Liver injury in hospitalized patients with COVID-19: An International observational cohort study: An International observational cohort study

Bharath Kumar Tirupakuzhi Vijayaraghavan; Saptarshi Bishnu; Joaquin Baruch; Barbara Wanjiru Citarella; Christiana Kartsonaki; Aronrag Meeyai; Zubair Mohamed; Shinichiro Ohshimo; Benjamin Lefèvre; Abdulrahman Al-Fares; Jose A. Calvache; Fabio Silvio Taccone; Piero Olliaro; Laura Merson; Neill K.J. Adhikari; Sheryl Ann Abdukahil; Nurul Najmee Abdulkadir; Ryuzo Abe; Laurent Abel; Amal Abrous; Lara Absil; Andrew Acker; Elisabeth Adam; Diana Adrião; Saleh Al Ageel; Kate Ainscough; Ali Ait Hssain; Younes Ait Tamlihat; Takako Akimoto; Ernita Akmal; Eman Al Qasim; Angela Alberti; Tala Al-Dabbous; Senthilkumar Alegesan; Marta Alessi; Beatrice Alex; Kévin Alexandre; Huda Alfoudri; Imran Ali; Kazali Enagnon Alidjnou; Jeffrey Aliudin; Clotilde Allavena; Nathalie Allou; João Melo Alves; Rita Alves; Joana Alves Cabrita; Maria Amaral; Tom Fletcher; Benjamin Morton; Ymkje Stienstra

doi:10.1371/journal.pone.0277859

Liver injury in hospitalized patients with COVID-19: An International observational cohort study: An International observational cohort study

Bharath Kumar Tirupakuzhi Vijayaraghavan
, Saptarshi Bishnu
, Joaquin Baruch
, Barbara Wanjiru Citarella
, Christiana Kartsonaki
, Aronrag Meeyai
, Zubair Mohamed
, Shinichiro Ohshimo
, Benjamin Lefèvre
, Abdulrahman Al-Fares
, Jose A. Calvache
, Fabio Silvio Taccone
, Piero Olliaro
, Laura Merson
, Neill K.J. Adhikari
, Sheryl Ann Abdukahil
, Nurul Najmee Abdulkadir
, Ryuzo Abe
, Laurent Abel
, Amal Abrous

Lara Absil, Andrew Acker, Elisabeth Adam, Diana Adrião, Saleh Al Ageel, Kate Ainscough, Ali Ait Hssain, Younes Ait Tamlihat, Takako Akimoto, Ernita Akmal, Eman Al Qasim, Angela Alberti, Tala Al-Dabbous, Senthilkumar Alegesan, Marta Alessi, Beatrice Alex, Kévin Alexandre, Huda Alfoudri, Imran Ali, Kazali Enagnon Alidjnou, Jeffrey Aliudin, Clotilde Allavena, Nathalie Allou, João Melo Alves, Rita Alves, Joana Alves Cabrita, Maria Amaral, Tom Fletcher, Benjamin Morton, Ymkje Stienstra

Liverpool School of Tropical Medicine

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.

Original language	English
Article number	e0277859
Journal	PLoS ONE
Volume	18
Issue number	9 September
DOIs	https://doi.org/10.1371/journal.pone.0277859
Publication status	Published - 1 Sept 2023

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10.1371/journal.pone.0277859Licence: CC BY

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Vijayaraghavan, B. K. T., Bishnu, S., Baruch, J., Citarella, B. W., Kartsonaki, C., Meeyai, A., Mohamed, Z., Ohshimo, S., Lefèvre, B., Al-Fares, A., Calvache, J. A., Taccone, F. S., Olliaro, P., Merson, L., Adhikari, N. K. J., Abdukahil, S. A., Abdulkadir, N. N., Abe, R., Abel, L., ... Stienstra, Y. (2023). Liver injury in hospitalized patients with COVID-19: An International observational cohort study: An International observational cohort study. PLoS ONE, 18(9 September), Article e0277859. https://doi.org/10.1371/journal.pone.0277859

@article{3faf03df6abd453ca3b4447924b1708d,

title = "Liver injury in hospitalized patients with COVID-19: An International observational cohort study: An International observational cohort study",

abstract = "Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95\% confidence intervals (CI). Results Of 17,531 included patients, 46.2\% (8099) and 8.2\% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.",

author = "Vijayaraghavan, \{Bharath Kumar Tirupakuzhi\} and Saptarshi Bishnu and Joaquin Baruch and Citarella, \{Barbara Wanjiru\} and Christiana Kartsonaki and Aronrag Meeyai and Zubair Mohamed and Shinichiro Ohshimo and Benjamin Lef{\`e}vre and Abdulrahman Al-Fares and Calvache, \{Jose A.\} and Taccone, \{Fabio Silvio\} and Piero Olliaro and Laura Merson and Adhikari, \{Neill K.J.\} and Abdukahil, \{Sheryl Ann\} and Abdulkadir, \{Nurul Najmee\} and Ryuzo Abe and Laurent Abel and Amal Abrous and Lara Absil and Andrew Acker and Elisabeth Adam and Diana Adri{\~a}o and \{Al Ageel\}, Saleh and Kate Ainscough and Hssain, \{Ali Ait\} and Tamlihat, \{Younes Ait\} and Takako Akimoto and Ernita Akmal and \{Al Qasim\}, Eman and Angela Alberti and Tala Al-Dabbous and Senthilkumar Alegesan and Marta Alessi and Beatrice Alex and K{\'e}vin Alexandre and Huda Alfoudri and Imran Ali and Alidjnou, \{Kazali Enagnon\} and Jeffrey Aliudin and Clotilde Allavena and Nathalie Allou and Alves, \{Jo{\~a}o Melo\} and Rita Alves and Cabrita, \{Joana Alves\} and Maria Amaral and Tom Fletcher and Benjamin Morton and Ymkje Stienstra",

year = "2023",

month = sep,

day = "1",

doi = "10.1371/journal.pone.0277859",

language = "English",

volume = "18",

journal = "PLoS ONE",

publisher = "Public Library of Science",

number = "9 September",

}

Vijayaraghavan, BKT, Bishnu, S, Baruch, J, Citarella, BW, Kartsonaki, C, Meeyai, A, Mohamed, Z, Ohshimo, S, Lefèvre, B, Al-Fares, A, Calvache, JA, Taccone, FS, Olliaro, P, Merson, L, Adhikari, NKJ, Abdukahil, SA, Abdulkadir, NN, Abe, R, Abel, L, Abrous, A, Absil, L, Acker, A, Adam, E, Adrião, D, Al Ageel, S, Ainscough, K, Hssain, AA, Tamlihat, YA, Akimoto, T, Akmal, E, Al Qasim, E, Alberti, A, Al-Dabbous, T, Alegesan, S, Alessi, M, Alex, B, Alexandre, K, Alfoudri, H, Ali, I, Alidjnou, KE, Aliudin, J, Allavena, C, Allou, N, Alves, JM, Alves, R, Cabrita, JA, Amaral, M, Fletcher, T , Morton, B & Stienstra, Y 2023, 'Liver injury in hospitalized patients with COVID-19: An International observational cohort study: An International observational cohort study', PLoS ONE, vol. 18, no. 9 September, e0277859. https://doi.org/10.1371/journal.pone.0277859

TY - JOUR

T1 - Liver injury in hospitalized patients with COVID-19: An International observational cohort study: An International observational cohort study

AU - Vijayaraghavan, Bharath Kumar Tirupakuzhi

AU - Bishnu, Saptarshi

AU - Baruch, Joaquin

AU - Citarella, Barbara Wanjiru

AU - Kartsonaki, Christiana

AU - Meeyai, Aronrag

AU - Mohamed, Zubair

AU - Ohshimo, Shinichiro

AU - Lefèvre, Benjamin

AU - Al-Fares, Abdulrahman

AU - Calvache, Jose A.

AU - Taccone, Fabio Silvio

AU - Olliaro, Piero

AU - Merson, Laura

AU - Adhikari, Neill K.J.

AU - Abdukahil, Sheryl Ann

AU - Abdulkadir, Nurul Najmee

AU - Abe, Ryuzo

AU - Abel, Laurent

AU - Abrous, Amal

AU - Absil, Lara

AU - Acker, Andrew

AU - Adam, Elisabeth

AU - Adrião, Diana

AU - Al Ageel, Saleh

AU - Ainscough, Kate

AU - Hssain, Ali Ait

AU - Tamlihat, Younes Ait

AU - Akimoto, Takako

AU - Akmal, Ernita

AU - Al Qasim, Eman

AU - Alberti, Angela

AU - Al-Dabbous, Tala

AU - Alegesan, Senthilkumar

AU - Alessi, Marta

AU - Alex, Beatrice

AU - Alexandre, Kévin

AU - Alfoudri, Huda

AU - Ali, Imran

AU - Alidjnou, Kazali Enagnon

AU - Aliudin, Jeffrey

AU - Allavena, Clotilde

AU - Allou, Nathalie

AU - Alves, João Melo

AU - Alves, Rita

AU - Cabrita, Joana Alves

AU - Amaral, Maria

AU - Fletcher, Tom

AU - Morton, Benjamin

AU - Stienstra, Ymkje

PY - 2023/9/1

Y1 - 2023/9/1

N2 - Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.

AB - Background Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]). Conclusions Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.

U2 - 10.1371/journal.pone.0277859

DO - 10.1371/journal.pone.0277859

M3 - Article

VL - 18

JO - PLoS ONE

JF - PLoS ONE

IS - 9 September

M1 - e0277859

ER -

Liver injury in hospitalized patients with COVID-19: An International observational cohort study: An International observational cohort study

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