Elevated liver enzymes in black COVID-19 patients linked to higher rates of icu admittance and intubation compared to non-black patients

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Conference Proceeding

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, has infected millions worldwide since its discovery in 2019. Current research suggests that abnormalities in liver function tests (LFTs) are related to complicated disease course and negative outcomes, such as hospital/ICU admittance, intubation, and death. However, while Black populations in the United States have been disproportionally affected by COVID-19, there has been limited research on population specific risk factors or disease modifiers. Specifically, to date, there has been no research exploring the relationship between LFT elevation and its relationship to negative outcomes in Black populations compared to non-Black populations. Aim: We evaluated disparities in outcomes between black and nonblack patients with COVID-19 infection and elevated liver enzymes. Methods: 8,028 patients infected with COVID-19 were identified and included in the study at a single academic center; 4268 (53%) were identified as Black and 3,760 (47%) were non-Black. Data from medical charts on laboratory testing including AST, ALT, AP, and bilirubin levels, past history of liver disease, and disease course indicators including hospital admission, ICU admission, intubation, and death were recorded and analyzed. Elevated liver enzymes were defined as ALT/AST greater than 60, AP greater than 150, or bilirubin greater than 1.5, super-elevated liver enzymes were defined as ALT/AST greater than 120, AP greater than 300, or bilirubin greater than 3.0 Results: Liver function testing from 3,937 patients were available for interpretation. For both Black and non-Black patients, 45% were found to have elevated or super-elevated LFTs. In patients with liver function test elevations, 51.8% of Black patients were admitted to the ICU while 39.4% of non-Black patients were admitted to the ICU. 46% of Black patients with LFT elevations were intubated, compared to 34.8% of non-Black patients with elevations. This indicates Black patients are at higher odds of ICU admission (p<0.001) and intubation (p<0.002) compared to other races. In spite of this, non-Black patients with elevated LFTs were at significantly higher odds of death that Black patients (34.4% compared to 27.1%; p<0.003). Conclusion: The findings from this study suggest that for Black COVID-19 patients who have LFT abnormalities are at increased odds of ICU admittance and intubation, but non-Black patients are at increased risk of death.

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