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).