455 - Hepatic Laboratory Abnormalities Associated with Disease Severity in Patients with COVID-19: A Pooled Analysis of 6 Retrospective Cohort Studies Including 755 Patients

Background: Patients with COVID-19 are at high risks of developing significant pulmonary complications. However, its possible hepatic involvement has not been researched extensively. This study amis to analyze liver abnormality associated with disease severity in patients with COVID-19.

Methods: This was a pooled analysis of 6 retrospective, cohorts studies including 755 Chinese adult patients ( > 18 years) diagnosed with COVID-19, admitted from January through February 2020.  These patients were classified into two groups: non- severe and severe, based on interim guidelines of World Health Organization and the National Health Commission of China. Patients would be classified into severe group if one of three following criteria were met: respiratory rate > 30 breaths/min, SpO2 < 93% on room air, or PaO2/FiO2 ≤ 300mmHg. Results were analyzed with Student’s t- test, Pearson’s Chi-Squared test and Wilcoxon rank-sum test by SAS Enterprise Guide 7.1.Table 1: Pooled Results


Results: 755 Chinese adult patients ( >18 years) with COVID-19 were included. Gender of male (OR 1.95; 95% CI 1.26-3.0; P=0.0022), and Wuhan region (OR 2.17; 95% CI 1.4-3.34; P= 0.0004) were significantly associated with the severe group compared with the non-severe group. Also the severe group had a significant lower albumin (g/dL) (3.5±1.1 vs. 4.1±1.0, P= 0.001), higher AST (U/L) (34.1±24.8 vs. 22.3±17.9, P= 0.001), and higher CRP (mg/L) (54.1±122.2 vs. 9.3±59.0, P= 0.0135) compared with the non-severe group. Surprisingly, no significant difference of age between these two groups was identified. Furthermore, no significant difference of ALT, Total bilirubin, D-dimer or INR with disease severity were identified.Table 2: Lab Results And Age With Disease Severity
Table 3: Age And Location With Disease Severity
Figure 1: Variables Comparison Severe vs. Non- Severe


Conclusion: This study demonstrated that male gender and of Wuhan origin were significantly higher in proportion in the severe group. Of Wuhan origin as a risk factor of severe COVID-19 could be explained by limited medical resources for overwhelming COVID-19 patients in Wuhan during the period of January and February 2020. It is unclear why male was the risk factor of severe COVID-19 based on our data. Also, there were significant lower Albumin, higher AST and CRP in severe COVID-19, but their values were not too impressive. However due to limited data and studies, future studies are needed to elucidate risks factors associated with severe COVID-19.Figure 2: Locations of Patients by Cities
Locations of Severe COVID-19 by Cities