Transaminitis is an indicator of mortality in patients with COVID-19: A retrospective cohort study

Table 1 Charlson Co-morbidity index

Co-morbid condition	cCCI weights	uCCI weights
Myocardial infarction	1	0
Congestive heart failure	1	2
Peripheral vascular disease	1	0
Cerebrovascular disease	1	0
Dementia	1	2
Chronic obstructive pulmonary disease	1	1
Connective tissue disorder	1	1
Peptic ulcer disease	1	0
Mild liver disease	1	2
Diabetes without complication	1	0
Diabetes with complication	2	1
Hemiplegia or paraplegia	2	2
Chronic kidney disease stage III	2	1
Any malignancy without metastasis	2	2
Leukemia	2
Lymphoma	2
Moderate or severe liver disease	3	4
Metastatic tumor	6	6
AIDS	6	4
Maximum score	33	24

Adapted from Ternavasio-de la Vega et al[27] (2018). AIDS: Acquired Immune Deficiency Syndrome; cCCI: Classical Charlson Comorbidity Index; uCCI: Updated Charlson Comorbidity Index.

Table 2 Demographic and baseline characteristics of the study population

Variable	Study population (n = 130)
Age, yr, median (IQR)	62 (48, 73)
Females	59 (45.4)
Body mass index, kg/m2, median (IQR)	28.7 (26, 36)
Smoking	38 (29.2)
Alcohol	30 (23.1)
Diarrhea	34 (26.2)
Nausea	32 (24.6)
Abdominal pain	21 (16.2)
Anorexia	34 (26.2)
Other gastro-intestinal symptoms1	37 (28.5)
X-ray findings2	87 (66.9)
Hypertension	69 (53.1)
Admitted to ICU	58 (44.6)
On ventilator	43 (33.1)
Age-adjusted Charlson Index, median (IQR)	3.5 (1, 6)
On medications with gastro-intestinal side-effects	46 (35.4)
Death	28 (21.5)
Lactic Acid, mean (SD), n = 97	1.7 (1.4)
Lactic acid dehydrogenase, mean (SD), n = 92	424 (182.6)
D-dimer, median (IQR), n = 105	1.7 (0.9, 3.7)
Alanine aminotransferase, IU/L, median (IQR)	29 (16, 53)
Aspartate aminotransferase, IU/L, median (IQR)	39 (23, 68)
Alkaline phosphatase, IU/L, median (IQR)	77 (60, 115)
Total bilirubin, mean (SD)	0.4 (0.3)
Direct bilirubin, mean (SD), n = 92	0.2 (0.1)
Albumin, g/dL, mean (SD)	3.2 (0.8)
Prothrombin time, seconds, mean (SD), n = 81	16.9 (8.1)

¹Other gastro-intestinal symptoms include loss of taste or smell, constipation, dysphagia, reflux and vomiting.

²X-ray findings including ground glass opacities and bilateral infiltrate. All values are reported as n (%), mean (SD) or median (25^th, 75^th). P value: Chi-square test for categorical variables, two-sided t-test for parametric continuous variables and Wilcoxon rank-sum test for nonparametric continuous variables. ICU: Intensive care unit; IQR: Interquartile range.

Table 3 Characteristics of those with and without transaminitis

	Transaminitis (n = 73)	No transaminitis (n = 57)	P value
Age, yr, median (IQR)	63 (48, 72)	62 (48, 76)	0.9
Females	31 (42.5)	28 (49.1)	0.4
Body mass index, kg/m2, median (IQR)	30.2 (26.5, 36.8)	27.3 (24.5, 33.2)	0.04
Smoking	19 (26)	19 (33.3)	0.4
Alcohol	20 (27.4)	10 (17.5)	0.2
Diarrhea	24 (32.9)	10 (17.5)	0.05
Nausea	18 (24.7)	14 (24.6)	1.0
Abdominal pain	11 (15.1)	10 (17.5)	0.7
Anorexia	19 (26)	15 (26.3)	1.0
Other gastro-intestinal symptoms1	19 (26)	18 (31.6)	0.5
X-ray findings2	55 (75.3)	32 (56.1)	0.02
Hypertension	38 (52.1)	31 (54.4)	0.8
Age-adjusted Charlson Index, median (IQR)	3 (1, 6)	4 (1, 6)	0.7
On ventilator	31 (42.5)	12 (21.1)	0.01
Admitted to intensive care unit	39 (53.4)	19 (33.3)	0.02
On medications with GI side-effects	26 (35.6)	20 (35.1)	1.0
Alanine aminotransferase, IU/L, median (IQR)	48 (34, 84)	15 (10, 20)	< 0.001
Aspartate aminotransferase, IU/L, median (IQR)	66 (42, 100)	20 (14, 26)	< 0.001
Alkaline phosphatase, IU/L, median (IQR)	97 (66, 124)	70 (56, 92)	< 0.001
Total bilirubin, mean (SD)	0.6 (0.3)	0.4 (0.2)	< 0.001
Albumin, g/dL, mean (SD)	3.0 (0.8)	3.4 (0.7)	0.01

¹Other gastro-intestinal symptoms include loss of taste or smell, constipation, dysphagia, reflux and vomiting.

²X-ray findings including ground glass opacities and bilateral infiltrate. All values are reported as n (%), mean (SD) or median (25^th, 75^th). P value: Chi-square test for categorical variables, two-sided t-test for parametric continuous variables and Wilcoxon rank-sum test for nonparametric continuous variables. IQR: Interquartile range; GI: Gastrointestinal.

Table 4 Multivariable logistic model for death in patients with and without transaminitis

Variable	Model 1		Model 2		Model 3
	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
Transaminitis	2.9 (1.1-7.4)	0.03	3.1 (1.2-8.0)	0.02	3.4 (1.2-10.1)	0.03
Gender, reference females	-		0.5 (0.2-1.2)		0.5 (0.2-1.4)
AACI above median score of 3.5	-		-		12.9 (3.5-48.4)
Admission to intensive care unit	-		-		3.6 (1.2-10.4)

Model 1 is unadjusted. Model 2 is adjusted for gender. Model 3 is adjusted for gender, age adjusted-Charlson Index and admission to the intensive care unit. AACI: Age adjusted-Charlson Index; OR: Odds ratio; CI: Confidence interval.