Clinical and Laboratory Determinants of Elevated Transaminases in COVID-19 Patients

Abstract

Background: Liver enzyme elevation is a common but serious extrapulmonary manifestation of COVID-19 and has been associated with increased disease severity and adverse patient outcomes. Objectives: This study aimed to identify independent clinical and laboratory factors associated with elevated transaminases among hospitalized patients with COVID-19. Methods: We conducted a retrospective cross-sectional analysis at Bu-Ali Sina Hospital in Qazvin, Iran, using data from 266 patients with confirmed COVID-19. Consecutive eligible records were selected using an outcome-based case-control sampling structure, with 133 patients in each group. Patients were categorized as having elevated or normal transaminase levels based on admission measurements. Demographic, clinical, and laboratory parameters were extracted for all participants. Logistic regression using the forward conditional method was performed to identify independent factors associated with elevated transaminase levels. Results: Statistically significant factors associated with elevated transaminases were male sex (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.73 - 5.95; P < 0.001), high-acuity Emergency Severity Index (ESI) levels 1 - 2 (OR, 3.18; 95% CI, 1.47 - 6.89; P = 0.003), lymphopenia (OR per 100 cells/μL decrease, 0.90; 95% CI, 0.84 - 0.97; P = 0.004), and elevated erythrocyte sedimentation rate (ESR; OR per unit increase, 1.024; 95% CI, 1.006 - 1.042; P = 0.008). Elevated transaminases were also significantly associated with higher odds of intensive care unit (ICU) admission (adjusted OR, 2.7; 95% CI, 1.6 - 4.6; P < 0.001) and in-hospital mortality (OR, 2.5; 95% CI, 1.3 - 4.8; P = 0.005). Conclusions: Routine early monitoring of liver enzymes in high-risk patients, particularly males with high-acuity ESI levels 1 - 2, lymphopenia, and elevated ESR, may guide management and potentially improve prognosis. However, these associations do not establish causality because the study was retrospective and cross-sectional, with an outcome-based case-control structure.