The effect of elevated liver enzymes on mortality in COVID-19 patients followed in the intensive care unit of Karadeniz Technical University Faculty of Medicine Farabi Hospital, a retrospective observational study

Objective: In our study, we aimed to reveal the relationship between elevated liver enzymes and mortality in COVID-19 patients in ICU at our hospital. Materials and Methods: Between 1 March 2020 and 15 March 2022, 435 patients admitted to the ICU of Karadeniz Technical University Faculty of Medicine with a diagnosis of COVID-19 were included in the study. The data obtained for serum ALT, AST on days 1,3,9 and first day values for ALP, GGT, INR, total bilirubin were recorded from the hospital automation system and bedside charts. Laboratory data were compared and the effect on mortality was investigated retrospectively. Findings: 435 patients were included in the study. Of the patients, %42.5 (n= 185) were female and %57.5 (n= 250) were male. The mean age of the patients was 58.4 years. The most common comorbid diseases were hypertension %49.2 (n= 214), obesity %37.2 (n= 162) and diabetes %26.9 (n= 117). Of the patients included in the study, %42.3 (n= 184) were mortal. Our study showed that ALT in the first three days of ICU hospitalization was significantly higher in deceased patients than in surviving patients (p= 0.033). In the followup of the patients, ALT elevation on day 9, which is the median hospitalization day in the ICU, was not associated with mortality (p> 0.05). In our study, AST values in the first three days of ICU hospitalization were not significantly different between survivors and patients who died (p> 0.05). However, AST elevation on day 9 was associated with mortality in the follow-up of the patients (p= 0.003). There was no significant difference in GGT, ALP and total bilirubin levels on the first day of ICU admission in patients who died compared to patients who survived (p> 0.05). When we evaluated with multivariate Cox regression analysis, we found that each unit increase in ALT, AST, INR values of the patients was significant in terms of mortality (ALT; p= 0.036, AST; p= 0.001, INR; p= 0.006). In this analysis, baseline APACHE II (p= 0.002), mechanical ventilation (p= 0.000) and long ICU stay (p= 0.000) significantly increased mortality. Results: In patients diagnosed with COVID-19 with a mortal course, a significant increase in liver enzymes was found at admission and during follow-up. We thought that the significant increase in ALT, AST and INR values in COVID-19 patients may be meaningful parameters in determining the progression to mortality in ICU patients. Keywords: ALT, AST, COVID-19, liver enzymes, mortality