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JFSF Vol 8, No 3, September 2023, p.148-154

doi: 10.22540/JFSF-08-148


Original Article

Do low levels of alanine aminotransferase, a baseline marker of sarcopenia and frailty, associate with worse clinical outcomes among hospitalized COVID-19 patients? A Retrospective Cohort Study

Ehud Raz Gatt1, Eyal Zilber1,2, Max Perelman1,2, Nitsan Landau1,2, Maya Yakir1,2, Noam Glick1,2, Liat Negru1,2, Gad Segal1,2, Edward Itelman1,2

  1. Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
  2. Internal Department “T”, Tel Hashomer Hospital, Ramat Gan, Israel

Keywords: ALT, Clinical outcomes, Corona virus, Frailty, Sacrcopenia


Objectives: COVID-19 geoperdize lives. Not all the risk factors for negative outcomes are known. Sarcopenia and frailty are common, negatively affecting clinical outcomes. Studies have shown that sarcopenia and frailty are associated with worse outcomes. Our objective was to examine whether low ALT (Alanine-aminotranferase), a surrogate marker for sarcopenia, is associated with worse clinical outcomes among hospitalized COVID-19 patients. Methods: We reviewed cases of COVID-19 in a tertiary hospital, during three COVID-19 waves and examined correlations between ALT and mortality using crude, univariate and multivariate analysis for age, gender, hypertension, Chronic obstructive pulmonary disease and Congestive heart failure. Results: 357 patients were included in this analysis. Median age was 69, 54% were males. Median ALT was 19 IU/L. During follow-up, 73 (20%) died. Patients with low ALT were more likely to die (HR 1.82, 95% CI 1.06-3.09, P=0.028). Other predictors for mortality were low albumin, background COPD, dyslipidemia, dementia, and malignancy. The multivariate analysis showed that low ALT was still an independent predictor of poor prognosis (HR 1.7, 95% CI 1.0-2.9, P=0.049). Conclusions: In our analysis of COVID-19 patients, low ALT levels were independently associated with increased risk of mortality, both as standalone and when incorporated into a multivariate analysis.
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