慢性肝脏疾病对 COVID-19 住院患者结局的影响:美国多中心经验。

Impact of chronic liver disease on outcomes of hospitalized patients with COVID-19: A multicentre United States experience.

机构信息

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.

Harvard Medical School, Boston, MA, USA.

出版信息

Liver Int. 2020 Oct;40(10):2515-2521. doi: 10.1111/liv.14583. Epub 2020 Jul 5.

Abstract

Liver injury has been described with COVID-19, and early reports suggested 2%-11% of patients had chronic liver disease (CLD). In this multicentre retrospective study, we evaluated hospitalized adults with laboratory-confirmed COVID-19 and the impact of CLD on relevant clinical outcomes. Of 363 patients included, 19% had CLD, including 15.2% with NAFLD. Patients with CLD had longer length of stay. After controlling for age, gender, obesity, cardiac diseases, hypertension, hyperlipidaemia, diabetes and pulmonary disorders, CLD and NAFLD were independently associated with ICU admission ([aOR 1.77, 95% CI 1.03-3.04] and [aOR 2.30, 95% CI 1.27-4.17]) and mechanical ventilation ([aOR 2.08, 95% CI 1.20-3.60] and [aOR 2.15, 95% CI 1.18-3.91]). Presence of cirrhosis was an independent predictor of mortality (aOR 12.5, 95% CI 2.16-72.5). Overall, nearly one-fifth of hospitalized COVID-19 patients had CLD, which was associated with more critical illness. Future studies are needed to identify interventions to improve clinical outcomes.

摘要

已有研究报道 COVID-19 可导致肝损伤,早期报告显示 2%-11%的患者合并慢性肝病(CLD)。在这项多中心回顾性研究中,我们评估了住院的 COVID-19 患者,并分析了 CLD 对相关临床结局的影响。363 例患者中,19%合并 CLD,其中 15.2%患有非酒精性脂肪性肝病(NAFLD)。合并 CLD 的患者住院时间更长。在校正年龄、性别、肥胖、心脏疾病、高血压、高脂血症、糖尿病和肺部疾病后,CLD 和 NAFLD 与入住 ICU([aOR 1.77,95%CI 1.03-3.04] 和 [aOR 2.30,95%CI 1.27-4.17])和机械通气([aOR 2.08,95%CI 1.20-3.60] 和 [aOR 2.15,95%CI 1.18-3.91])独立相关。肝硬化的存在是死亡的独立预测因素(aOR 12.5,95%CI 2.16-72.5)。总体而言,近五分之一的住院 COVID-19 患者合并 CLD,且 CLD 与更严重的疾病相关。需要进一步研究以确定改善临床结局的干预措施。

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