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Malo De Molina Ruiz, RosaAuthorGarcia-Samaniego, JAuthorMostaza, JmAuthorCalleja, JlCorresponding Author
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Mild AST elevation as an early sign of COVID-19 severity in a multicenter Madrid cohort

Publicated to:REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS. 113 (11): 780-786 - 2021-01-01 113(11), DOI: 10.17235/reed.2021.8007/2021

Authors: Fernández Carrillo, Carlos; Perelló Muñoz, Christie; Llop Herrera, Elba; García-Samaniego Rey, Javier; Romero, Miriam; Mostaza Prieto, José María; Ibáñez Samaniego, Luis; Bañares Cañizares, Rafael; Bighelli, F; Usón Peirón, C; Fernández, Inmaculada; Hernández Castro, Olga; Lalueza Blanco, Antonio; Albillos Martínez, Agustín; Malo de Molina, R; Múñez Rubio, Elena; Jiménez Tejero, Elena; Calleja Panero, José Luis

Affiliations

Hosp Gen Univ Gregorio Maranon, IiSGM, Gastroenterol Dept, Liver Unit, Madrid, Spain - Author
Hosp Univ 12 Octubre I 12, Internal Med Dept, Madrid, Spain - Author
Hosp Univ La Paz, Internal Med Dept, Madrid, Spain - Author
Hosp Univ La Paz, Liver Unit, IdiPAZ, Madrid, Spain - Author
Hosp Univ Puerta Hierro Majadahonda, Infect Dis Unit, Internal Med Dept, IDIPHISA, Madrid, Spain - Author
Hosp Univ Puerta Hierro Majadahonda, Liver Unit, Gastroenterol & Hepatol Dept, IDIPHISA, Madrid, Spain - Author
Hosp Univ Puerta Hierro Majadahonda, Prevent Med Dept, Madrid, Spain - Author
Hosp Univ Puerta Hierry Majadahonda, Pneumol Serv, IDIPHISA, Madrid, Spain - Author
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain - Author
Univ Alcala De Henares, Fac Med, Madrid, Spain - Author
Univ Alcala De Henares, Gastroenterol & Hepatol Dept, Hosp Univ Ramon y Cajal, IRYCIS, Madrid, Spain - Author
Univ Autonoma Madrid, Fac Med, Madrid, Spain - Author
Univ Complutense Madrid, Fac Med, Madrid, Spain - Author
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Abstract

Introduction: liver enzyme elevation has been reported in SARS-CoV-2 disease (COVID-19) in heterogeneous cohorts, mainly from China. Comprehensive reports from other countries are needed. In this study, we dissect the pattern, evolution, and predictive value of such abnormalities in a cohort from Madrid, Spain.Methods: a retrospective study with a prospective 14-day follow-up of 373 patients with confirmed COVID-19 in five Madrid hospitals, including 50 outpatients. A COVID-19 severe course was defined as the need for mechanical ventilation.Results: a total of 33.1 % of hospitalized patients showed baseline AST elevation and 28.5 % showed ALT elevation, compared with 12 % and 8 % of outpatients (p <= 0.001). Baseline AST, ALT and GGT levels correlated with LDH and C-reactive protein (CRP) levels (r <= 0.598, p < 0.005). AST elevation was associated with other severity markers such as male sex, lymphopenia, and pneumonia on X-Ray (p < 0.05 for all). ALP and bilirubin levels were rarely increased. Patients with elevated baseline AST showed a progressive normalization of this enzyme and an increase in ALT and GGT levels. Patients with normal baseline AST showed a flattened evolution pattern with levels within the range. Patients with a severe course of COVID-19 more frequently showed elevated baseline AST than those with a milder evolution (54.2 % vs. 25.4 %, p < 0.001). Age, AST and CRP were independent risk factors for a severe course of COVID-19.Conclusion: mild liver enzyme elevation is associated with COVID-19 severity. Baseline AST is an independent predictor of severe COVID-19 course, and tends to normalize over time. ALT and GGT show a late elevation.

Keywords
Ace2Acute respiratory syndromeAlkaline phosphataseBiomarkerCoronavirusLiverManifestationsSars-covSars-cov-2

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS, and although the journal is classified in the quartile Q4 (Agencia WoS (JCR)), its regional focus and specialization in Gastroenterology & Hepatology, give it significant recognition in a specific niche of scientific knowledge at an international level.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 1.53, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-12, the following number of citations:

  • WoS: 2
  • Scopus: 4
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-12:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 23.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 23 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 6.2.
  • The number of mentions on the social network X (formerly Twitter): 11 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Bolivia.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (CALLEJA PANERO, JOSE LUIS).

the author responsible for correspondence tasks has been CALLEJA PANERO, JOSE LUIS.