Liver Transaminase Levels and Neutrophil to Lymphocyte Ratio as Prognostic and Predictor in Coronavirus Disease 2019

Jonathan Arifputra; Bradley Jimmy Waleleng; Fandy Gosal; Nelly Tendean  Wenas; Luciana Rotty; Jeanne Winarta; Andrew  Waleleng

doi:10.3889/oamjms.2020.5395

Authors

Jonathan Arifputra Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Bradley Jimmy Waleleng Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Fandy Gosal Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Nelly Tendean Wenas Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Luciana Rotty Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Jeanne Winarta Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia
Andrew Waleleng Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Sam Ratulangi University, Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5395

Keywords:

Aspartate aminotransferase, Alanine aminotransferase, COVID-19, Liver transaminase, Neutrophil to lymphocyte ratio

Abstract

Introduction: COVID 19 was a disease caused by the SARS-CoV 2 virus with severe respiratory distress syndrome. SARS-CoV 2 can attack the gastrointestinal and liver system. In several studies, elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were reported, ranging from 14% to 53%. The increase of neutrophil to lymphocyte ratio (NLR) also increases the risk of mortality in COVID 19. This research wants to study ALT, AST, and NLR as prognostic and predictor in COVID 19.

Methods: A cross sectional retrospective study conducted on COVID 19 patients. The diagnostic criteria are based on the recommendations of the Indonesian Ministry of Health. The patient's blood was examined in a central laboratory at hospital. Data analysis were done using SPSS version 22.

Results: A total of 126 patients with COVID 19 were included in this study. There are 57 (45.2%) patients having abnormal liver test. There was a significant difference in the mean AST and NLR between COVID 19 patients with nonsurvival and survive outcome (82.91 ± 103.82 vs. 40.54 ± 33.59 U/L; p = 0.0001 and 7.42 ± 3.65 vs. 3.47 ± 2.41; p = 0.0001). High AST (≥34.5 U/L) and NLR (≥4.7) independently associated with nonsurvival outcome in COVID 19 patient with odds ratio (OR) 5.31 and 9.49 [1.89 – 14.95, 95% CI; p = 0.002 and 3.57 – 25.22, 95% CI; p = 0.0001].

Conclusion: This study revealed that high AST and NLR at hospital admission was associated with high mortality risk in COVID 19 patients. Therefore, the AST and NLR can be a significant prognostic of outcome in COVID 19 patients.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. PMid:31978945

World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report-201; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/ s i t u a t i o n - r e p o r t s / 2 0 2 0 0 8 0 8 - c o v i d - 1 9 - s i t r e p - 2 0 1 . pdf?sfvrsn=121bb855_2. [Last accessed on 2020 Aug 08].

Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of covid-19. Viruses. 2020;12(4):1-17. PMid:32230900

Adiwinata R, Irawan VR, Arifputra J, Waleleng BJ, Gosal F, Rotty L, et al. Potential of fecal-oral transmission and gastrointestinal manifestation of COVID-19. Indones J Gastroenterol Hepatol Dig Endosc. 2020;21(1):53. https://doi. org/10.24871/211202053-58

Faria SS, Fernandes PC, Silva MJ, Lima VC, Fontes W, Freitas-Junior R, et al. The neutrophil-to-lymphocyte ratio: A narrative review. Ecancermedicalscience. 2016;10:1-12. https:// doi.org/10.3332/ecancer.2016.702 PMid:28105073

Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):1-4. https://doi. org/10.1186/s13104-016-2335-5 PMid:28057051

Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HH, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-12. https://doi.org/10.1016/j.jinf.2020.04.002 PMid:32283162

Garrido I, Liberal R, Macedo G. Review article: COVID-19 and liver disease-what we know on 1st May 2020. Aliment Pharmacol Ther. 2020;52(2):267-75. https://doi.org/10.1111/apt.15813 PMid:32402090

Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, et al. COVID-19: Abnormal liver function tests. J Hepatol. 2020;73(3):566-74. PMid:32298767

Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, et al. Clinical features of COVID-19-related liver functional abnormality. Clin Gastroenterol Hepatol. 2020;18(7):1561-6.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/ s0140-6736(20)30211-7 PMid:32007143

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. https://doi.org/10.1001/jama.2020.1585 PMid:32031570

Lei F, Liu YM, Zhou F, Qin JJ, Zhang P, Zhu L, et al. Longitudinal association between markers of liver injury and mortality in COVID-19 in China. Hepatology. 2020;72:389-98. PMid:32359177

Feng G, Zheng KI, Yan QQ, Rios RS, Targher G, Byrne CD, et al. COVID-19 and liver dysfunction: Current insights and emergent therapeutic strategies. J Clin Transl Hepatol. 2020;8(1):18-24. https://doi.org/10.14218/jcth.2020.00018 PMid:32274342

Youssef M, Hussein M, Attia AS, Elshazli RM, Omar M, Zora G, et al. COVID-19 and liver dysfunction: A systematic review and meta-analysis of retrospective studies. J Med Virol. 2020;92(10):1825-33. https://doi.org/10.1002/jmv.26055 PMid:32445489

Zhang Y, Zheng L, Liu L, Zhao M, Xiao J, Zhao Q. Liver impairment in COVID-19 patients: A retrospective analysis of 115 cases from a single centre in Wuhan city, China. Liver Int. 2020;40(9):2095-103. https://doi.org/10.1111/liv.14455 PMid:32239796

Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998-1004. https://doi.org/10.1111/liv.14435 PMid:32170806

Alqahtani SA, Schattenberg JM. Liver injury in COVID-19: The current evidence. United Eur Gastroenterol J. 2020;8(5):509-19. PMid:32450787

Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol. 2020;2020;1-9. PMid:32458459

Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients. Shock. 2020;54(5):652-8. doi: 10.1097/ SHK.0000000000001585. PMID: 32554992.