Patients with COVID-19, liver injury at higher risk for morbidity, mortality

Researchers observed a significantly increased risk for mortality, mechanical ventilation, ICU admission and 30-day re-admission in patients with COVID-19 with liver disease, according to a presentation at the American College of Gastroenterology virtual annual meeting.

“COVID-19 patients with [liver injury] had increased 30-day readmission rates,” Mohammad Siddiqui, MD, from the Henry Ford Health System in Detroit, Michigan, said. “Cirrhosis is associated with increased mortality in COVID-19.”

From March 1, 2020, to April 30, 2020, Siddiqui and colleagues performed a retrospective study that included 1,935 patients with confirmed COVID-19. Of these patients, 507 had normal liver function tests, 1,030 patients had mild elevation in liver function test and 397 patients had liver injury. Investigators compared these cohorts against a control group of patients with normal liver function tests from presentation to hospital and throughout hospitalization.

Investigators reported more men had mild elevation in liver function tests (P = .0004) and liver injury groups vs. the control group (P < .0001).

“Patients in the [mild elevation liver] function tests cohort were older [P = .0005]” he said. “African Americans were more likely to develop [liver injury] (P = .0318).”

According to Siddiqui, no differences were seen between the groups regarding comorbidities. There were 241 patients with hepatocellular pattern, 20 patients with cholestatic pattern and 135 patients with mixed pattern among patients with liver injury. Increased risk for mortality (RR = 4.26; 95% CI, 3.12-5.81), ICU admission (RR = 5.52; 95% CI, 4.07-7.49), intubation (RR = 11.01; 95% CI, 6.97-17.34) and 30-day readmission (RR = 1.81; 95% CI, 1.17-2.8) was seen in patients with liver injury vs. the control group.

“Given lack of vaccine and definitive treatment options, prognostication is critical,” Siddiqui said. “This data will help stratify COVID-19 patients.”