamma-glutamyltransferase (GGT) and albumin, are at greater risk of severe course of SARS-CoV-2 infection, according to a study.

The study used data from the COVID-19 registry of the Ludwig Maximilians University of Munich in Germany and included 217 COVID-19 patients (median age, 63 years; 66 percent male) without pre-existing liver disease. Arterial hypertension, diabetes mellitus type II, coronary artery disease, and chronic kidney disease were the most common underlying medical conditions.

Of the patients, 36 percent required treatment in the intensive care unit (ICU) and 32 percent underwent mechanical ventilation. The total mortality rate was 14.7 percent, mostly related to COVID-19. Median time from hospital admission to ICU admission was 1 day. About one-third of the 77 patients (35 percent) were admitted to the ICU on the same day of admission, while the majority of the ICU patients had an interval of ≥2 days from admission and 15 (19 percent) an interval of a week or more.

At baseline, 58 percent of the patients had abnormal LFT, with a predominant elevation of aspartate aminotransferase (AST; 42 percent), GGT (37 percent), and alanine aminotransferase (ALT; 27 percent); 33 percent had hypoalbuminaemia. Increased levels of ALT and GGT, as well as hypoalbuminaemia, correlated with higher proportions of patients requiring ICU treatment and mechanical ventilation.

Multivariable logistic regression analysis revealed that hypoalbuminaemia combined with abnormal AST or GGT at hospital admission significantly predicted ICU admission (odds ratios [ORs], 46.22 and 38.8, respectively) and a composite endpoint of ICU admission and/or COVID-19-related death (ORs, 42.0 and 26.9, respectively).