Elevated Liver Aminotransferases Level and COVID-19 Prognosis in Hospitalized Patients: A Prospective Study from Iran

Masood Faghih Dinevari, Mohamad Hossein Somi, Elham Sadeghi Majd, Afshin Fattahzadeh, Zeinab Nikniaz



 Considering the conflicting results and limited studies on the association between elevated liver enzyme levels and COVID-19 outcomes, in the present study, we aimed to investigate the association between hepatic enzyme changes and the prognosis of COVID-19 during hospital admission.


In this prospective study, 1017 consecutive patients with COVID-19 participated and were followed up from admission until they were discharged or deceased. The liver enzyme levels were recorded on admission. The patient/disease-related information was recorded by trained nurses using questionnaires. The primary endpoint was the association between elevated liver enzymes and liver injury and mortality from COVID.


 The mean age of the participants was 62.58±17.45 years; 55.4% of them were male. There was no significant difference between groups regarding the COVID-19 outcomes except for the need for ICU admission (p=0.02). Moreover, all COVID-19 outcomes were significantly higher in patients with liver injury compared with other patients except for the quick sequential organ failure assessment (qSOFA) score. After adjusting for covariates, the patients with Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) levels of more than 40 (IU/L) and participants with liver injury on admission had significantly greater odds of death, ICU admission, and mechanical ventilation requirements.


 The results of the present study support the hypothesis that poor outcomes of COVID-19 infection were higher in patients with elevated liver enzyme levels and liver injury. Therefore, liver chemicals should be closely monitored during the illness and hospital admission, and patients with COVID-19 and an elevated level of transaminases should be followed up carefully, and necessary interventions should be considered to prevent poor outcomes.


COVID-19; Liver enzymes; Transaminases; Liver injury; Prognosis

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