S1068 Transaminases Are Potential Biomarkers of Disease Severity in Coronavirus Disease-2019 (COVID-19) Patients

INTRODUCTION: Considering the rapid spread of SARS-CoV2, the clinical implications of hepatic manifestations of COVID-19 in the U S population requires analysis METHODS: We retrospectively reviewed all adult patients with COVID-19 admitted to our facility between March 13th and May 1st, 2020 Patients were divided into two groups based on the presence or absence of transaminitis at presentation All patients with elevated alanine transaminase (ALT) or aspartate transaminase (AST) >1 x upper limit of normal were considered to have transaminitis Kruskal-Wallis and Pearson's chi-square tests were used to compare median of continuous and categorical variables, respectively Multivariate logistic regression analysis was performed to identify predictors of mechanical ventilation (MV), cytokine release syndrome (CRS), and mortality after adjusting for baseline variables RESULTS: A total of 84 patients were included in the analysis;44 (52 3%) patients had transaminitis on admission There was a higher number of male patients with transaminitis than without transaminitis (79 5% vs 42 5%, P = 0 0001) (Table 1) Baseline demographics and laboratory parameters were similar among patients with and without transaminitis (Table 2) Patients with transaminitis had significantly higher risk of developing acute hypoxic respiratory failure, shock, CRS, and deep vein thrombosis as demonstrated in Table 3A On a multivariate analysis, presence of transaminitis on admission ((adjusted odds ratio (aOR): 5 69, 95% CI, 1 47-21 99, P = 0 01) was associated with an increased risk of developing cytokine release syndrome (CRS) Transaminitis on admission and elevated total bilirubin during hospitalization were associated with an increased need for MV (aOR of 6 17, 95% CI, 1 49-25 44, P = 0 02 and aOR of 7 29, 95% CI, 1 73-30 75, P = 0 007, respectively) Elevated AST on admission (aOR of 13 41, 95% CI, 1 08-165 69, P = 0 04) and elevated total bilirubin during hospitalization (aOR of 82 68, 95% CI, 1 67-4074 8, P = 0 02) were independently associated with an increased risk of mortality in COVID-19 patients (Table 3B) CONCLUSION: COVID-19 patients with transaminitis had higher risk of requiring MV and developing CRS Patients with elevated AST on admission and elevated total bilirubin during hospitalization had higher mortality As such, elevated transaminases seemed to correlate with worsening disease severity and could be potential markers for risk stratification in the western population (Table Presented)