An increase in aspartate aminotransferase levels can predict worsening disease severity in Japanese patients with COVID-19

Background The prognostic significance of liver dysfunction in coronavirus disease 2019 (COVID-19) patients remains unclear. This study aimed to investigate the association between liver function test results and severe disease progression in COVID-19 patients. Methods We conducted a retrospective study that included consecutive Japanese COVID-19 patients between February 2020 and May 2021. We identified the predictive variables for severe disease progression by utilizing established factors and multivariate logistic analysis. The Kaplan‒Meier method was used to estimate severe disease-free survival. Furthermore, we evaluated the hazard ratios (HRs) among three aspartate aminotransferase (AST) grades using Cox regression analysis: grade 1, AST < 30 U/L; grade 2, 30 U/L≤ AST < 60 U/L; and grade 3, AST >60 U/L. Results After exclusion, 604 symptomatic COVID-19 patients were enrolled during the study period, and 141 (23.3%) of them developed severe disease at a median of 2 days postadmission. The median hospital stay was 10 days, and 43 patients (7.1%) died during hospitalization. Multivariate regression analysis of the fourteen significant variables revealed that hypertension, decreased lymphocyte count, and elevated LDH, CRP, and AST levels (grade 2 and grade 3 relative to grade 1) were significant predictive variables. Severe disease-free survival times were significantly separated according to AST grade severity (HR: grade 2 to grade 1: 4.07 (95% CI: 2.06-8.03); HR: grade 3 to grade 1: 7.66 (95% CI: 3.89-15.1)). Conclusion AST levels at admission were an independent risk factor for severe disease in hospitalized Japanese patients with COVID-19.