Among Aspartate Aminotransferase, Alanine Transaminase, and Alkaline Phosphatase, Which Can Predict Poor Outcomes in COVID-19? A Retrospective Cohort Study

Background: The coronavirus disease 2019 (COVID-19) caused a recent pandemic that killed thousands of people by causing mild and severe systemic organ involvement. Researchers are still trying to find a suitable diagnostic tool for the disease. We investigated the effect of aspartate aminotransferase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) enzyme levels on long-term outcomes. Methods: The data in this retrospective cohort study were collected from the records of patients with COVID-19 referred to Rouhani hospital in Mazandaran, northern Iran. Patients were followed up to determine the cut-off points for predicting mortality. Results: The data of the 320 eligible patients showed that AST levels, unlike ALT and ALP levels, were significantly associated with mortality (P<0.001) and disease severity (P=0.016). Unlike the levels of other tests, AST levels on admission had a significant association with mortality (P<0.001, 95% CI=2.433 to 20.463, MD=7.056) and the intensive care unit (ICU) length of stay (P=0.012, 95% CI=1.291 to 7.907, MD=3.195). None of the tests (AST, ALT, or ALP) could predict long-term mortality in patients. Conclusion: Unlike ALP and ALT levels, AST levels showed an excellent ability to predict mortality and disease severity at admission. However, AST, ALT, and ALP could not predict long-term adverse outcomes.