Association of inflammatory markers with abnormal liver biochemistry in hospitalized patients with COVID-19: a cross-sectional study

Abstract

Coronavirus disease 2019 (COVID-19) is frequently accompanied by extrapulmonary manifestations, including abnormal liver biochemistry. Although inflammatory markers are widely used in clinical assessment, their associations with hepatic biochemical abnormalities in hospitalized patients with COVID-19 remain incompletely defined. This retrospective cross-sectional secondary analysis included adults admitted with RT-PCR-confirmed COVID-19 at King Fahad Hospital Hofuf, Al-Ahsa, Saudi Arabia, from August through October 2020. Abnormal liver biochemistry was defined as alanine aminotransferase (ALT) >40 U/L, aspartate aminotransferase (AST) >40 U/L, or total bilirubin >21 μmol/L. C-reactive protein (CRP), ferritin, and D-dimer were evaluated as exposure variables. Group comparisons used nonparametric tests, correlations were assessed using Spearman coefficients, and marker-specific multivariable logistic regression models adjusted for age, sex, diabetes mellitus, hypertension, and chronic kidney disease. Among 631 hospitalized patients (mean age 54.4 ± 14.4 years; 64.1% male), abnormal liver biochemistry was present in 59.2%. Ferritin levels were significantly higher in patients with abnormal than normal liver biochemistry ( p < 0.001), whereas CRP and D-dimer did not differ significantly. Ferritin correlated positively with ALT, AST, and total bilirubin. In adjusted analysis, ferritin remained associated with abnormal liver biochemistry (adjusted odds ratio 3.59 per ten-fold increase; 95% CI 2.19–5.90; p < 0.001). CRP and D-dimer were not independently associated; these null findings should be interpreted cautiously because these markers had substantially more missing data. Abnormal liver biochemistry was common in this cohort of hospitalized patients with COVID-19. Ferritin showed the most consistent association with hepatic biochemical abnormalities, supporting its potential value as a marker of inflammation-related liver involvement in this population. Prospective studies with standardized laboratory assessment are needed to confirm temporality and clinical utility.