Subclinical association of AST/ALT and BNP as risk factors for mortality in patients with COVID-19


Martínez-Cardozo D, Martínez-Cardozo E, Osuna-Ramos JF, Sandoval-Bedolla KL, Melchor-López A, Bernal-Martínez DM. Subclinical association of AST/ALT and BNP as risk factors for mortality in patients with COVID-19. Am J Med Surg. July 2021; 4(3). 21-34

Abstract: Background. In the general population, Ast/Alt is related to BNP as a predictor of mortality and in coronavirus disease 2019 (Covid-19); Elevations in alanine aminotransferase (Alt) or aspartate aminotransferase (Ast) are associated with liver damage, Ast/Alt with mortality, and brain natriuretic peptide (BNP) identifies subclinical myocardial dysfunction. Objective. To evaluate the Ast/Alt association with subclinical BNP, and its use as prognostic risk factors, at hospital admission of patients with Covid-19.

Methods. A cohort study (240 patients with Covid-19) was carried out until the clinical outcome (improvement, death). Performing descriptive statistics, curves: operating characteristic of the receiver and Kaplan Meier, Pearson's correlation, Wilcoxon test, Cox analysis and multivariate logistic.

Results. BNP (AUC 0.77; p<0.0001) and Ast/Alt (AUC 0.67; p<0.0001) predicted mortality, in patients with Covid-19, a BNP level> 67 (HR 2.99) and Ast/Alt> 1.09 (HR 1.74) explained lower survival (p<0.0001). Ast/Alt predicted BNP> 67 (AUC 0.63, p=0.0004), with significant association (r=0.219; p<0.001); both associated with: creatinine, Ast, creatine kinase, fibrinogen, D-dimer, lactate, glomerular filtration rate. Risk factors for mortality were: BNP OR 2.203, hypertension OR 45.452, Ast/Alt OR 1.004, ferritin OR 1.002, and lymphopenia OR 0.998. There was a significant decrease in BNP (p<0.05), Ast (p<0.001) and Ast/Alt (p<0.0001) in non-survivors.

Conclusions. Ast/Alt (> 1.09) and subclinical BNP (> 67) were evaluated as risk factors for mortality at hospital admission, given their association, Ast/Alt could be a risk factor for subclinical cardiovascular disease.

Key words: Ast/Alt, BNP, Covid-19, mortality, subclinical myocardial dysfunction.


Key words: COVID-19, BNP, ALT, AST.