COVID-19 患者的肝脏检查异常：美国主要医院网络中 1827 例患者的回顾性观察性队列研究。
Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network.
机构信息
Department of Medicine, Yale School of Medicine, New Haven, CT.
Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT.
出版信息
Hepatology. 2020 Oct;72(4):1169-1176. doi: 10.1002/hep.31487.
BACKGROUND AND AIMS
The coronavirus-19 disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 virus, is associated with significant morbidity and mortality attributable to pneumonia, acute respiratory distress syndrome, and multiorgan failure. Liver injury has been reported as a nonpulmonary manifestation of COVID-19, but characterization of liver test abnormalities and their association with clinical outcomes is incomplete.
APPROACH AND RESULTS
We conducted a retrospective cohort study of 1,827 patients with confirmed COVID-19 who were hospitalized within the Yale-New Haven Health System between March 14, 2020 and April 23, 2020. Clinical characteristics, liver tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALP], total bilirubin [TBIL], and albumin) at three time points (preinfection baseline, admission, and peak hospitalization), and hospitalization outcomes (severe COVID-19, intensive care unit [ICU] admission, mechanical ventilation, and death) were analyzed. Abnormal liver tests were commonly observed in hospitalized patients with COVID-19, both at admission (AST 66.9%, ALT 41.6%, ALP 13.5%, and TBIL 4.3%) and peak hospitalization (AST 83.4%, ALT 61.6%, ALP 22.7%, and TBIL 16.1%). Most patients with abnormal liver tests at admission had minimal elevations 1-2× the upper limit of normal (ULN; AST 63.7%, ALT 63.5%, ALP 80.0%, and TBIL 75.7%). A significant proportion of these patients had abnormal liver tests prehospitalization (AST 25.9%, ALT 38.0%, ALP 56.8%, and TBIL 44.4%). Multivariate analysis revealed an association between abnormal liver tests and severe COVID-19, including ICU admission, mechanical ventilation, and death; associations with age, male sex, body mass index, and diabetes mellitus were also observed. Medications used in COVID-19 treatment (lopinavir/ritonavir, hydroxychloroquine, remdesivir, and tocilizumab) were associated with peak hospitalization liver transaminase elevations >5× ULN.
CONCLUSIONS
Abnormal liver tests occur in most hospitalized patients with COVID-19 and may be associated with poorer clinical outcomes.
背景和目的
由严重急性呼吸系统综合征冠状病毒 2 型病毒引起的新型冠状病毒病（COVID-19）大流行与肺炎、急性呼吸窘迫综合征和多器官衰竭导致的高发病率和高死亡率有关。已有报道称，肝脏损伤是 COVID-19 的非肺部表现，但对肝酶异常的特征及其与临床结局的关系的描述尚不完全。
方法和结果
我们对 2020 年 3 月 14 日至 2020 年 4 月 23 日期间在耶鲁-纽黑文卫生系统住院的 1827 例确诊 COVID-19 患者进行了回顾性队列研究。分析了临床特征、肝酶（天冬氨酸氨基转移酶[AST]、丙氨酸氨基转移酶[ALT]、碱性磷酸酶[ALP]、总胆红素[TBIL]和白蛋白）在三个时间点（感染前基线、入院和住院高峰）以及住院结局（严重 COVID-19、入住重症监护病房[ICU]、机械通气和死亡）。在住院的 COVID-19 患者中，无论是在入院时（AST 66.9%、ALT 41.6%、ALP 13.5%和 TBIL 4.3%）还是在住院高峰时（AST 83.4%、ALT 61.6%、ALP 22.7%和 TBIL 16.1%），都常观察到异常的肝酶。大多数入院时肝酶异常的患者，肝酶升高仅为正常上限（ULN）的 1-2 倍（AST 63.7%、ALT 63.5%、ALP 80.0%和 TBIL 75.7%）。这些患者中有相当一部分在入院前就存在肝酶异常（AST 25.9%、ALT 38.0%、ALP 56.8%和 TBIL 44.4%）。多变量分析显示，异常的肝酶与严重 COVID-19，包括入住 ICU、机械通气和死亡相关；也观察到与年龄、男性、体重指数和糖尿病相关的关联。用于 COVID-19 治疗的药物（洛匹那韦/利托那韦、羟氯喹、瑞德西韦和托珠单抗）与住院高峰时肝转氨酶升高 >5×ULN 相关。
结论
异常的肝酶在大多数住院的 COVID-19 患者中发生，并且可能与较差的临床结局相关。
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