Expert Stewardship Inc., Newport Beach.
David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA.
J Clin Gastroenterol. 2020 Nov/Dec;54(10):841-849. doi: 10.1097/MCG.0000000000001432.
Coronavirus disease 2019 (COVID-19) has infected over 2 million people worldwide over the course of just several months. Various studies have highlighted that patients infected with COVID-19 may develop various degrees of liver injury. Here, we discuss the impact of underlying liver disease and manifestations of hepatic injury with COVID-19. We also review mechanisms of hepatic injury.
We searched the database PubMed for all studies focused on hepatic injury in COVID-19.
We identified 13 studies that assessed the impact of underlying liver disease in patients infected with COVID-19 (N=3046). Underlying liver disease was one of the most common known comorbid categories in patients infected with COVID-19. Overall, 25% of the patients identified from the 13 studies had hepatic injury. Twenty-one percent and 24% had elevated alanine transaminase and aspartate transaminase values, respectively. Nine percent of the patients had elevated total bilirubin values. Ten of the 13 studies assessed COVID-19 acuity with severity of hepatic injury. In 9 of the 10 studies, clinical outcomes were worse with hepatic injury.
Liver injury is highly prevalent in patients that present with COVID-19. Since the liver is one of the most affected organs outside of the respiratory system in COVID-19, more intensive surveillance is warranted for severe cases, particularly among those with pre-existing advanced liver disease.
在短短几个月的时间里，新型冠状病毒病 2019（COVID-19）已在全球范围内感染了超过 200 万人。多项研究强调，感染 COVID-19 的患者可能会出现不同程度的肝损伤。在这里，我们讨论了潜在肝脏疾病对 COVID-19 的影响和肝损伤的表现。我们还回顾了肝损伤的机制。
我们在 PubMed 数据库中搜索了所有关于 COVID-19 肝损伤的研究。
我们确定了 13 项评估 COVID-19 患者潜在肝脏疾病影响的研究（N=3046）。潜在的肝脏疾病是 COVID-19 患者最常见的已知合并症之一。总的来说，从 13 项研究中发现的患者中有 25%有肝损伤。21%和 24%的患者分别有丙氨酸转氨酶和天冬氨酸转氨酶升高。9%的患者总胆红素值升高。13 项研究中有 10 项评估了 COVID-19 的严重程度与肝损伤的严重程度。在 10 项研究中有 9 项研究表明，肝损伤患者的临床结局更差。
肝损伤在出现 COVID-19 的患者中非常普遍。由于肝脏是 COVID-19 中除呼吸系统以外受影响最严重的器官之一，因此对于严重病例，特别是对于那些患有预先存在的晚期肝脏疾病的患者，需要更加强烈的监测。
