Role of transaminases, CRP and LDH in COVID-19 patients with and without respiratory failure during the disease outbreak

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Bianca Magro, MD Matteo Tacelli, MD Luisa Pasulo, MD Massimo De Giorgio, MD Filippo Leonardi, MD Lucà Maria Grazia, MD Giovanna Gaffuri, MD Michela Triolo, MD, PhD Giampaolo Mangia, MD Domenico Nobile, MD Marco Rizzi, MD Fabiano Di Marco, MD, PhD Roberto Cosentini, MD Andrea Gianatti, MD Stefano Fagiuoli, MD, PhD


BACKGROUND: Sars-Cov-2 pneumonia is a pandemic disease with high morbidity and mortality. In literature transaminases, CRP and LDH were frequently found abnormal but their role has not been clarified.

OBJECTIVES: Aim of this retrospective study is to explore the role of transaminases, CRP and LDH on short-term prognosis of hospitalized COVID-19 patients.

METHODS: patients admitted in hospital for COVID-19 were consecutively recruited. Primary endpoint: evaluate role of transaminases, CRP and LDH on disease progression (DP). Secondary endpoints: find possible risk factors for (1) mortality and (2) CPAP ventilation at day 7. We also analyzed patients without respiratory failure at admission, also a subgroup of patients with liver disease.

RESULTS: 342 patients were included. Median age of patients was 64 years (IQR 55-74), and 35.1% (n=120) was female. At multivariate analysis moderate ALT elevation at Day 1 (p=0.001, OR 2,42, CI95% 1.23-4,73) and CRP at Day 7 (p=0.001, OR 1, CI95% 1-1,1) were predictors of DP; LDH at admission (p=0.05, OR 1, CI95% 1.23-1,1) and moderate AST elevation at day 7 (p=0.04, OR 4,5, CI95% 1.05-19,4) were predictors of CPAP at day 7. At multivariate analysis age (p<0,001, OR 1,12, CI95% 1-1,2) and sex (p=0.01, OR 14, CI95% 1,7-116,7) were predictors of death. Mortality rate of patients with liver disease was 25%(n=3/12).

CONCLUSIONS: Moderate ALT elevation at day 1 and moderate AST elevation at day 7 were respectively, predictors of DP and CPAP at day 7. For patients without respiratory failure, transaminases are not significative for anyone of our outcomes. Age, sex and CRP at day 1 are death risk factors.

Keywords: Coronavirus, COVID-19, risk factors, prognosis, mortality, italy, pandemic

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How to Cite
MAGRO, Bianca et al. Role of transaminases, CRP and LDH in COVID-19 patients with and without respiratory failure during the disease outbreak. Medical Research Archives, [S.l.], v. 9, n. 12, dec. 2021. ISSN 2375-1924. Available at: <>. Date accessed: 17 apr. 2024. doi:
Research Articles


1. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. Published online February 28, 2020:NEJMoa2002032. doi:10.1056/NEJMoa2002032
2. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017
3. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-269. doi:10.1038/s41586-020-2008-3
4. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet. 2020;395(10224):565-574. doi:10.1016/S0140-6736(20)30251-8
5. Phan LT, Nguyen T V., Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. New England Journal of Medicine. 2020;382(9):872-874. doi:10.1056/NEJMc2001272
6. Zhang C, Shi L, Wang F. Liver injury in COVID-19 : management and challenges. The Lancet. 2020;10(20):2019-2021. doi:10.1016/S2468-1253(20)30057-1
7. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
8. Zhang J jin, Dong X, Cao Y yuan, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy: European Journal of Allergy and Clinical Immunology. Published online 2020. doi:10.1111/all.14238
9. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
10. Li L, Huang T, Wang Y, et al. 2019 novel coronavirus patients’ clinical characteristics, discharge rate and fatality rate of meta‐analysis. Journal of Medical Virology. Published online March 2020:jmv.25757. doi:10.1002/jmv.25757
11. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020;0(0). doi:10.1016/S2213-2600(20)30079-5
12. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-NCOV infection from an asymptomatic contact in Germany. New England Journal of Medicine. 2020;382(10):970-971. doi:10.1056/NEJMc2001468
13. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. New England Journal of Medicine. 2020;382(10):929-936. doi:10.1056/NEJMoa2001191
14. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy. JAMA. Published online March 2020. doi:10.1001/jama.2020.4031
15. Spina S, Marrazzo F, Migliari M, Stucchi R, Sforza A, Fumagalli R. The response of Milan’s Emergency Medical System to the COVID-19 outbreak in Italy. The Lancet. 2020;395(10227):e49-e50. doi:10.1016/S0140-6736(20)30493-1
16. Nacoti M, Ciocca A, Giupponi A, Brambillasca P. At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation. NEJM Catalyst: Innovations in Care Delivery. 2020;(Figure 1):1-5. doi:10.1056/CAT.20.0080
17. Lopes Ferreira F, Peres Bota D, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. Journal of the American Medical Association. 2001;286(14):1754-1758. doi:10.1001/jama.286.14.1754
18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457. doi:10.1016/S0140-6736(07)61602-X
19. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. American Journal of Gastroenterology. 2017;112(1):18-35. doi:10.1038/ajg.2016.517
20. Daugherty Biddison L, Berkowitz KA, Courtney B, et al. Ethical considerations: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(4):e145S-e155S. doi:10.1378/chest.14-0742
21. Sandrock CE. Care of the critically ill and injured during pandemics and disasters: Groundbreaking results from the task force on mass critical care. Chest. 2014;146(4):881-883. doi:10.1378/chest.14-1900
22. Kumar VCS, Harne PS, Mukherjee S, et al. Transaminitis is an indicator of mortality in patients with COVID-19: A retrospective cohort study. World Journal of Hepatology. 2020;12(9):619-627. doi:10.4254/WJH.V12.I9.619
23. Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. Journal of Hepatology. 2020;73(3):566-574. doi:10.1016/j.jhep.2020.04.006
24. Medetalibeyoglu A, Catma Y, Senkal N, et al. The effect of liver test abnormalities on the prognosis of COVID-19. Annals of Hepatology. 2020;19(6):614-621. doi:10.1016/j.aohep.2020.08.068
25. Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013. Journal of Hepatology. 2014;60(6):1310-1324. doi:10.1016/j.jhep.2014.01.024
26. Lei F, Liu Y, Zhou F, et al. Longitudinal association between markers of liver injury and mortality in COVID‐19 in China. Hepatology. Published online May 2020:hep.31301. doi:10.1002/hep.31301
27. Harsh G, Farah H, Kawish G, Pooja S, Daly t AK and HJ. The liver in COVID-19: prevalence, patterns, predictors, and impact on outcomes of liver test abnormalities - PubMed.
28. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - Journal of the American Medical Association. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585
29. Chai X, Hu L, Zhang Y, et al. Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection. bioRxiv. Published online February 2020:2020.02.03.931766. doi:10.1101/2020.02.03.931766
30. Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver International. Published online March 2020:liv.14435. doi:10.1111/liv.14435
31. Zhang C, Shi L, Wang F. Liver injury in COVID-19 : management and challenges. The Lancet. 2020;10(20):2019-2021. doi:10.1016/S2468-1253(20)30057-1
32. Mantovani A, Beatrice G, Dalbeni A. Coronavirus disease 2019 and prevalence of chronic liver disease: A meta‐analysis. Sun J, ed. Liver International. Published online April 2020:liv.14465. doi:10.1111/liv.14465
33. Ashktorab H, Pizuorno A, Aduli F, Laiyemo AO, Oskrochi G, Brim H. Elevated liver enzymes, ferritin, CRP, D-dimer, and age are predictive markers of outcomes among Covid-19 African Americans and Hispanic patients. Gastroenterology. Published online March 2021. doi:10.1053/j.gastro.2021.03.043
34. Ruiz-González A, Utrillo L, Bielsa S, Falguera M, Porcel JM. The Diagnostic Value of Serum C-Reactive Protein for Identifying Pneumonia in Hospitalized Patients with Acute Respiratory Symptoms. Journal of Biomarkers. 2016;2016. doi:10.1155/2016/2198745
35. Magro B, Zuccaro V, Novelli L, et al. Predicting in-hospital mortality from Coronavirus Disease 2019: A simple validated app for clinical use. PLoS ONE. 2021;16(1). doi:10.1371/journal.pone.0245281
36. Tsui PT, Kwok ML, Yuen H, Lai ST. Severe acute respiratory syndrome: Clinical outcome and prognostic correlates. Emerging Infectious Diseases. 2003;9(9):1064-1069. doi:10.3201/eid0909.030362
37. Bartz D, Chitnis T, Kaiser UB, et al. Clinical Advances in Sex- and Gender-Informed Medicine to Improve the Health of All: A Review. JAMA Internal Medicine. 2020;180(4):574-583. doi:10.1001/jamainternmed.2019.7194
38. Raimondi F, Novelli L, Ghirardi A, et al. Covid-19 and gender: lower rate but same mortality of severe disease in women—an observational study. BMC Pulmonary Medicine. 2021;21(1). doi:10.1186/s12890-021-01455-0