Low ALT levels and a New Diagnosis of Congestive Heart Failure Following COVID-19 Infection

Asher Shafrir^1,2,3*Gil Dagan^2,3Ronny Alcalai^2,3David Leibowitz^2,3

• ¹Meuhedet Health Care, Tel Aviv, Israel
• ²Hadassah Medical Center, Jerusalem, Israel
• ³Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel

Aims: COVID-19 infection may result in complications including congestive heart failure (CHF). It is vital to identify factors associated with CHF post COVID so as to improve outcomes. The aim of this study was to determine whether baseline low alanine transaminase (ALT) levels are associated with new diagnosis of CHF following infection with COVID-19. Methods and results: The study was a retrospective cohort study of patients in the Meuchedet Health Fund database. The analysis was performed on all subjects aged 18 years and older who tested positive for SARS-CoV-2 and had ALT levels measured prior to infection. Patients were excluded if diagnosed with congestive heart failure or cirrhosis prior to COVID-19, or if they died within 30 days of SARS-CoV-2 contraction. The study endpoint was a new diagnosis of CHF as recorded in the subject's electronic medical record. Results: 131,953 adult patients infected with COVID were included in the cohort. Of them, 205 patients (0.16%) were diagnosed with CHF following COVID-19 infection.The occurrence of CHF was significantly higher in the low ALT group (0.34% vs. 0.14%, p-value<0.001). This difference was more prominent when analyzing patients aged 50 and older (1.4% vs. 0.35, p-value<0.001). In a multivariate logistic regression, pre-morbid low ALT remained significantly associated with the occurrence of post COVID-19 CHF (OR -1.95, 95% CI -1.03-2.53). Conclusions: This study demonstrates that low ALT levels prior to infection with COVID-19 is associated with a new diagnosis of CHF following infection. Patients with low ALT levels prior to COVID-19 infection should have cardiovascular complaints post COVID carefully assessed.