Clinical characteristics of liver and kidney injuries and correlation with severity and mortality in patients with COVID-19

Objective To describe the clinical characteristics of liver and kidney injuries and investigate its effect on the severity and mortality in the COVID-19 patients. Methods A total of 3 548 patients diagnosed with COVID-19 but without liver and kidney diseases admitted in the Huoshenshan Hospital, Jinyintan Hospital and Taikang Tongji Hospital from February 4, 2020 to April 16, 2020 were recruited in this study. Their clinical data were extracted from medical database, including general information, clinical features, laboratory results and outcomes such as death were collected and analyzed. SPSS statistics 23.0 was used to perform the statistical description and analysis. Results Among the 3 548 patients with COVID-19, 875 (24.7%) cases were severe illness and above and 91 (2.6%) died during hospitalization. The proportions of the patients with higher alanine amiotransferase (ALT), aspartate aminotransferase (AST) and creatinine (Cr) were 14.6% (513/3 548), 3.4% (119/3 548) and 2.8% (101/3 548), respectively. Compared with the patients with normal ALT, AST and Cr, the patients with elevated ALT did not have a significantly increased risk of severe illness or death (P>0.05), and the risk of severe illness and death was significantly increased in those with elevated AST and Cr (P < 0.05). The risk of severe disease was 2.32 times (95%CI: 1.73-3.10) and 11.40 times (95% CI: 2.36-54.98) for those with single or both liver and kidney injuries, and the risk of death was 5.21 times (95% CI: 3.10-8.75) and 13.53 times (95% CI: 2.76-66.32) for those with normal liver and kidney function, respectively. Logistic regression analysis indicated that after independent factors related to severe illness and death screened out as correction factors, the risk of severe illness and death was 1.612 times (95% CI: 1.17-2.22) and 2.907 times (95% CI: 1.61-5.24) of patients with liver or kidney injuries when compared with those with normal function, respectively. Conclusion The COVID-19 patients with liver and renal injuries have a significantly increased tendency to become severity and mortality, and should undergo early intervention