Liver injury, hypoalbuminaemia and severe SARS-CoV-2 infection

A review of 310 patients admitted with COVID-19 to our institution in Dublin revealed abnormal liver blood tests were present in almost 50% of patients, in particular raised gamma-glutamyl transferase (gGT) levels (table 1), similar to that noted by Weber and colleagues.1 In our patient cohort, hypoalbuminaemia on admission to hospital was also an independent predictor of mortality, validating the findings of their prospective study. Multivariate analysis of our cohort showed a significant association between COVID-19-related mortality and serum albumin on admission (OR 0.90, 0.85–0.96; p=0.002); in a model incorporating older age, male sex, high MULBSTA score (a predictive score of viral pneumonia mortality4) and body mass index, hypoalbuminaemia predicted death, with area under the curve receiver operating characteristic at 0.8 (figure 1). Table 1 Baseline characteristics and liver blood tests on admission for 310 COVID-19 patients Baseline characteristics* Patients with COVID-19 (N=310) Age, median (years) 69 (range 21–95) Male gender, % (n) 61 (188/310) Ethnicity, % (n) Caucasian 96.5 (299/310) Black 1.6 (5/310) Romany 1.9 (6/310) BMI (kg/m2) 26 (15–55) CRP (mg/L) 155 (1.6–510) MULBSTA score, median 9 (range 2–19) Death, % (n) 26.8 (83/310) Liver blood tests on admission, % (n) Bilirubin >20 μmol/L (range 0–21 μmol/L) 5 (18/310) ALT >40 IU/L (range 0–41 IU/L) 20 (62/310) AST >40 IU/L (range 0–40 IU/L) 28 (87/310) Alkaline phosphatase >130 IU/L (range 40–130 IU/L) 17 (54/310) GGT >40 IU/L (range 0–59 IU/L) 48 (150/310) Albumin