Prognostic markers are needed to understand the disease course and severity in 
patients with Covid-19. There is evidence that Covid-19 causes gastrointestinal 
symptoms and abnormalities in liver enzymes. We aimed to determine if 
hepatobiliary laboratory data could predict disease severity in patients with 
Covid-19. In this retrospective, single institution, cohort study that analyzed 
patients admitted to a community academic hospital with the diagnosis of 
Covid-19, we found that elevations of Aspartate Aminotransferase (AST), Alanine 
Aminotransferase (ALT) and Alkaline Phosphatase (AP) at any time during hospital 
admission increased the odds of ICU admission by 5.12 (95% CI: 1.55-16.89; 
p = 0.007), 4.71 (95% CI: 1.51-14.69; p = 0.01) and 4.12 (95% CI: 1.21-14.06, 
p = 0.02), respectively. Hypoalbuminemia found at the time of admission to the 
hospital was associated with increased mortality (p = 0.02), hypotension 
(p = 0.03), and need for vasopressors (p = 0.02), intubation (p = 0.01) and 
hemodialysis (p = 0.002). Additionally, there was evidence of liver injury: AST 
was significantly elevated above baseline in patients admitted to the ICU 
(54.2 ± 15.70 U/L) relative to those who were not (9.2 ± 4.89 U/L; p = 0.01). 
Taken together, this study found that hypoalbuminemia and abnormalities in 
hepatobiliary laboratory data may be prognostic factors for disease severity in 
patients admitted to the hospital with Covid-19.