Introduction
The ongoing COVID-19 pandemic caused by the novel corona virus
SARS-COV-2 remains a significant global public health threat. Ever since
the isolation of SARS-COV-2 in a cluster of pneumonia cases from Wuhan
in China 1, it has spread globally at an alarming rate
where it continues to overburden public health systems thus resulting in
substantial morbidity and mortality.
Abnormal liver function tests (LFTs) is a common finding among
hospitalized COVID-19 patients and is being increasingly recognized as
the most common extra-pulmonary manifestation of COVID-19 infection2 . A recent meta-analysis concluded that abnormal
aspartate aminotransferase (AST) and Alanine transaminase (ALT) were
reported in 50% and 40% of patients admitted to the normal COVID-19
wards and both were quantitively higher in ICU-treated patients3. The LFTs abnormality in COVID-19 patients is not
merely a manifestation of hepatic injury or the severity of the
underlying illness, but may also bear a prognostic significance as these
patients appear to have poorer outcomes compared to their counterparts
with normal LFTs 4. Abnormal liver function tests
during hospitalization were shown to be independently associated with
death or transfer to ICU unit in a retrospective multi-centric Italian
Cohort 5, and patients with abnormal liver tests had
significantly higher odds of developing severe pneumonia in a
cross-sectional study conducted in China 6.
Most of the existing literature have focused almost exclusively on the
association between abnormal LFTs and patients’ outcomes during
hospitalization, with a relative scarcity of studies investigating the
relation between baseline liver function abnormality and patient
outcomes during hospitalization. We therefore designed and conducted a
single-center observational study in an attempt to address this
potential and clinically important association.