LAUSR

Introduction The identification of prognostic factors related to worse outcomes in the coronavirus disease (COVID-19) is essential in the care of this challenging disease. Objectives To identify prognostic factors that may help in decision-making related to patients’ care with COVID-19. Methods This retrospective observational study included confirmed COVID-19 patients hospitalized in a private Brazilian hospital between March and September/2020. The following variables were analyzed: age, gender, comorbidities, admission laboratory data (leukocyte, lymphocyte and platelet count, D-dimer [DD], C-reactive protein [CRP], aspartate aminotransferase [AST], alanine aminotransferase [ALT], and total bilirubin [Bb]) and during follow-up (DD, CRP, AST, ALT, Bb). The severity of disease was evaluated according to the extension of pulmonary infiltration by CT scan at admission, classified as mild (<25%), moderate (25%-50%) or severe (>50%), and by mechanical ventilation need. Results 414 patients (63% males, aged 61) were included. The main comorbidities were arterial hypertension (54%) and diabetes mellitus (34%). Typical pulmonary involvement was present at admission in 318 patients: 51% mild, 39% moderate, 10% severe. 65% of patients were admitted to ICU and 25% needed mechanical ventilation. The mortality rate was 20.4%. Admission DD values (p=0.012), Bb (p=0.039), need for mechanical ventilation (p<0.001) and the extension of lung infiltration (p<0.001) were associated with mortality. During follow-up, the peak of DD (AUROC=0.875), CRP (AUROC=0.875), AST (AUROC=0.820) and Bb (AUROC=0.804) were significantly associated to mortality and the peak levels of DD (p=0.019), AST (p=0.039), ALT (p=0.021) and Bb (p=0.011) were associated to severe pulmonary infiltration. Follow-up levels of AST >60U/L (N<59) with specificity=76% and sensitivity=78%, ALT>70U/L (N<51) with specificity=77% and sensitivity=58% and Bb>0.5mg/dL with specificity=77% and sensitivity=73%, were able to predict mortality. Conclusion In association with well-known prognostic factors of mortality, serial measurements of aminotransferases and Bb can identify patients of greater severity and higher mortality risk.