Liver involvement is not associated with mortality: results from a large cohort of SARS-CoV-2-positive patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is frequently associated with liver test abnormalities. Aims: To describe the evolution of liver involvement during SARS-CoV-2 infection and its effect on clinical course and mortality. Methods: Data of 515 SARS-CoV-2-positive patients were collected at baseline and during follow-up, last evaluation or death. Stratification based on need for hospitalisation, severe disease and admission to intensive care unit (ICU) was performed. The association between liver test abnormalities (baseline and peak values) and ICU admission or death was also explored. Results: Liver test abnormalities were found in 161 (31.3%) patients. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) were increased in 20.4%, 19% and 13.6% of patients, respectively. Baseline liver test abnormalities were associated with increased risk of ICU admission (OR 2.19 [95% CI 1.24-3.89], P = 0.007) but not with mortality (OR 0.84 [95% CI 0.49-1.41], P = 0.51). Alkaline phosphatase (ALP) peak values were correlated with risk of death (OR 1.007 [95% CI 1.002-1.01], P = 0.005) along with age, multiple comorbidities, acute respiratory distress syndrome, ICU admission and C-reactive protein. Alterations of liver tests worsened within 15 days of hospitalisation; however, in patients with the longest median follow-up, the prevalence of liver test alterations decreased over time, returning to around baseline levels. Conclusions: In SARS-CoV-2-positive patients without pre-existing severe chronic liver disease, baseline liver test abnormalities are associated with the risk of ICU admission and tend to normalise over time. The ALP peak value may be predictive of a worse prognosis.