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Prognostic markers are needed to understand the disease course and severity in patients with Covid-19. There is evidence that Covid-19 causes gastrointestinal symptoms and abnormalities in liver enzymes. We aimed to determine if hepatobiliary laboratory data could predict disease severity in patients with Covid-19. In this retrospective, single institution, cohort study that analyzed patients admitted to a community academic hospital with the diagnosis of Covid-19, we found that elevations of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Alkaline Phosphatase (AP) at any time during hospital admission increased the odds of ICU admission by 5.12 (95% CI: 1.55–16.89;  p  = 0.007), 4.71 (95% CI: 1.51–14.69;  p  = 0.01) and 4.12 (95% CI: 1.21–14.06,  p  = 0.02), respectively. Hypoalbuminemia found at the time of admission to the hospital was associated with increased mortality ( p  = 0.02), hypotension ( p  = 0.03), and need for vasopressors ( p  = 0.02), intubation ( p  = 0.01) and hemodialysis ( p  = 0.002). Additionally, there was evidence of liver injury: AST was significantly elevated above baseline in patients admitted to the ICU (54.2 ± 15.70 U/L) relative to those who were not (9.2 ± 4.89 U/L;  p  = 0.01). Taken together, this study found that hypoalbuminemia and abnormalities in hepatobiliary laboratory data may be prognostic factors for disease severity in patients admitted to the hospital with Covid-19.

Elevated transaminases and hypoalbuminemia in Covid-19 are prognostic factors for disease severity