Letter to the Editors: Additional Factors to Consider When Studying Liver Injury Indicators and Mortality in COVID-19 Patients

In a recent issue of Hepatology, Lei et al.⁽¹⁾ conducted a multicenter retrospective cohort study that included 5,771 adult patients with coronavirus disease 2019 (COVID-19) pneumonia in Hubei Province. The purpose of the study was to evaluate the relationships between liver injury indicators (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and total bilirubin [TBIL]) and mortality in COVID-19 patients. The authors considered the possibility that elevated liver injury indicators, particularly AST, are strongly associated with mortality risk. However, the association between liver injury indicators and mortality in COVID-19 patients should be interpreted cautiously in light of the following issues.