Magnitude of Liver Biochemical Test Abnormalities and its Effect on Patient Outcomes Among Patients Admitted to St. Paul’s COVID-19 Treatment Center

Abstract

Summary Background: Coronavirus disease (COVID-19) is an infectious disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 virus. In addition to its pulmonary manifestations, COVID-19 also causes extrapulmonary manifestations which includes liver involvement. Understanding the prevalence of liver biochemical test abnormalities and identifying the relationship between elevation in liver biochemical tests and adverse clinical outcomes can help improve care of patients. Objective: The aim of the study is to measure the prevalence of liver biochemical test abnormalities and its association with adverse patient outcomes in patients admitted to SPHMMC COVID-19 treatment center. Methods: A descriptive and analytical cross-sectional study was conducted in SPHMMC COVID- 19 treatment center between May 2022 to August 2022. From a total of 2200 of patients, 331 patients were included in the study using systemic random sampling. A structured checklist was used to screen records for completeness. The data was entered, cleaned, analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Bivariate and multivariate analysis between dependent and independent variables was performed. Results: Prevalence of abnormal liver biochemical test abnormalities was determined among patients admitted to SPHMMC COVID-19 treatment center. Elevations in alanine aminotransferase, aspartate aminotransferase and alkaline phospatase were present at baseline in 40.2%, 43.8% and 48.3% of patients, respectively. Assessment of relationships between elevated liver biochemical tests and adverse patient outcomes was also conducted. Parameters that were associated with increased risk of death were baseline elevation in ALT (OR = 3.271; 95% CI = 1.349-7.931; P = 0.009), in-hospital elevation in AST (OR = 2.192; 95% CI = 1.273-3.773; P = 0.005) and in hospital elevation in ALP (OR = 6.047; 95% CI = 2.863-12.773; P < 0.001). In-hospital elevation in AST was also found to be predictor of increased risk of transfer to the ICU and Mechanical ventilator (OR = 2.030; 95% CI = 1.099-3.749; P <0.024). Conclusion: Abnormalities in liver biochemical tests are common among patients admitted with COVID-19 patients. Elevation in parameters such as AST and ALP, particularly during the course of hospitalization should be looked after as it may signal an increased risk of transfer to the ICU, requirement of MV and death. Keywords: Coronavirus-19, liver dysfunction, hepatitis, severe acute respiratory syndrome coronavirus 2.