This study presents a slide-based video cognitive behavioral therapy (CBT)-informed psychoeducational intervention for chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients. The intervention addresses the lack of mental healthcare interventions for CKD patients, who experience disproportionate mental health challenges. The intervention is available in English and Spanish. The intervention includes four modules on the following: 1. depression; 2. anxiety; 3. locus of control and social support; and 4. treatment adherence, each with exercises. The intervention was tested with a sample of 45 CKD and ESKD patients, including individuals with CKD not receiving hemodialysis (HD) and individuals with ESKD receiving HD. Results showed a statistically significant within-participant reduction in PHQ-9 scores from pre- to post-intervention. The intervention did not yield significant pre- to post- changes in patients’ anxiety or locus of control. Associations between treatment adherence and depression, anxiety, locus of control, social support, and resilient coping were not statistically significant after applying the Bonferroni correction. Participant feedback was positive; they identified breathing exercises as the most helpful component, followed by medication adherence strategies, and referenced family members as supports. These preliminary results show that this CBT-informed intervention may have the potential to address depression in CKD/ESKD patients.

Introduction: Managing fluid balance in COVID-19 patients can be challenging, particularly if acute kidney injury (AKI) develops. Aim of the study: We study the relationship between fluid net input and output (FNIO) in COVID-19 patients with development of AKI, time to development of AKI, in-hospital length of stay (LOS), and in-hospital mortality. Material and Methods: Retrospective study of 403 patients with COVID-19. Data for FNIO were from day 1 through day 10 or earlier if AKI occurred. Results: AKI occurred in 22.8%, in-hospital mortality occurred in 26.3%, mean days to AKI were 7.7 (SD=6.3), and mean LOS was 11.5 (SD=13.2) days. In the multivariate logistic regression analyses, increased FNIO mean was significantly associated with slightly increased odds for mortality (OR=1.001, 95% CI:1.0001, 1.0011, p=0.02) but was not significantly associated with AKI. In the multivariate linear regression analyses, increased FNIO mean was significantly associated with lesser days to AKI (B=-6.63*10-5, SE=<0.001, p=0.003) in the whole sample, greater days to AKI in the subset of those with ICU treatment (B=<0.001, SE=<0.001, p<0.001), while FNIO mean was not significantly associated with LOS. Conclusions: Positive fluid balance was associated with faster onset of AKI and increased mortality. Fluid administration in patients with COVID-19 should be guided by routinely measuring FNIO. A restrictive fluid management regimen rather than usual care should be practiced.

This study examined 112 CKD patients’ adherence to and satisfaction with treatment, and their quality of life, as mediated by the level of psychological stress experienced as well as their working alliance, resilience, and social support. The patients were receiving care at a public teaching hospital in the northeast region of the U.S. The results indicated a significant moderate negative correlation between psychological distress and quality of life (r = −0.34, p < 0.01). The results also indicated significant positive moderate to strong correlations between the physician–patient working alliance and adherence (r = 0.42, p < 0.001), satisfaction (r = 0.55, p < 0.001), and quality of life (r = 0.51, p < 0.001), between social support and quality of life (r = 0.39, p < 0.001), and significant moderate positive correlations between resilience and adherence (r = 0.35, p < 0.001) and satisfaction (r = 0.26, p < 0.01). Regression analyses indicated that the following predictors were significant: patient adherence was positively predicted by the working alliance (β = 0.42, p < 0.001); patient satisfaction was positively predicted by the working alliance (β = 0.51, p < 0.001) and negatively predicted by psychological distress (β = −18, p < 0.048); and quality of life was positively predicted by the working alliance (β = 0.38, p < 0.001) and social support (β = 0.28, p < 0.016) and negatively predicted by psychological distress (β = −0.34, p < 0.002). Moderation analyses indicated that the working alliance moderated the relationship between COVID impact and adherence (R2 = 0.27, F(df1, df2) = 8.36, p < 0.001, 95% CI = 0.29–2.74), social support moderated the relationship between COVID impact and adherence (R2 = 0.19, F(df1, df2) = 5.77, p < 0.001, 95% CI = 0.47–2.77), and resilient coping moderated the relationship between COVID impact and satisfaction (R2 = 0.20, F(df1, df2) = 7.89, p < 0.001, 95% CI = 0.94–2.81). The present study provides evidence of the significant role of psychological stressors and social support in influencing CKD patients’ adherence to and satisfaction with treatment, as well as their quality of life.

Background:Coronavirus disease 2019 (COVID-19) has multiple organ system involvement but the association of organ system involvement with disease prognosis has not been reported. We study the association of organ systems involved with in-hospital mortality and hospital length of stay (LOS) in COVID-19.Methods:Retrospective study of 808 consecutive patients with confirmed-laboratory diagnosis of COVID-19 in a New York hospital from March 1-May 15, 2020.Results:Increased number of organs systems involved was associated with increased odds for in-hospital mortality (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.11-1.66, p < 0.01) and increased LOS (B = 0.02, SE = 0.01, p < 0.05). Increased platelet count was associated with decreased odds for mortality (OR: 0.996, 95% CI: 0.994-0.998, p < 0.001). Increased white blood cell count was associated with increased odds for mortality (OR: 14.00, 95% CI: 3.41-57.38, p < 0.001). Increased creatinine and glucose were each associated with increased LOS (B = 0.11, SE = 0.04, p < 0.01, and B = 0.12, SE = 0.05, p < 0.05, respectively). Increased odds for mortality were also found in high FiO2 oxygen requirement (OR: 11.63, 95% CI: 3.90-34.75, p < 0.001) and invasive mechanical ventilation (OR: 109.93, 95% CI: 29.44-410.45, p < 0.001).Conclusion:Multiple organ systems involvement in COVID-19 is associated with worse prognosis. Clinical/laboratory values corresponding to each organ system may be used as prognostic tools in clinical settings to tailor treatments for COVID-19 patients.

Background:Impaired consciousness is associated with complications and mortality in COVID-19 patients. We study factors associated with impaired consciousness as measured by the Glasgow Coma Scale (GCS) in COVID-19 patients. Methods:This is a retrospective study of 604 patients with COVID-19 in the metropolitan New York City area. We study the association of demographics, comorbidity, disease severity, treatment management, and laboratory measurements with both GCS nadir during hospitalization and GCS at discharge. Results:Age was significantly associated with severe GCS nadir during hospitalization and at hospital discharge. Body mass index comorbidity was significantly associated with severe GCS at hospital discharge. Sedation treatment was significantly associated with both moderate and severe GCS nadir during hospitalization. Glucose nadir was significantly associated with severe GCS nadir during hospitalization. Sodium level at admission was associated with decreased relative risk while BUN peak level during hospitalization was associated with increased relative risk for severe GCS on discharge. Conclusion:We found that factors from demographics, comorbidity, treatment management, and laboratory measurements were associated with GCS while disease severity was not significantly associated with GCS. These findings can guide clinicians for treatment approaches for the early identification of impaired consciousness and its degrees of severity in COVID-19 patients.

Background:Patients with chronic kidney disease (CKD) are at increased risk for adverse drug events due to medication dosing errors. We studied the awareness and knowledge among internal medicine housestaff (IMHS) of proper dose adjustment of commonly used rheumatology and allergy/immunology medications for patients with CKD.Methods:We surveyed 353 IMHS to evaluate their awareness of the need for medication dose adjustments for patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate for common rheumatology and allergy/immunology medications.Results:There was lack of awareness and knowledge for both rheumatology and allergy/immunology medications. Incorrect awareness and knowledge were as follows: allopurinol, 21.2%, 73.4%; colchicine, 19.0%, 75.9%; diphenhydramine, 34.0%, 34.0%; loratadine, 82.2%, 93.2%; and montelukast, 34.0%, 34.0%, respectively. Exploratory logistic regression analyses showed that PGY1 residents had higher odds for lack of awareness for allopurinol (odds ratio [OR] 24.57, 95% CI [confidence interval] 4.69, 99.13, P < 0.001), colchicine (OR 3.98, 95% CI 1.50, 10.51, P < 0.01), diphenhydramine (OR 2.24, 95% CI 1.10, 4.54, P < 0.04), and montelukast (OR 2.45, 95% CI 1.20, 5.00, P < 0.05) than PGY3 residents. A nephrology rotation in medical school was associated with lower odds for incorrect knowledge for allopurinol (OR 0.46, 95% CI 0.25, 0.87, P < 0.05) and montelukast (OR 0.50, 95% CI 0.27, 0.92, P < 0.05).Conclusion:Overall, awareness and knowledge were poor among IMHS for dose adjustments of rheumatology and allergy/immunology medications in patients with CKD. Proper education and exposure to nephrology during training may improve quality and safety of care for patients with CKD.

INTRODUCTION:COVID-19 affects the hematologic system. This article evaluated the impact of hematologic involvement of different blood cell line parameters of white blood cells including absolute neutrophil count (ANC), hemoglobin, and platelets in COVID-19 patients and their association with hospital mortality and length of stay (LOS).METHODS:This was a retrospective study of 475 patients with confirmed positive COVID-19 infection and hematologic abnormalities in the metropolitan New York City area.RESULTS:Elevated absolute neutrophil count (OR: 1.20; 95% CI: 1.02-1.42; p < 0.05) increased days of hematologic involvement (OR: 4.44; 95% CI: 1.42-13.90; p < 0.05), and persistence of hematologic involvement at discharge (OR: 2.87; 95% CI: 1.20-6.90; p < 0.05) was associated with higher mortality. Higher hemoglobin at admission (OR: 0.77; 95% CI:0.60-0.98; p < 0.001) and platelets peak (OR: 0.995; 95% CI: 0.992-0.997; p < 0.001) were associated with decreased mortality. Patients with higher white blood cell peak (B = 0.46; SE = 0.07; p < 0.001) and higher hemoglobin at admission (B = 0.05; SE = 0.01; p < 0.001) were associated with higher LOS. Those with higher hemoglobin nadir (B = -0.06; SE = 0.01; p < 0.001), higher platelets nadir (B = -0.001; SE = < 0.001; p < 0.001), and hematologic involvement at discharge or death (B = -0.06; SE = 0.03; p < 0.05) were associated with lower LOS.CONCLUSIONS:These findings can be used by clinicians to better risk-stratify patients with hematologic involvement in COVID-19 and tailor therapies potentially to improve patient outcomes.

Introduction/Background Patients with Coronavirus Disease 2019 (COVID-19) present with a spectrum of respiratory symptoms. There are no studies describing respiratory system involvement adjusted for other organ systems, oxygen saturation nadir, hospitalization days until respiratory involvement, proportion of days of respiratory system involvement, and persistent respiratory involvement at discharge in COVID-19 patients. We studied these parameters in COVID-19 patients that received respiratory therapy interventions and their association with mortality and length of stay (LOS). Methods A single-center cross-sectional retrospective study of 738 COVID-19 patients with respiratory involvement at a hospital in the New York metropolitan area. Results COVID-19 patients with respiratory involvement had increased mortality with oxygen requirement of FiO2 >55% (OR:39.02, 95% CI:1.59–960.51, P < 0.05) and mechanical ventilation (OR:236.64, 95% CI:8.24–6798.93, P < 0.01). Respiratory system involvement adjusted for other organ system involvement was associated with increased mortality (OR:1.60, 95% CI:1.20, 2.14, P < 0.01) and LOS (B = 0.02, SE = 0.01, P < 0.01). Oxygen saturation nadir of 70%–89% was significantly associated with increased LOS (B = 0.07, SE = 0.03, P < 0.05), whereas oxygen saturation nadir of <70% was associated with increased mortality (OR:12.95, 95% CI:2.72–61.61, P < 0.01). An increased proportion of days in hospital with respiratory system involvement was associated with decreased mortality (OR:0.004, 95% CI:<0.001–0.06, P < 0.001) and increased LOS (B = 0.90, SE = 0.07, P < 0.001). Respiratory involvement on days 4–7 was associated with decreased mortality (OR:0.02, 95% CI:<0.003–0.17, P < 0.001), and respiratory involvement on day >1 was associated with increased LOS. Respiratory involvement persistent at discharge was associated with increased mortality (OR:56.82, 95%CI:18.51–174.43, P < 0.001). Conclusions Among all respiratory parameters, high oxygen requirements and low oxygen saturation nadir are the most predictive of COVID-19 prognosis.

Background: The Acute Physiologic and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease modified for Sodium concentration (MELD-Na) scores are validated to predict disease mortality. We studied the prognostic utility of these scoring systems in critically ill coronavirus disease 2019 (COVID-19) patients with liver injury.Methods: This was a retrospective study of 291 confirmed COVID-19 and liver injury patients requiring intensive care unit level of care. These patients required supplemental oxygen requirement with fraction of inspired oxygen >55% and/or the use of vasopressor. MELD-Na, SOFA, and APACHE-II scores were adjusted. Outcomes were mortality and length of stay (LOS).Results: SOFA (odds ratio: 0.78, 95% confidence interval: 0.63–0.98, P < 0.05) was associated with decreased odds for mortality. APACHE-II and MELD-Na were not associated with mortality or LOS.Conclusions: We suggest that the novel nature of COVID-19 necessitates new scoring systems to predict outcomes in critically ill COVID-19 patients with liver injury.

BACKGROUND AND AIMS:We investigate the impact of blood glucose on mortality and hospital length of stay (HLOS) among COVID-19 patients. METHODS:Retrospective study of 456 patients with confirmed COVID-19 and glycemic dysregulation in the New York City area. RESULTS:We found that impaired glucose adjusted for other organs systems involved (OR:1.87; 95% CI:1.36-2.57, p < 0.001), increased glucose nadir (OR:34.28; 95% CI:3.97-296.05, p < 0.01) and abnormal blood glucose levels at discharge (OR:5.07; 95% CI:2.31-11.14, p < 0.001) were each significantly associated with increased odds for mortality. New or higher from baseline insulin requirement during hospitalization (OR:0.34; 95% CI:0.15-0.78; p < 0.05) was significantly associated with decreased odds for mortality. Increased glucose peak (B = 0.001, SE=<0.001, p < 0.001), new or higher from baseline insulin requirement during hospitalization (B = 0.11, SE = 0.03, p < 0.001), and increased days to dysglycemia (B = 0.15, SE = 0.04, p < 0.001) were each significantly associated with increased HLOS. Increased glucose nadir (B = -0.67, SE = 0.07, p < 0.001), insulin intravenous drip (B = -0.10, SE = 0.05, p < 0.05), and increased proportion days endocrine system involved (B = -0.25, SE = 0.06, p < 0.001) were each significantly associated with decreased HLOS. CONCLUSION:Glucose dysregulation adversely affects mortality and HLOS in COVID-19. These data can help clinicians to guide patient treatment and management in COVID-19 patients.

Bhutta, Salman; Munshi, Rezwan F.; Fogel, Joshua; Nehru, Narois; Pellegrini, James R.; Lam, Eric H.; Paz, Sandra Gomez; Rubinstein, Sofia Author Information

PURPOSE: Coronavirus disease 2019 (COVID-19) has multiple organ system involvement but the association of organ systems involvement with mortality has not been reported.We study the association of organ systems involved with mortality in COVID-19.METHODS: Retrospective study of 808 consecutive patients with confirmed-laboratory diagnosis of COVID-19 in a New York hospital from March 1 -May 15, 2020.We investigated involvement of eight organ systems: respiratory, neurologic, renal, cardiovascular, liver, endocrine, musculoskeletal, and hematologic.Respiratory was nadir oxygen saturation <95% or any new requirement of supplemental oxygenation from baseline.Neurologic was any new decrease of Glasgow Coma Scale (GCS).Renal was any absolute increase in serum creatinine level >0.3mg/dL or 1.5-fold increase from baseline.Cardiovascular was any new troponin elevation >0.04ng/mL, new onset of HF, acute on chronic HF, new or worsening of atrial fibrillation, supraventricular tachycardia, new AV block, new ventricular tachycardia, new inotrope use, or new vasopressor use.Liver was serum alanine aminotransferase more than 1.5 times normal limit (>60IU/L) or abnormal total serum bilirubin >1.1mg/dL.Endocrine was any blood glucose level <60 mg/dL or >140 mg/dL, or any new or higher (from baseline) insulin administration requirement.Musculoskeletal was any creatine kinase values >1,000 units/L.Hematologic was involvement of any one cell line: white blood cell count <4Â10^9/L or >11Â10 9 /L, absolute neutrophil count <1.8Â10 9 /L or >7Â10 9 /L, hemoglobin <9.2g/dL, or platelet <110Â10 9 /L. RESULTS:The average number of organ systems involved in COVID-19 hospitalized patient was 3.8.Majority of the COVID-19 patients admitted to the hospital had respiratory involvement (92%), followed by GI/liver (65%), hematologic (59%) endocrine (57%) and renal (42%) involvement.In our multivariate analysis, increased number of organs systems involved was associated with increased odds for mortality (OR:1.49,95% CI:1.24-1.79,p<0.001).While the total mortality was 31%, patients with <2 organ systems involved had a mortality rate of 2%, 2-3 organ systems involved mortality rate of 8%, 4-5 organ systems involved mortality rate of 33%, and >5 organ systems involved mortality rate of 81%.Increased GCS was associated with decreased odds for mortality (OR:0.90,95% CI:0.82-0.98,p<0.05).Increased platelet count was associated with decreased odds for mortality (OR:0.996,95% CI:0.994 -0.998, p<0.001).Increased white blood cell count was associated with increased odds for mortality (OR:21.18,p<0.001).Increased odds for mortality were also found in high FiO2 oxygen requirement (OR:12.12,95% CI:2.46-59.80,p<0.01) and invasive ventilation (OR:150.36,p<0.001).CONCLUSIONS: Increased number of organ systems involved in COVID-19 was significantly associated with increased odds for mortality.We found that multiple organ systems involvement in COVID-19, similar to other disease processes such as sepsis and shock, is a useful predictor of disease mortality.CLINICAL IMPLICATIONS: Multiple organ systems involvement in COVID-19 is associated with increased mortality.Clinical scores and laboratory values corresponding to each organ system may be used as prognostic tools in clinical settings to predict mortality in COVID-19 patients.

Background: Renal involvement in COVID-19 leads to severe disease and higher mortality. We study renal parameters in COVID-19 patients and their association with mortality and length of stay in hospital. Methods: A retrospective study (n=340) of confirmed COVID-19 patients with renal involvement determined by the presence of acute kidney injury. Multivariate analyses of logistic regression for mortality and linear regression for length of stay (LOS) adjusted for relevant demographic, comorbidity, disease severity, and treatment covariates. Results: Mortality was 54.4% and mean LOS was 12.9 days. For mortality, creatinine peak (OR:35.27, 95% CI:2.81, 442.06, p<0.01) and persistent renal involvement at discharge (OR:4.47, 95% CI:1.99,10.06, p<0.001) were each significantly associated with increased odds for mortality. Increased blood urea nitrogen peak (OR:0.98, 95%CI:0.97,0.996, p<0.05) was significantly associated with decreased odds for mortality. For LOS, increased blood urea nitrogen peak (B:0.001, SE:<0.001, p<0.01), renal replacement therapy (B:0.19, SE:0.06, p<0.01), and increased days to acute kidney injury (B:0.19, SE:0.05, p<0.001) were each significantly associated with increased length of stay. Conclusion: Our study emphasizes the importance in identifying renal involvement parameters in COVID-19 patients. These parameters are associated with LOS and mortality, and may assist clinicians to prognosticate COVID-19 patients with renal involvement.

The morbidity and mortality associated with chronic kidney disease remains unacceptably high. Psychosocial issues in CKD patients are frequently overlooked yet are often modifiable risk factors for mortality. Addressing patient perception of social support can potentially improve patient outcomes.

Patients with chronic kidney disease (CKD) are vulnerable to adverse-drug events from cardiovascular drugs. To evaluate awareness and knowledge for appropriate dose adjustment of cardiovascular drugs in CKD patients among Internal Medicine house-staff (IMHS). Cross-sectional convenience sample survey in Fall 2015 among 341 IMHS from multiple academic institutions in the suburban New York City metropolitan area. Awareness was whether drug dose adjustment was needed. Knowledge was correct GFR level for drug dose adjustment. Multivariate logistic regression was conducted. We found overall high percentages and high odds for all cardiovascular drugs for incorrect awareness and knowledge. Postgraduate year (PGY)-1 had greater odds than PGY-3 for Carvedilol (OR: 5.56, 95% CI: 2.19–14.12, p < 0.001) and Digoxin (OR: 3.87, 95% CI: 1.37–10.95, p < 0.05), and lesser odds than PGY3 for Atenolol (OR: 0.31, 95% CI: 0.10–0.91, p < 0.05). Nephrology exposure during medical school rotation, renal clinic, or family history had lesser odds for Carvedilol (OR: 0.45, 95% CI: 0.21–0.97, p < 0.05), Simvastatin (OR: 0.40, 95% CI: 0.16–0.97, p < 0.05), and Hydralazine (OR: 0.31, 95% CI: 0.12–0.81, p < 0.05). Nephrology exposure during residency (OR: 1.96, 95% CI: 1.10–3.50, p < 0.05) and US osteopathic graduates (OR: 2.40, 95% CI: 1.04–5.50, p < 0.05) each had greater odds for Enalapril (OR: 2.40, 95% CI: 1.04–5.50, p < 0.05). International medical graduates had lesser odds than US graduates for Amlodipine (OR: 0.30, 95% CI: 0.11–0.82, p < 0.05). IMHS had overall poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with CKD. As the majority of CKD patients are managed by their primary care providers, training programs should ensure that IMHS have adequate education in Nephrology during their residency training.

Abstract Purpose: The purpose of this study is to identify whether Internal Medicine house-staff (IMHS) have awareness and knowledge about the correct dosage of antidiabetic medications for patients with chronic kidney disease (CKD), as dosing errors result in adverse patient outcomes for those with diabetes mellitus (DM) and CKD. Methods: There were 353 IMHS surveyed to evaluate incorrect level of awareness of medication dose adjustment in patients with CKD (ILA) and incorrect level of knowledge of glomerular filtration rate level for medication adjustment (ILK-GFR) for Glipizide, Pioglitazone, and Sitagliptin. Results: Lack of awareness and knowledge was high, with the highest for Pioglitazone at 72.8%. For ILA, the percentages were: Pioglitazone: 72.8%, Glipizide: 43.9%, and Sitagliptin: 42.8%. For ILK-GFR, the percentages were: Pioglitazone: 72.8%, Glipizide: 68.3%, and Sitagliptin: 65.4%. Conclusions: IMHS have poor awareness and knowledge for antidiabetic medication dose adjustment in patients with DM and CKD. Both Electronic Medical Rerecord best practice advisory and physician–pharmacist collaborative drug therapy management can enhance safe drug prescribing in patients with CKD. In addition, IMHS’s practice for antidiabetic medication dose adjustment was better with Nephrology exposure. A formal didactic educational training during medical school and residency for antidiabetic medication dose adjustment in patients with DM and CKD is highly encouraged to prevent medication dosing errors and to more effectively and safely allow IMHS to manage complex treatment regimens.

Introduction: Liver injury in COVID-19 patients has been associated with severe disease and higher mortality. We describe not previously studied indicators of liver injury and their association with mortality and length of stay (LOS) in COVID-19 patients. Methods: A retrospective study was conducted in 528 patients with confirmed COVID-19 infection and liver injury. Multivariate analyses of logistic regression was applied to mortality and linear regression for LOS, and adjusted for relevant demographic, comorbidity, disease severity, and treatment covariates. Results: Mortality was 34.5% and mean LOS was 11.9 days. Medicaid insurance (OR:2.80, 95% CI:1.02,7.66, p< 0.05), increased aspartate transaminase (AST) peak level (OR:15.03, 95% CI:2.43,83.11, p< 0.01), and persistent liver injury at discharge (OR:4.86, 95% CI:1.92, 12.31 p< 0.01) were significantly associated with increased odds for mortality. Increased alanine transaminase (ALT) peak (OR:0.05, 95% CI:0.01,0.44, p< 0.01), higher albumin on admission (OR:0.36, 95% CI:0.16, 0.78, p< 0.05), and increased days to liver injury (OR:0.21, 95% CI:0.06,0.79, p< 0.05), were significantly associated with decreased odds for mortality. Increased ALT peak (B:0.25, SE:0.07, p< 0.001), increased total bilirubin (TBL) peak (B:0.36, SE:0.07, p< 0.001) and increased days to liver injury (B:0.22, SE:0.04, p< 0.001) were each significantly associated with increased LOS. Increased AST peak (B:-0.14, SE:0.06, p< 0.05) and persistent liver injury at discharge (B:-0.16, SE:0.03, p< 0.001) were significantly associated with decreased LOS. Conclusion: We found that AST peak level and persistent liver injury at discharge are associated with higher mortality and should be used as prognostic indicators. Conflicting current evidence suggests that ALT level alone may not be an accurate prognostic indicator and even suggestive of a potential protective effect in COVID-19 patients with liver injury. We found that ALT peak level was associated with decreased mortality, which supports the latter. Other liver injury parameters of TBL level, ALT level and increased days to liver injury can be used by clinicians to predict LOS. Early identification of these liver injury parameters should be made for determining prognosis and constructing a tailored approach in the management of COVID-19 patients with liver injury.