{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T20:27:57Z","timestamp":1789417677384,"version":"build-2803163510"},"reference-count":42,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T00:00:00Z","timestamp":1727395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Polish Association of Epidemiologists and Infectiologists"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>(1) Background: Liver damage is an important component of acute COVID-19, and the advancement of preexisting liver disease is associated with a worse prognosis; (2) Methods: A nationwide retrospective study including 7444 patients aimed to evaluate levels of selected markers of liver damage and disease advancement and their association with mortality and mechanical ventilation (MV); (3) Results: Elevation of the following markers in multivariate models were associated with increased odds of mortality: Alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), lactate dehydrogenase (LDH), fibrosis-4 score (FIB-4), AST-to-platelet ratio index (APRI), and decreased levels of platelet count (PLT). Elevated levels of AST, LDH, APRI, FIB-4, and the AST\/ALT ratio and decreased levels of PLT were associated with increased odds of MV in multivariate models. The best predictive accuracy against mortality was achieved with FIB-4 with AUC = 0.733 (95% CI, 0.718\u20130.749) at the optimal cut-off point of 2.764, while against MV was achieved with LDH with AUC = 0.753 (95% CI, 0.727\u20130.778) at the optimal cut-off point of 449.5 IU\/L. (4) Conclusions: Our study confirms that the advancement of liver damage contributes to a worse prognosis in COVID-19 patients. Markers for liver damage and the advancement of liver disease can provide predictive value in clinical practice among COVID-19 patients.<\/jats:p>","DOI":"10.3390\/v16101530","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T07:49:24Z","timestamp":1727423364000},"page":"1530","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between Liver Damage and Disease Progression Markers with Mortality Risk and Mechanical Ventilation in Hospitalized COVID-19 Patients: A Nationwide Retrospective SARSTer Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7215-5989","authenticated-orcid":false,"given":"Karol","family":"\u017bmudka","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0139-4753","authenticated-orcid":false,"given":"Jerzy","family":"Jaroszewicz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0938-1084","authenticated-orcid":false,"given":"Dorota","family":"Zar\u0119bska-Michaluk","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Allergology, Jan Kochanowski University, 25-317 Kielce, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Rogalska","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0072-2180","authenticated-orcid":false,"given":"Piotr","family":"Czupryna","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-540 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5318-4945","authenticated-orcid":false,"given":"Marta","family":"Rorat","sequence":"additional","affiliation":[{"name":"Department of Social Sciences and Infectious Diseases, Medical Faculty, Wroclaw University of Science and Technology, 50-470 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4651-6443","authenticated-orcid":false,"given":"Dorota","family":"Kozielewicz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-030 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadwiga","family":"Maciukaj\u0107","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, District Healthcare Center, 27-200 Starachowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4031-0076","authenticated-orcid":false,"given":"S\u0142awomir","family":"Kiciak","sequence":"additional","affiliation":[{"name":"Independent Voivodeship Hospital \u201cJana Bo\u017cego\u201d in Lublin, 20-400 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Kr\u0119pa","sequence":"additional","affiliation":[{"name":"Szpital Powiatowy w Mielcu, 39-300 Mielec, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Dutkiewicz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Infectious Diseases, Regional Hospital in Szczecin, 71-252 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Stojko","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Spycha\u0142","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5432-5394","authenticated-orcid":false,"given":"Przemys\u0142aw","family":"Ciechanowski","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Infectious Diseases, Regional Hospital in Szczecin, 71-252 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Bolewska","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Pozna\u0144 University of Medical Sciences, 61-285 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4063-1646","authenticated-orcid":false,"given":"Regina","family":"Podlasin","sequence":"additional","affiliation":[{"name":"IV-th Department, Hospital for Infectious Diseases, 01-201 Warsaw, Poland"},{"name":"Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3394-1635","authenticated-orcid":false,"given":"Robert","family":"Flisiak","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Bialystok, 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(2021). COVID-19 Diagnosis\u2014A Review of Current Methods. Biosens. Bioelectron., 172.","DOI":"10.1016\/j.bios.2020.112752"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/liv.14730","article-title":"Pathophysiological Mechanisms of Liver Injury in COVID-19","volume":"41","author":"Nardo","year":"2021","journal-title":"Liver Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1136\/gutjnl-2021-326792","article-title":"COVID-19 and Liver Disease","volume":"71","author":"Dufour","year":"2022","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1136\/postgradmedj-2015-133715","article-title":"Evaluation of Abnormal Liver Function Tests","volume":"92","author":"Agrawal","year":"2016","journal-title":"Postgrad. Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/1097-0134(20010501)43:2<175::AID-PROT1029>3.0.CO;2-#","article-title":"Structural Basis for Altered Activity of M- and H-Isozyme Forms of Human Lactate Dehydrogenase","volume":"43","author":"Read","year":"2001","journal-title":"Proteins"},{"key":"ref_6","first-page":"292","article-title":"Positive Association between Severity of COVID-19 Infection and Liver Damage: A Systematic Review and Meta-Analysis","volume":"13","author":"Ghorbani","year":"2020","journal-title":"Gastroenterol. Hepatol. Bed Bench"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3139","DOI":"10.1111\/jth.15534","article-title":"Platelets Contribute to Disease Severity in COVID-19","volume":"19","author":"Barrett","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1002\/hep4.1843","article-title":"COVID-19 and Liver Injury: Role of Inflammatory Endotheliopathy, Platelet Dysfunction, and Thrombosis","volume":"6","author":"McConnell","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.jfma.2021.07.013","article-title":"The Role of Fibrosis Index FIB-4 in Predicting Liver Fibrosis Stage and Clinical Prognosis: A Diagnostic or Screening Tool?","volume":"121","author":"Xu","year":"2022","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhang, J., Liu, F., Song, T., Li, Z., Xia, P., Tang, X., Xu, M., Shen, Y., Ma, J., and Liu, X. (2022). Liver Fibrosis Scores and Clinical Outcomes in Patients with COVID-19. Front. Med., 9.","DOI":"10.3389\/fmed.2022.829423"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jaroszewicz, J., Kowalska, J., Paw\u0142owska, M., Rogalska, M., Zar\u0119bska-Michaluk, D., Rorat, M., Lorenc, B., Czupryna, P., Sikorska, K., and Piekarska, A. (2022). Remdesivir Decreases Mortality in COVID-19 Patients with Active Malignancy. Cancers, 14.","DOI":"10.3390\/cancers14194720"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the Areas under Two or More Correlated Receiver Operating Characteristic Curves: A Nonparametric Approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Elshazli, R.M., Toraih, E.A., Elgaml, A., El-Mowafy, M., El-Mesery, M., Amin, M.N., Hussein, M.H., Killackey, M.T., Fawzy, M.S., and Kandil, E. (2020). Diagnostic and Prognostic Value of Hematological and Immunological Markers in COVID-19 Infection: A Meta-Analysis of 6320 Patients. PLoS ONE, 15.","DOI":"10.1101\/2020.07.08.20141218"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zhang, H., Wu, H., Pan, D., and Shen, W. (2022). D-Dimer Levels and Characteristics of Lymphocyte Subsets, Cytokine Profiles in Peripheral Blood of Patients with Severe COVID-19: A Systematic Review and Meta-Analysis. Front. Med., 9.","DOI":"10.3389\/fmed.2022.988666"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.chest.2021.10.031","article-title":"Pneumonia Severity Index and CURB-65 Score Are Good Predictors of Mortality in Hospitalized Patients with SARS-CoV-2 Community-Acquired Pneumonia","volume":"161","author":"Bradley","year":"2022","journal-title":"Chest"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S2213-2600(20)30559-2","article-title":"Development and Validation of the ISARIC 4C Deterioration Model for Adults Hospitalised with COVID-19: A Prospective Cohort Study","volume":"9","author":"Gupta","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"108427","DOI":"10.1016\/j.clim.2020.108427","article-title":"COVID-19 Pathophysiology: A Review","volume":"215","author":"Yuki","year":"2020","journal-title":"Clin. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"107587","DOI":"10.1016\/j.pharmthera.2020.107587","article-title":"Cathepsin L-Selective Inhibitors: A Potentially Promising Treatment for COVID-19 Patients","volume":"213","author":"Liu","year":"2020","journal-title":"Pharmacol. Ther."},{"key":"ref_19","first-page":"2021-10","article-title":"SARS-CoV-2 Spike Protein Induces Abnormal Inflammatory Blood Clots Neutralized by Fibrin Immunotherapy","volume":"13","author":"Ryu","year":"2021","journal-title":"Biorxiv"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s00535-021-01760-9","article-title":"COVID-19-Associated Liver Injury: From Bedside to Bench","volume":"56","author":"Li","year":"2021","journal-title":"J. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.14309\/ajg.0000000000000691","article-title":"COVID-19 and the Digestive System","volume":"115","author":"Ma","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e7235860","DOI":"10.1155\/2022\/7235860","article-title":"Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis","volume":"2022","author":"Liu","year":"2022","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e368","DOI":"10.1097\/MEG.0000000000002091","article-title":"Fibrosis-4 Index and Mortality in Coronavirus Disease 2019: A Meta-Analysis","volume":"33","author":"Pranata","year":"2021","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_24","first-page":"13072","article-title":"Prevalence of Liver Injury and Correlation with Clinical Outcomes in Patients with COVID-19: Systematic Review with Meta-Analysis","volume":"24","author":"Ianiro","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.3748\/wjg.v26.i19.2323","article-title":"Gastrointestinal and Hepatic Manifestations of COVID-19: A Comprehensive Review","volume":"26","author":"Cha","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100618","DOI":"10.1016\/j.cpcardiol.2020.100618","article-title":"COVID-19 and Multiorgan Response","volume":"45","author":"Zaim","year":"2020","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1093\/infdis\/jiaa355","article-title":"Elevation of Liver Fibrosis Index FIB-4 Is Associated with Poor Clinical Outcomes in Patients with COVID-19","volume":"222","author":"Bighelli","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1093\/infdis\/jiaa550","article-title":"The Fibrosis-4 Index Is Associated with Need for Mechanical Ventilation and 30-Day Mortality in Patients Admitted with Coronavirus Disease 2019","volume":"222","author":"Sterling","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kolesova, O., Vanaga, I., Laivacuma, S., Derovs, A., Kolesovs, A., Radzina, M., Platkajis, A., Eglite, J., Hagina, E., and Arutjunana, S. (2021). Intriguing Findings of Liver Fibrosis Following COVID-19. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01939-7"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/hep4.1650","article-title":"Liver Fibrosis Index FIB-4 Is Associated with Mortality in COVID-19","volume":"5","author":"Li","year":"2021","journal-title":"Hepatol. Commun."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1515\/cclm-2020-0369","article-title":"Hematologic, Biochemical and Immune Biomarker Abnormalities Associated with Severe Illness and Mortality in Coronavirus Disease 2019 (COVID-19): A Meta-Analysis","volume":"58","author":"Henry","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_32","first-page":"496","article-title":"Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease 2019","volume":"43","author":"Zhang","year":"2020","journal-title":"Zhonghua Jie He He Hu Xi Za Zhi"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e192","DOI":"10.1111\/bjh.16968","article-title":"COVID-19 Mortality in Patients on Anticoagulants and Antiplatelet Agents","volume":"190","author":"Sivaloganathan","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1111\/jth.14830","article-title":"Prevalence of Venous Thromboembolism in Patients with Severe Novel Coronavirus Pneumonia","volume":"18","author":"Cui","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sutandyo, N., Kurniawati, S.A., Jayusman, A.M., Syafiyah, A.H., Pranata, R., and Hanafi, A.R. (2021). Repurposing FIB-4 Index as a Predictor of Mortality in Patients with Hematological Malignancies and COVID-19. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0257775"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1080\/17476348.2022.2108796","article-title":"Predictors of Invasive Mechanical Ventilation in Hospitalized COVID-19 Patients: A Retrospective Study from Jordan","volume":"16","author":"Kabbaha","year":"2022","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e2022310","DOI":"10.1001\/jamanetworkopen.2020.22310","article-title":"Risk Factors for Hospitalization, Mechanical Ventilation, or Death Among 10 131 US Veterans with SARS-CoV-2 Infection","volume":"3","author":"Ioannou","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1753466620963017","DOI":"10.1177\/1753466620963017","article-title":"Early Predictors for Mechanical Ventilation in COVID-19 Patients","volume":"14","author":"Li","year":"2020","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/labmed\/lmaa105","article-title":"Absolute Lymphocytes, Ferritin, C-Reactive Protein, and Lactate Dehydrogenase Predict Early Invasive Ventilation in Patients with COVID-19","volume":"52","year":"2021","journal-title":"Lab. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mihai, N., Lazar, M., Tiliscan, C., Barbu, E.C., Chitu, C.E., Stratan, L., Ganea, O.A., Arama, S.S., Ion, D.A., and Arama, V. (2022). Predictors of Liver Injury in Hospitalized Patients with SARS-CoV-2 Infection. Medicina, 58.","DOI":"10.3390\/medicina58121714"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s12072-022-10364-1","article-title":"SARS-CoV-2 Infection and Liver Involvement","volume":"16","author":"Luo","year":"2022","journal-title":"Hepatol. Int."},{"key":"ref_42","first-page":"e33600","article-title":"Predictivity of CRP, Albumin, and CRP to Albumin Ratio on the Development of Intensive Care Requirement, Mortality, and Disease Severity in COVID-19","volume":"15","author":"Uzum","year":"2023","journal-title":"Cureus"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/10\/1530\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:05:06Z","timestamp":1760112306000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/16\/10\/1530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,27]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["v16101530"],"URL":"https:\/\/doi.org\/10.3390\/v16101530","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,27]]}}}