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Volume 8
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Article

SARS-CoV-2 Infection Induces a Dual Response in Liver Function Tests: Association with Mortality during Hospitalization

by
Vanesa Bernal-Monterde
1,2,
Diego Casas-Deza
1,2,
Laura Letona-Giménez
3,
Natalia de la Llama-Celis
4,
Pilar Calmarza
5,
Olivia Sierra-Gabarda
1,
Elena Betoré-Glaria
1,
María Martínez-de Lagos
3,
Lucía Martínez-Barredo
3,
María Espinosa-Pérez
3 and
Jose M. Arbones-Mainar
2,6,7,*
1
Gastroenterology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
2
Instituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, Spain
3
Internal Medicine Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
4
Hospital Pharmacy Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
5
Clinical Biochemistry Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
6
Translational Research Unit, Miguel Servet University Hospital, Instituto Aragonés de Ciencias de la Salud, 50009 Zaragoza, Spain
7
Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
Biomedicines 2020, 8(9), 328; https://doi.org/10.3390/biomedicines8090328
Submission received: 28 July 2020 / Revised: 24 August 2020 / Accepted: 1 September 2020 / Published: 4 September 2020
(This article belongs to the Section Molecular and Translational Medicine)
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Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with abnormal liver function tests. We hypothesized that early altered liver biochemistries at admission might have different clinical relevance than subsequent changes during hospitalization. A single-center retrospective study was conducted on 540 consecutive hospitalized patients, PCR-diagnosed with SARS-CoV-2. Liver test abnormalities were defined as the elevation of either gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), or aspartate aminotransferase (AST), above the upper limit of normality set by our laboratory. Linear mixed models (LMM) evaluated longitudinal associations, incorporating all available follow-up laboratory chemistries. By the end of the follow-up period, 502 patients (94.5%) were discharged (109 (20.5%) died). A total of 319 (64.3%) had at least one abnormal liver test result at admission. More prevalent were elevated AST (40.9%) and GGT (47.3%). Abnormalities were not associated with survival but with respiratory complications at admission. Conversely, LMM models adjusted for age and sex showed that longitudinal increases during hospitalization in ferritin, GGT, and alkaline phosphatase (ALP), as well as a decreased albumin levels, were associated with reduced survival. This dual pattern of liver damage might reconcile previous conflicting reports. GGT and ALP trajectories could be useful to determine who might need more surveillance and intensive care.
Keywords: hepatic biomarkers; COVID-19; mixed models hepatic biomarkers; COVID-19; mixed models

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MDPI and ACS Style

Bernal-Monterde, V.; Casas-Deza, D.; Letona-Giménez, L.; de la Llama-Celis, N.; Calmarza, P.; Sierra-Gabarda, O.; Betoré-Glaria, E.; Martínez-de Lagos, M.; Martínez-Barredo, L.; Espinosa-Pérez, M.; et al. SARS-CoV-2 Infection Induces a Dual Response in Liver Function Tests: Association with Mortality during Hospitalization. Biomedicines 2020, 8, 328. https://doi.org/10.3390/biomedicines8090328

AMA Style

Bernal-Monterde V, Casas-Deza D, Letona-Giménez L, de la Llama-Celis N, Calmarza P, Sierra-Gabarda O, Betoré-Glaria E, Martínez-de Lagos M, Martínez-Barredo L, Espinosa-Pérez M, et al. SARS-CoV-2 Infection Induces a Dual Response in Liver Function Tests: Association with Mortality during Hospitalization. Biomedicines. 2020; 8(9):328. https://doi.org/10.3390/biomedicines8090328

Chicago/Turabian Style

Bernal-Monterde, Vanesa, Diego Casas-Deza, Laura Letona-Giménez, Natalia de la Llama-Celis, Pilar Calmarza, Olivia Sierra-Gabarda, Elena Betoré-Glaria, María Martínez-de Lagos, Lucía Martínez-Barredo, María Espinosa-Pérez, and et al. 2020. "SARS-CoV-2 Infection Induces a Dual Response in Liver Function Tests: Association with Mortality during Hospitalization" Biomedicines 8, no. 9: 328. https://doi.org/10.3390/biomedicines8090328

APA Style

Bernal-Monterde, V., Casas-Deza, D., Letona-Giménez, L., de la Llama-Celis, N., Calmarza, P., Sierra-Gabarda, O., Betoré-Glaria, E., Martínez-de Lagos, M., Martínez-Barredo, L., Espinosa-Pérez, M., & M. Arbones-Mainar, J. (2020). SARS-CoV-2 Infection Induces a Dual Response in Liver Function Tests: Association with Mortality during Hospitalization. Biomedicines, 8(9), 328. https://doi.org/10.3390/biomedicines8090328

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