Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission

Introduction & objectives: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. Materials & methods: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. Results: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7–47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4–16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9–21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1–14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1–2.0); P = 0.01], and severe COVID-19 (2.6 [2.0–3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. Conclusions: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. Fil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Anders, Margarita. Hospital Aleman; Argentina Fil: Silveyra, María Dolores. Sanatorio Anchorena; Argentina Fil: Torre, Aldo. Centro Médico ABC; México Fil: Montes, Pedro. Hospital Nacional Daniel A. Carrión; Perú Fil: Urzúa, Alvaro. Hospital Clínico de la Universidad de Chile; Chile Fil: Pages, Josefina. Universidad Austral. Hospital Universitario Austral; Argentina Fil: Toro, Luis G.. Hospitales de San Vicente Fundación de Medellín y Rionegro; Colombia Fil: Díaz, Javier. Hospital Nacional Edgardo Rebagliati Martins; Perú Fil: Gonzalez Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina Fil: Miranda Zazueta, Godolfino. Instituto Nacional de Ciencias Médicas y Nutrición; México Fil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; Argentina Fil: Gutiérrez, Isabel. Centro Médico ABC; México Fil: Michelato, Douglas. Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia; Brasil Fil: Venturelli, Maria Grazia. Hospital Nacional Guillermo Almenara Irigoyen; Perú Fil: Varón, Adriana. Fundación Cardio-Infantil; Colombia Fil: Vera Pozo, Emilia. Hospital Regional Dr. Teodoro Maldonado Carbo; Ecuador Fil: Tagle, Martín. Clínica Anglo-Americana; Perú Fil: García, Matías. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Tassara, Alfredo. Hospital Aleman; Argentina Fil: Brutti, Julia. Sanatorio Anchorena; Argentina Fil: Ruiz García, Sandro. Hospital de Víctor Lazarte Echegaray; Perú Fil: Bustios, Carla. Clínica Delgado; Perú Fil: Escajadillo, Nataly. Hospital Nacional Almanzor Aguinaga Asenjo; Perú Fil: Macias, Yuridia. No especifíca; Fil: Higuera de la Tijera, Fátima. Hospital General de México “Dr. Eduardo Liceaga"; México Fil: Gómez, Andrés J.. Hospital Universitario Fundación Santa Fé de Bogotá; Colombia Fil: Dominguez, Alejandra. Hospital Padre Hurtado; Chile Fil: Castillo Barradas, Mauricio. Hospital de Especialidades del Centro Médico Nacional La Raza; México Fil: Contreras, Fernando. No especifíca; Fil: Scarpin, Aldana. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Schinoni, Maria Isabel. Hospital Alianza; Brasil Fil: Toledo, Claudio. Universidad Austral de Chile; Chile Fil: Girala, Marcos. Universidad Nacional de Asunción; Paraguay Fil: Mainardi, Victoria. Hospital Central De las Fuerzas Armadas; Uruguay Fil: Sanchez, Abel. Hospital Roosevelt; Guatemala Fil: Bessone, Fernando. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina Fil: Rubinstein, Fernando Adrian. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Silva, Marcelo Oscar. Universidad Austral. Hospital Universitario Austral; Argentina