Impact of Elevated Liver Enzymes on the Severity of Clinical Course of COVID‐19: A Retrospective Study From Saudi Arabia

Eyad Makkawy; Shaden Mohammed Alamro; Safiya Ibn Awadh; Reem Basalasil; Ziyad Alkhelaiwi; Bassam AL-Mutairi; Fatimah Rebh

Eyad Makkawy, Shaden Mohammed Alamro, Safiya Ibn Awadh, Reem Basalasil, Ziyad Alkhelaiwi, Bassam Al-Mutairi, Fatimah Rebh

International Journal of Hepatology, doi:10.1155/ijh/7385050

Background: According to recent research, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause liver injury, which may be linked to a poorer prognosis. In this retrospective study, we evaluated the incidence of high liver enzyme levels in patients with COVID-19 and their correlation with the severity and prognosis of clinical outcomes. Methods: A retrospective cohort study was performed from March 2020 to October 2020 at Prince Mohammed Bin Abdulaziz Hospital (PMAH), Riyadh, Saudi Arabia. Demographic information of COVID-19 patients as well as data on clinical features and laboratory parameters were collected. Pearson's correlation (r) test was used to assess the correlation between elevated liver enzymes and COVID-19 severity. The multivariate logistic binary regression analysis was used to identify the predictors of elevated liver enzyme levels and mortality among patients with COVID-19. Results: This cohort included 1033 patients, 73% of whom were male, with a mean age of 49.9 years. Elevated liver enzymes were observed in 52.7% of patients, most commonly with a hepatitis pattern (63.1%). Elevated levels of hemoglobin, creatine kinasemyocardial band, and C-reactive protein, as well as pneumoniae, the requirement of an intensive care unit, comorbidities, and the use of paracetamol, β-lactamase, and steroids were significant predictors of elevated liver enzymes (p < 0 05). Interestingly, Saudi patients (p = 0 019) were found to be a significant protective predictor of elevated liver enzymes. Our findings revealed that elevated liver enzyme levels were significantly correlated with the severity of COVID-19 (p < 0 05) in terms of qSOFA score. Moreover, older age, diabetes, qSOFA score, and elevated hepatitis enzymes were associated with mortality (p = 0 043). Conclusions: Elevated liver enzyme levels were common in patients with COVID-19 and were associated with the severity and prognosis of clinical outcomes.

Conflicts of Interest The authors declare no conflicts of interest. Author Contributions Eyad Makkawy: writingreview and editing. Shaden Mohammed Alamro: methodology, resources. Safiya Ibn Awadh: data curation. Reem Basalasil: data curation. Ziyad Alkhelaiwi: data curation. Bassam AL-Mutairi: data curation. Fatimah Rebh: formal analysis, writingreview and editing. Supporting Information Additional supporting information can be found online in the Supporting Information section. (Supporting Information) Table S1 reported data about the type of comorbidity, symptoms, medication use after admission, and medical complications of the COVID-19 patients.

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The multivariate logistic binary regression analysis was used to identify the predictors of elevated liver enzyme levels and mortality among patients with COVID‐19.\n \n \n \n Results\n \n This cohort included 1033 patients, 73% of whom were male, with a mean age of 49.9 years. Elevated liver enzymes were observed in 52.7% of patients, most commonly with a hepatitis pattern (63.1%). Elevated levels of hemoglobin, creatine kinase–myocardial band, and C‐reactive protein, as well as pneumoniae, the requirement of an intensive care unit, comorbidities, and the use of paracetamol,\n β\n ‐lactamase, and steroids were significant predictors of elevated liver enzymes (\n p\n < 0.05). Interestingly, Saudi patients (\n p\n = 0.019) were found to be a significant protective predictor of elevated liver enzymes. Our findings revealed that elevated liver enzyme levels were significantly correlated with the severity of COVID‐19 (\n p\n < 0.05) in terms of qSOFA score. 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