Liver injury on admission linked to worse outcomes in COVID-19: an analysis of 14,138 patients.

IF 3 4区医学 Q1 Medicine

Translational gastroenterology and hepatology Pub Date : 2023-01-01 DOI:10.21037/tgh-21-94

Harleen Kaur Chela, Erin M Tallon, William Baskett, Karthik Gangu, Veysel Tahan, Chi-Ren Shyu, Ebubekir Daglilar

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引用次数: 2

Abstract

Background: Infection with the SARS-CoV-2 virus, which can result in hepatic inflammation and injury that varies from mild to severe and potentially acute fulminant liver injury, may be associated with poor outcomes. Our aims were to: (I) assess baseline clinical and demographic characteristics in patients with coronavirus disease 2019 (COVID-19) who did and did not have abnormalities in liver chemistries [alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (Tbili)] and (II) evaluate associations between abnormalities in liver chemistries and the primary outcomes of in-hospital death, intubation, and hospital length of stay (LOS).

Methods: In this nationwide retrospective cohort study of 14,138 patients, we analyzed associations between abnormalities in liver chemistries (ALT, AST, ALP, and Tbili) and mortality, intubation, and prolonged hospital LOS in patients with laboratory-confirmed COVID-19. We used Pearson's chi-squared tests to detect significant differences in categorical variables for patients with and without abnormal liver chemistries. Welch's two-sample t-tests were used to make comparisons of liver chemistry (ALT, AST, ALP, Tbili) and serum albumin results. All other continuous variables were analyzed using independent samples t-tests. A P value of <0.05 was considered significant.

Results: Propensity score matching demonstrated that abnormalities in liver chemistries at admission are significantly associated with increased risk for mortality (RR 1.70) and intubation (RR 1.44) in patients with COVID-19. Elevated AST is the liver chemistry abnormality associated with the highest risk for mortality (RR 2.27), intubation (RR 2.12), and prolonged hospitalization (RR 1.19). Male gender, pre-existing liver disease, and decreased serum albumin are also significantly associated with severe outcomes and death in COVID-19.

Conclusions: Routine liver chemistry testing should be implemented and used for risk stratification at the time of COVID-19 diagnosis.

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入院时肝损伤与COVID-19患者预后较差有关:对14138例患者的分析

背景:感染SARS-CoV-2病毒可导致肝脏炎症和从轻度到重度不等的损伤，并可能导致急性暴发性肝损伤，这可能与预后不良有关。我们的目的是:(1)评估有和没有肝化学异常(碱性磷酸酶(ALP)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和总胆红素(Tbili))的2019冠状病毒病(COVID-19)患者的基线临床和人口统计学特征;(2)评估肝化学异常与院内死亡、插管和住院时间(LOS)等主要结局之间的关系。方法:在这项全国14138例患者的回顾性队列研究中，我们分析了实验室确诊的COVID-19患者的肝脏化学物质(ALT、AST、ALP和Tbili)异常与死亡率、插管和住院时间延长之间的关系。我们使用皮尔逊卡方检验来检测肝化学异常患者和非肝化学异常患者的分类变量的显著差异。采用Welch双样本t检验比较肝化学(ALT、AST、ALP、Tbili)和血清白蛋白结果。所有其他连续变量采用独立样本t检验进行分析。结果的P值:倾向评分匹配显示入院时肝脏化学物质异常与COVID-19患者死亡风险增加(RR 1.70)和插管风险增加(RR 1.44)显著相关。AST升高是肝化学异常，与死亡率(RR 2.27)、插管(RR 2.12)和住院时间延长(RR 1.19)相关。男性、既往肝病和血清白蛋白降低也与COVID-19的严重结局和死亡显著相关。结论:在COVID-19诊断时应实施常规肝化学检测，并将其用于风险分层。

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来源期刊

Translational gastroenterology and hepatology Medicine-Gastroenterology

CiteScore

8.20

自引率

0.00%

发文量

期刊介绍： Translational Gastroenterology and Hepatology (Transl Gastroenterol Hepatol; TGH; Online ISSN 2415-1289) is an open-access, peer-reviewed online journal that focuses on cutting-edge findings in the field of translational research in gastroenterology and hepatology and provides current and practical information on diagnosis, prevention and clinical investigations of gastrointestinal, pancreas, gallbladder and hepatic diseases. Specific areas of interest include, but not limited to, multimodality therapy, biomarkers, imaging, biology, pathology, and technical advances related to gastrointestinal and hepatic diseases. Contributions pertinent to gastroenterology and hepatology are also included from related fields such as nutrition, surgery, public health, human genetics, basic sciences, education, sociology, and nursing.