P1780 - Liver Injury in COVID-19 Patients and Its Association with Mortality at a Safety-Net Hospital

Sanda Gomez-Paz, MD¹, Eric Lam, DO¹, Paul Mustacchia, MD, MBA¹, Joshua Fogel, PhD², Sofia Rubinstein, MD^1
1Nassau University Medical Center, East Meadow, NY; ²Brooklyn College, Brooklyn, NY

Introduction: Liver injury in COVID-19 patients has been associated with severe disease and higher mortality. We describe not previously studied indicators of liver injury and their association with mortality and length of stay (LOS) in COVID-19 patients.

Methods: A retrospective study was conducted in 528 patients with confirmed COVID-19 infection and liver injury. Multivariate analyses of logistic regression was applied to mortality and linear regression for LOS, and adjusted for relevant demographic, comorbidity, disease severity, and treatment covariates.

Results: Mortality was 34.5% and mean LOS was 11.9 days. Medicaid insurance (OR:2.80, 95% CI:1.02,7.66, p< 0.05), increased aspartate transaminase (AST) peak level (OR:15.03, 95% CI:2.43,83.11, p< 0.01), and persistent liver injury at discharge (OR:4.86, 95% CI:1.92, 12.31 p< 0.01) were significantly associated with increased odds for mortality. Increased alanine transaminase (ALT) peak (OR:0.05, 95% CI:0.01,0.44, p< 0.01), higher albumin on admission (OR:0.36, 95% CI:0.16, 0.78, p< 0.05), and increased days to liver injury (OR:0.21, 95% CI:0.06,0.79, p< 0.05), were significantly associated with decreased odds for mortality. Increased ALT peak (B:0.25, SE:0.07, p< 0.001), increased total bilirubin (TBL) peak (B:0.36, SE:0.07, p< 0.001) and increased days to liver injury (B:0.22, SE:0.04, p< 0.001) were each significantly associated with increased LOS. Increased AST peak (B:-0.14, SE:0.06, p< 0.05) and persistent liver injury at discharge (B:-0.16, SE:0.03, p< 0.001) were significantly associated with decreased LOS.

Discussion: We found that AST peak level and persistent liver injury at discharge are associated with higher mortality and should be used as prognostic indicators. Conflicting current evidence suggests that ALT level alone may not be an accurate prognostic indicator and even suggestive of a potential protective effect in COVID-19 patients with liver injury. We found that ALT peak level was associated with decreased mortality, which supports the latter. Other liver injury parameters of TBL level, ALT level and increased days to liver injury can be used by clinicians to predict LOS. Early identification of these liver injury parameters should be made for determining prognosis and constructing a tailored approach in the management of COVID-19 patients with liver injury.


Disclosures:


Sanda Gomez-Paz, MD¹, Eric Lam, DO¹, Paul Mustacchia, MD, MBA¹, Joshua Fogel, PhD², Sofia Rubinstein, MD¹. P1780 - Liver Injury in COVID-19 Patients and Its Association with Mortality at a Safety-Net Hospital, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.