肝损伤与 COVID-19 患者的不良临床结局独立相关。

Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19.

机构信息

Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.

Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.

出版信息

Gut. 2021 Apr;70(4):733-742. doi: 10.1136/gutjnl-2020-321726. Epub 2020 Jul 8.

DOI:10.1136/gutjnl-2020-321726

PMID:32641471

Abstract

OBJECTIVE

Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear.

DESIGN

This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death.

RESULTS

We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation.

CONCLUSION

ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.

摘要

目的

缺乏关于不同人类冠状病毒（HCoV）感染者连续肝功能生化数据。在 2019 年冠状病毒病（COVID-19）患者中，肝损伤对不良临床结局的影响尚不清楚。

设计

这是一项使用香港全港数据库中数据的回顾性队列研究。通过诊断代码和/或病毒学结果识别 COVID-19、严重急性呼吸综合征（SARS）和其他 HCoV 患者。丙氨酸氨基转移酶（ALT）/天冬氨酸氨基转移酶（AST）升高定义为 ALT/AST≥2×正常值上限（即 80U/L）。主要终点是入住重症监护病房（ICU）、使用有创机械通气和/或死亡的复合终点。

结果

我们共纳入 1040 例 COVID-19 患者（平均年龄 38 岁，54%为男性）、1670 例 SARS 患者（平均年龄 44 岁，44%为男性）和 675 例其他 HCoV 患者（平均年龄 20 岁，57%为男性）。50.3%的 SARS 患者、22.5%的 COVID-19 患者和 36.0%的其他 HCoV 患者出现 ALT/AST 升高。COVID-19 患者中，53 例（5.1%）入住 ICU，22 例（2.1%）接受有创机械通气，4 例（0.4%）死亡。经白蛋白、糖尿病和高血压校正后，ALT/AST 升高与主要终点独立相关（调整后的比值比[aOR]7.92，95%CI 4.14 至 15.14，p<0.001）。洛匹那韦-利托那韦±利巴韦林+干扰素β（aOR 1.94，95%CI 1.20 至 3.13，p=0.006）和皮质类固醇（aOR 3.92，95%CI 2.14 至 7.16，p<0.001）的使用与 ALT/AST 升高独立相关。