Drastic decrease of urgent endoscopies outside regular working hours during the COVID-19 pandemic in the paris area

Introduction: The SARS-CoV2 pandemic poses a serious challenge to society and a threat to the global health care system Physicians are forced to make fast decisions based on limited knowledge By using machine learning techniques, we were able to exploit large amounts of data from intensive care unit (ICU) patients to derive patterns in the clinical picture of COVID-19 patients Among other parameters, we identified liver to be an important indicator for a severe discourse of the disease Aims & Methods: We analyzed the recorded data of 56 COVID patients in the Intensive Care Unit including demographics, laboratory reports and high-frequency vital measurements such as ventilation and heart signals A special focus was set on liver values namely glutamic-pyruvate transaminase (GPT), Bilirubin, alkaline phosphatase (ALP) and international normalized ratio (INR) By comparing this set of parameters with the baseline of a non-COVID patient group, we were able to define a simple yet effective severity score to classify liver involvements To calculate the score, each parameter is evaluated by the deviation to its defined normal value: Severity grade 1: deviation by 1,5-2x of normal value of GPT, Bilirubin and ALP and an INR of 1,15- 1,35 Severity grade 2: deviation by 2-3x of normal value and 0,5 step of INR Severity grade 3: deviation by 3-4x of normal value and 0,5 step of INR Severity grade 4: deviation of 4 or more of normal value and 0,5 step of INR Results: A cohort of 56 corona-virus positive patients were analyzed All of the patients depicted signs of a liver involvement 8 % show severity grade 1, 19 % severity grade 2 and 10 % severity grade 3 Of note, 60% of the cohort showed the highest severity grade 4 26% of the patients which has the highest severity grade died and 44% of them are still at the hospital Conclusion: All of the 56 corona-virus positive patients in the cohort showed massive liver symptoms There exists a clear correlation between elevated liver values and an increased mortality In particular, 26 % of patients with a severity grade of 4 died Thus, it is a challenging task for the future to unravel the molecular mechanisms of SARS-CoV-2 induced liver damage and to understand the connection of viral infection and liver involvement in detail