Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey.
Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul, Turkey.
Ann Hepatol. 2020 Nov-Dec;19(6):614-621. doi: 10.1016/j.aohep.2020.08.068. Epub 2020 Sep 10.
COVID-19 caused by the SARS-CoV-2 continues to spread rapidly across the world. In our study, we aim to investigate the relationship between the liver enzymes on admission (AST, ALT, ALP, GGT) and severity of COVID-19. We evaluated course of disease, hospital stay, liver damage and mortality.
Our study included 614 patients who were hospitalized with the diagnosis of COVID-19 between 03.16.20 and 05.12.20. Patients with liver disease, hematological and solid organ malignancy with liver metastases were excluded, resulting in 554 patients who met our inclusion criteria. We retrospectively evaluated liver transaminase levels, AST/ALT ratio, cholestatic enzyme levels and R ratio during hospital admission and these were compared in terms of morbidity, mortality and clinical course.
Mean age of 554 subjects were 66.21±15.45 years, 328 (59.2%) were men. The mean values of liver enzymes on admission were AST (36.2±33.6U/L), ALT (34.01±49.34U/L), ALP (78.8±46.86U/L), GGT (46.25±60.05U/L). Mortality rate and need for intensive care unit were statistically significant in subjects that had high ALT-AST levels during their admission to the hospital (p=0.001). According to the ROC analysis AST/ALT ratio was a good marker of mortality risk (AUC=0.713: p=0.001) and expected probability of intensive care unit admission (AUC=0.636: p=0.001). R ratio, which was used to evaluate prognosis, showed a poor prognosis rate of 26.5% in the cholestatic injury group, 36.1% in the mixed pattern group and 30% in the hepato-cellular injury group (p 0.001).
ALT-AST elevation and AST/ALT ratio >1 was associated with more severe course and increased mortality in COVID-19.
由 SARS-CoV-2 引起的 COVID-19 继续在全球范围内迅速传播。在我们的研究中，我们旨在研究入院时的肝酶（AST、ALT、ALP、GGT）与 COVID-19 严重程度之间的关系。我们评估了病程、住院时间、肝损伤和死亡率。
我们的研究包括 2020 年 3 月 16 日至 5 月 12 日期间因 COVID-19 住院的 614 名患者。排除了患有肝病、血液系统恶性肿瘤和肝转移的实体器官恶性肿瘤患者，因此符合纳入标准的患者有 554 名。我们回顾性评估了入院时的肝转氨酶水平、AST/ALT 比值、胆汁淤积酶水平和 R 比值，并根据发病率、死亡率和临床病程进行了比较。
554 名受试者的平均年龄为 66.21±15.45 岁，其中 328 名（59.2%）为男性。入院时肝酶的平均值为 AST（36.2±33.6U/L）、ALT（34.01±49.34U/L）、ALP（78.8±46.86U/L）、GGT（46.25±60.05U/L）。在入院时 ALT-AST 水平较高的患者中，死亡率和需要入住重症监护病房的发生率具有统计学意义（p=0.001）。根据 ROC 分析，AST/ALT 比值是死亡率风险的良好标志物（AUC=0.713：p=0.001）和入住重症监护病房的预期概率（AUC=0.636：p=0.001）。用于评估预后的 R 比值在胆汁淤积性损伤组、混合模式组和肝细胞损伤组中的不良预后率分别为 26.5%、36.1%和 30%（p 0.001）。
入院时 ALT-AST 升高和 AST/ALT 比值>1 与 COVID-19 更严重的病程和更高的死亡率相关。
