S1177 CPK to ALT Ratio in Patients With COVID-19 Without Known Chronic Liver Disease Is Predictive of Increased In-Hospital Mortality

INTRODUCTION: Abnormal liver chemistries and elevated CPK (creatinine phosphokinase) levels are known to be associated with COVID-19 infection CPK is a biomarker associated with disease progression with COVID-19 Outcomes related elevated CPK levels in relationship to ALT levels elevation has not been explored Our study assessed the predictive value of the ratio of alanine aminotransferase levels and CPK in a large cohort of COVID-19 patients without known chronic liver disease (CLD) METHODS: We reviewed the charts of 11,265 patients with confirmed COVID-19 infection via nasopharyngeal swabs admitted to our health system from March 1 to April 30, 2020 Baseline ALT and CPK were drawn within 24 hours of presentation After exclusion of patients who did not have an initial RESULTS: CPK to ALT ratio ≥ 1 (CPK/ALT / 5 1) was noted in 91 5% of the patients;8 5% with CPK/ALT≤1, 32% with CPK/ALT >1 and ≤4, 29 5% with CPK/ALT >4 and ≤10, and 29 9% with CPK/ ALT >10 In Kaplan-Meier survival analyses, patients with CPK/ALT ≥1 had an increased in-hospital mortality as compared to patients with CPK/ALT1 and ≤410 compared to patients with CPK/ALT ≤1 CONCLUSION: Our study found that a CPK/ALT >1 on presentation in COVID-19 patients without known chronic liver disease was predictive of increased in-hospital mortality in this large cohort Higher CPK/ ALT (≥1) correlates with increased in-hospital mortality even when adjusted for baseline demographics and the presence of comorbidities Based upon this large study, CPK/ALT ratio should be used to predict inhospital mortality in COVID-19 infection and included in the initial assessment of these patients