Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients

Arunkumar Krishnan, Laura Prichett, Xueting Tao, Saleh A. Alqahtani, James P. Hamilton, Esteban Mezey, Alexandra T. Strauss, Ahyoung Kim, James J. Potter, Po Hung Chen, Tinsay A. Woreta

Research output: Contribution to journalArticlepeer-review


BACKGROUND Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019 (COVID-19). However, the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood AIM We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality. METHODS This retrospective, observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System (Baltimore, MD, United States). Demographic data, clinical characteristics, laboratory findings, treatment measures, and outcome data were collected. Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis RESULTS A total of 2698 (70.4%) had abnormal alanine aminotransferase (ALT) at the time of admission. Other more prevalent abnormal liver chemistries were aspartate aminotransferase (AST) (44.4%), alkaline phosphatase (ALP) (16.1%), and total bilirubin (T-Bil) (5.9%). Factors associated with liver injury were older age, Asian ethnicity, other race, being overweight, and obesity. Higher ALT, AST, T-Bil, and ALP levels were more commonly associated with disease severity. Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization. Abnormal AST, T-Bil, and ALP were associated with a need for vasopressor drugs, whereas higher levels of AST, T-Bil, and a decreased albumin levels were associated with mechanical ventilation CONCLUSION Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient’s severity and prognosis. Elevated liver chemistries, specifically ALT, AST, ALP, and T-Bil levels, can be used to stratify risk and predict the need for advanced therapies in these patients.

Original languageEnglish (US)
Pages (from-to)570-587
Number of pages18
JournalWorld Journal of Gastroenterology
Issue number5
StatePublished - Feb 7 2022


  • Alanine aminotransferase
  • Aspartate aminotransferase
  • Bilirubin
  • Liver injury
  • Liver tests
  • Severe acute respiratory syndrome coronavirus 2

ASJC Scopus subject areas

  • Gastroenterology


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