Research Article

Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019

Number: 1 March 28, 2026
TR EN

Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019

Abstract

Aim: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), predominantly affects the respiratory system but may also involve hepatic dysfunction. This study evaluated liver enzyme abnormalities in hospitalized COVID-19 patients and their association with in-hospital mortality. Material and Methods: This retrospective study enrolled 1455 adults hospitalized with COVID-19. Admission peripheral oxygen saturation (SpO₂), intensive care unit (ICU) and non-invasive mechanical ventilation (NIMV) requirements, and laboratory parameters were recorded. Patients with admission aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) levels ≥ 2 times the upper limit of normal (ULN) formed the patient group, while those with values < 2 times the ULN served as the control group. Mortality predictors were analyzed using logistic regression; cut-off values for age, C-reactive protein (CRP), and SpO₂ were determined by ROC analysis, and survival was evaluated using Kaplan-Meier analysis with log-rank comparisons. Results: The patient group exhibited higher lactate dehydrogenase, total bilirubin, hemoglobin, and CRP levels and lower lymphocyte counts, without differences in in-hospital mortality, ICU admission, or NIMV requirement. Multivariable analysis identified older age, symptom status, lower admission SpO₂, and elevated CRP as independent mortality predictors. ROC analysis yielded cut-offs of 59.5 years, 122.5 mg/L CRP, and 90.5% SpO₂, beyond which survival was shorter (AUC 0.771; p < 0.001). Conclusion: In hospitalized patients with severe COVID-19, admission AST and/or ALT elevations were not associated with mortality or respiratory support, whereas mortality was independently driven by older age, symptom status, elevated CRP, and reduced admission SpO₂, highlighting the prognostic dominance of hypoxia and systemic inflammation over isolated transaminase elevations.

Keywords

Supporting Institution

None

Ethical Statement

Ethical approval was obtained from the Uşak University Faculty of Medicine Non-Interventional Clinical Research Ethics Committee (approval ID: 48-48-19; 22 March 2022), and the study was conducted in accordance with the Declaration of Helsinki, with written informed consent obtained from all patients.

Thanks

None

References

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Details

Primary Language

English

Subjects

​Internal Diseases

Journal Section

Research Article

Publication Date

March 28, 2026

Submission Date

December 26, 2025

Acceptance Date

February 10, 2026

Published in Issue

Year 2026 Number: 1

APA
Kartal, M., Akkuş, C., & Duran, C. (2026). Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019. Turkish Journal of Clinics and Laboratory, 1. https://doi.org/10.18663/tjcl.1849460
AMA
1.Kartal M, Akkuş C, Duran C. Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019. TJCL. 2026;(1). doi:10.18663/tjcl.1849460
Chicago
Kartal, Melih, Canan Akkuş, and Cevdet Duran. 2026. “Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019”. Turkish Journal of Clinics and Laboratory, no. 1. https://doi.org/10.18663/tjcl.1849460.
EndNote
Kartal M, Akkuş C, Duran C (March 1, 2026) Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019. Turkish Journal of Clinics and Laboratory 1
IEEE
[1]M. Kartal, C. Akkuş, and C. Duran, “Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019”, TJCL, no. 1, Mar. 2026, doi: 10.18663/tjcl.1849460.
ISNAD
Kartal, Melih - Akkuş, Canan - Duran, Cevdet. “Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019”. Turkish Journal of Clinics and Laboratory. 1 (March 1, 2026). https://doi.org/10.18663/tjcl.1849460.
JAMA
1.Kartal M, Akkuş C, Duran C. Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019. TJCL. 2026. doi:10.18663/tjcl.1849460.
MLA
Kartal, Melih, et al. “Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019”. Turkish Journal of Clinics and Laboratory, no. 1, Mar. 2026, doi:10.18663/tjcl.1849460.
Vancouver
1.Melih Kartal, Canan Akkuş, Cevdet Duran. Association Between Admission Liver Enzyme Elevation and Mortality in Coronavirus Disease 2019. TJCL. 2026 Mar. 1;(1). doi:10.18663/tjcl.1849460

e-ISSN: 2149-8296

Publication Model: Continuous Publication

Peer Review Model: Double-Blind Peer Review

Publication Language: Turkish and English

Access Model: Open Access

DOI Prefix: (Crossref DOI numaranız)

Publisher: DNT Ortadoğu Publishing Inc.

Journal Abbreviation: Turk J Clin Lab

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