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.