P2806 - Predictors of Elevated Liver Tests During COVID-19 Shelter in Place in Those Without Known Liver Disease

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Omar Alshuwaykh, MD

Stanford University School of Medicine
San Ramon, CA, United States

Omar Alshuwaykh, MD¹, Robert Wong, MD, MS, FACG², Janice Jiang, MD³, Natalie Torok, MD³, Ray Kim, MD³, Paul Kwo, MD³
¹Stanford University School of Medicine, San Ramon, CA; ²Stanford University School of Medicine, Palo Alto, CA; ³Stanford University School of Medicine, Redwood City, CA

Introduction: Elevated liver tests(LT) are associated with reduced liver related health. The AIM of our study was to determine the prevalence and predictors of new-onset elevated LT during COVID-19 shelter in place(SIP) in those without chronic liver disease(CLD)

Methods: Retrospective cohort study examining LT in patients ³18 years at one month after SIP from 4/19/2020 until 12/31/2020(2020). We excluded patients with CLD and those hospitalized. We extracted LT, serum low density lipoprotein(LDL), serum triglyceride(TG) and demographic data. We compared LT obtained during the same time period for the same patients from 4/19/2019 to 12/31/2019(2019). Elevated LT were defined as ALT >35U/L in males, >25U/L in females, AST >40U/L, or total bilirubin (TB) >1.1 mg/dL. Among patients with normal LT in 2019, we evaluated predictors of elevated LT in 2020 using multivariate analysis.

Results: We evaluated 44021 patients: median age 56 years (IQR54-75), median weight 173.9lb(IQR 149.2-202.9), 51.8%males, and 48.2%females. Higher rates of new onset ALT elevation were observed in females than males(18.9%vs9.4%,p< 0.001) and was predicted by higher weight, serum TG level. Younger age was associated with lower odds of ALT elevation. We observed new onset AST elevation in 2.8% and was predicted by higher TG, systolic blood pressure, and male gender. Younger age was also associated with lower odds of AST elevation. New onset elevated TB was observed in 2.6% and was predicted by Asian or Black race compared to White race, and male gender. Lower serum TG was associated with lower odds of TB elevation. Significantly more patients had FIB-4 >3.25 in 2020(5.3%) compared to(3.8%) patients with FIB-4 >3.25 in 2019(P< 0.001). Predictors of FIB-4 >3.25 in 2020 included age(OR1.0032,95%CI1.0030-1.0034,P< 0.001), male gender(OR1.03,95%CI1.02-1.04) and language barrier (non-English speaking) (OR1.07,95%CI1.05-1.08,P< 0.001).

Discussion: During SIP, in patients without history of CLD or hospitalization, we observed a higher rate of new onset abnormal ALT levels in females than males which were associated with features of metabolic syndrome and older age. Higher AST levels were associated with male gender, metabolic syndrome features and older age suggesting higher rates of alcohol use. We also observed higher rates of FIB-4 >3.25 in 2020 indicating worsening patterns of liver disease. Further follow-up will be required to determine the long-term effects of these changes.

Liver Test	Predictors	Median	OR (95% CI)	P value
Elevated LT Males 675/7175 (9.4%)	Age Weight TG	60 vs 67 years 193.8 vs 183.5 lb 119 vs 102 mg/dL	0.9977 (0.9972-0.9982) 1.00002 (1.00001-1.00003) 1.0003 (1.0002-1.0004)	< 0.001 0.005 < 0.001
Elevated ALT Females 970/5136 (18.9%)	Age Weight TG	62 vs 70 years 187.4 vs 179.8 lb 109 vs 97 mg/dL	0.9962 (0.9954-0.9969) 1.00004 (1.00002-1.0001) 1.0004 (1.0002-1.00005)	< 0.001 < 0.001 < 0.001
Elevated AST 470/16636 (2.8%)	Age Systolic BP TG Males	62 vs 65 years 127.7 vs 126.5 115 vs 103 mg/dL 61.7% vs 48.9%	0.9997 (0.9995-0.9999) 1.0002 (1.00004-1.0004) 1.0001 (1.00006-1.00008) 1.011 (1.006-1.02)	< 0.001 0.02 < 0.001 < 0.001
Elevated TB 394/15074 (2.6%)	Asians Blacks Males TG	26.6% vs 22.2% 6.1% vs 4.8% 71.2% vs 48.7% 98.4 vs 104 mg/dL	1.009(1.001-1.018) 1.017 (1.004-1.029) 1.025(1.019-1.031) 0.99995 (0.99991-0.99998)	0.009 0.02 < 0.001 0.006

Table: Predictors of elevated LT in multivariate analysis

Disclosures:

Omar Alshuwaykh indicated no relevant financial relationships.

Robert Wong indicated no relevant financial relationships.

Janice Jiang indicated no relevant financial relationships.

Natalie Torok indicated no relevant financial relationships.

Ray Kim indicated no relevant financial relationships.

Paul Kwo indicated no relevant financial relationships.

Omar Alshuwaykh, MD¹, Robert Wong, MD, MS, FACG², Janice Jiang, MD³, Natalie Torok, MD³, Ray Kim, MD³, Paul Kwo, MD³. P2806 - Predictors of Elevated Liver Tests During COVID-19 Shelter in Place in Those Without Known Liver Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.