{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:53:35Z","timestamp":1785340415886,"version":"3.55.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>The coronavirus\u201019 disease (COVID\u201019) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 virus, is associated with significant morbidity and mortality attributable to pneumonia, acute respiratory distress syndrome, and multiorgan failure. Liver injury has been reported as a nonpulmonary manifestation of COVID\u201019, but characterization of liver test abnormalities and their association with clinical outcomes is incomplete.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>We conducted a retrospective cohort study of 1,827 patients with confirmed COVID\u201019 who were hospitalized within the Yale\u2010New Haven Health System between March 14, 2020 and April 23, 2020. Clinical characteristics, liver tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP], total bilirubin [TBIL], and albumin) at three time points (preinfection baseline, admission, and peak hospitalization), and hospitalization outcomes (severe COVID\u201019, intensive care unit [ICU] admission, mechanical ventilation, and death) were analyzed. Abnormal liver tests were commonly observed in hospitalized patients with COVID\u201019, both at admission (AST 66.9%, ALT 41.6%, ALP 13.5%, and TBIL 4.3%) and peak hospitalization (AST 83.4%, ALT 61.6%, ALP 22.7%, and TBIL 16.1%). Most patients with abnormal liver tests at admission had minimal elevations 1\u20102\u00d7 the upper limit of normal (ULN; AST 63.7%, ALT 63.5%, ALP 80.0%, and TBIL 75.7%). A significant proportion of these patients had abnormal liver tests prehospitalization (AST 25.9%, ALT 38.0%, ALP 56.8%, and TBIL 44.4%). Multivariate analysis revealed an association between abnormal liver tests and severe COVID\u201019, including ICU admission, mechanical ventilation, and death; associations with age, male sex, body mass index, and diabetes mellitus were also observed. Medications used in COVID\u201019 treatment (lopinavir\/ritonavir, hydroxychloroquine, remdesivir, and tocilizumab) were associated with peak hospitalization liver transaminase elevations &gt;5\u00d7 ULN.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Abnormal liver tests occur in most hospitalized patients with COVID\u201019 and may be associated with poorer clinical outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31487","type":"journal-article","created":{"date-parts":[[2020,7,29]],"date-time":"2020-07-29T18:27:03Z","timestamp":1596047223000},"page":"1169-1176","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":217,"title":["Abnormal Liver Tests in COVID\u201019: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network"],"prefix":"10.1097","volume":"72","author":[{"given":"Melanie A.","family":"Hundt","sequence":"first","affiliation":[{"name":"Department of Medicine,Yale School of Medicine,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Deng","sequence":"additional","affiliation":[{"name":"Yale Center for Analytical Sciences,Yale School of Public Health,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria M.","family":"Ciarleglio","sequence":"additional","affiliation":[{"name":"Yale Center for Analytical Sciences,Yale School of Public Health,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael H.","family":"Nathanson","sequence":"additional","affiliation":[{"name":"Department of Medicine,Yale School of Medicine,New Haven,CT"},{"name":"Yale Liver Center and Section of Digestive Diseases,Yale School of Medicine,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph K.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medicine,Yale School of Medicine,New Haven,CT"},{"name":"Yale Liver Center and Section of Digestive Diseases,Yale School of Medicine,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"hep31487-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the coronavirus disease 2019 (COVID\u201019) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention","volume":"323","year":"2020","journal-title":"JAMA"},{"key":"hep31487-bib-0003-20241017","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","year":"2020","journal-title":"N 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