TY - JOUR
T1 - Liver injury in hospitalized patients with COVID-19
T2 - An International observational cohort study
AU - the ISARIC Clinical Characterisation Group
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 A.
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 - Luque, Nestor
N1 - 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 September
M1 - e0277859
ER -