Liver transaminase levels and neutrophil to lymphocyte ratio as prognostic and predictor in coronavirus disease 2019

Abstract

BACKGROUND: Coronavirus disease 2019 (COVID-19) was a disease caused by the severe acute respiratory syndrome coronavirus-2 (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. AIM: This research wants to study ALT, AST, and NLR as prognostic and predictor in COVID-19. METHODS: A cross-sectional retrospective study was 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 the hospital. Data analysis was 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 non-survival and survival outcome in COVID-19 patients (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 non-survival outcome in COVID-19 patient with odds ratio 5.31 and 9.49 (1.89–14.95, 95% confidence interval [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 were associated with high mortality risk in COVID-19 patients. Therefore, AST and NLR can be a significant prognostic of outcome in COVID-19 patients.