On-admission and cumulative LBAI associated with increased risk
of in-hospital mortality
In this cohort predominated by severe or critically COVID patients, a
mortality of 22.3% (98/440) was observed from admission to thereafter
two months with substantial differences between mortality in patients
with cumulative LBAI and normal cumulative LB (34.3% vs. 5.9%,
p<0.0001) (table 2). With the worsening status of liver
function on-admission, the mortality risk significantly increased from
double in on-admission LBA (adjusted HR 1.78; 95% CI 1.03 to 3.06) to
up to four times the risk in on-admission ALI (adjusted HR 4.00; 95% CI
1.68 to 9.50; figure 3a and supplementary table 2). Even stronger
association were noticed when cumulative liver injury instead of that of
on-admission was used (figure 3b).
In-depth analysis into single marker indicating liver function revealed
that the levels of AST and TBIL but not ALT at admission or at peak were
strong risk indicators of mortality (figure 3c-e; supplementary figure
3; supplementary table 2). To clarify the potential impact of existing
chronic liver disease on the prognosis, such as hepatitis, fatty liver
or cirrhosis, we conducted the sensitivity analysis by removing 12 cases
with chronic liver diseases, and found similar results (supplementary
table 2). Meanwhile, to clarify the effects of 38 censored patients on
the survival analysis, we also conducted another sensitivity analysis
and confirmed similar conclusions (supplementary table 2).
In addition, shorter intervals between illness onset to hospital
admission (12 days vs. 19 days, p<0.0001), longer hospital
stays (19 days vs. 12 days, p<0.0010), and prolonged time from
illness onset to death (25 days vs. 19 days, p=0.037) were observed in
the patients with cumulative LBAI compared to the patients with normal
cumulative LB (table 2).