Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
Department of General Medicine, Musashino Red Cross Hospital, Tokyo, Japan.
PLoS One. 2020 Nov 4;15(11):e0241663. doi: 10.1371/journal.pone.0241663. eCollection 2020.
BACKGROUND/AIM: The coronavirus disease 2019 (COVID-19) had become a big threat worldwide. Liver injury is not uncommon in patients with COVID-19, and clarifying its characteristics is needed. This study aimed to identify factors associated with liver injury and to develop a new classification of predictive severity in patients with COVID-19.
Confirmed patients with COVID-19 (n = 60) were recruited retrospectively from Musashino Red Cross Hospital. The factors of liver injury especially on the elevation of liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) were analyzed. Grading was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
During a median hospitalization follow-up of 15 (4-41) days, 51 (85.0%) patients had COVID-19 pneumonia. In clinical courses, oxygenation was needed for 25 (41.6%) patients and intubation was needed for 9 (15.0%) patients. A total of 27 (45.0%) patients had gastrointestinal symptoms (GS), such as appetite loss, diarrhea, and nausea. A logistic regression analysis revealed that C-reactive protein (CRP) at baseline, oxygenation, intubation, and GS were significant factors of liver injury. Based on these results, patients were classified into three groups: group 1, no oxygenation pneumonia; group 2, pneumonia with oxygenation or GS; and group 3, intubation. We classified 25 (41.7%), 26 (43.3%), and 9 (15.0%) patients into mild, moderate, and severe groups, respectively. The peak of AST and ALT levels was significantly stratified with this criteria (mild [median AST, 28 IU/L; median ALT, 33 IU/L], moderate [median AST, 48 IU/L; median ALT, 47.5 IU/L], and severe [median AST, 109 IU/L; median ALT, 106 IU/L]; P<0.001 and P = 0.0114, respectively).
COVID-19-related liver injury was significantly stratified based on GS and severity of pneumonia.
背景/目的：2019 年冠状病毒病（COVID-19）已成为全球的一大威胁。COVID-19 患者中肝损伤并不少见，需要明确其特征。本研究旨在确定与肝损伤相关的因素，并为 COVID-19 患者制定新的严重程度预测分类。
回顾性招募来自武藏野红十字医院的确诊 COVID-19 患者（n=60）。分析肝损伤的相关因素，特别是肝酶（天门冬氨酸氨基转移酶[AST]和丙氨酸氨基转移酶[ALT]）升高的相关因素。根据不良事件常用术语标准（CTCAE）版本 5.0 进行分级评估。
在中位 15（4-41）天的住院随访期间，51 例（85.0%）患者患有 COVID-19 肺炎。在临床病程中，25 例（41.6%）患者需要吸氧，9 例（15.0%）患者需要插管。共有 27 例（45.0%）患者出现胃肠道症状（GS），如食欲减退、腹泻和恶心。逻辑回归分析显示，基线时 C 反应蛋白（CRP）、氧合、插管和 GS 是肝损伤的显著因素。基于这些结果，患者被分为三组：组 1，无吸氧性肺炎；组 2，有吸氧或 GS 的肺炎；组 3，插管。我们将 25 例（41.7%）、26 例（43.3%）和 9 例（15.0%）患者分别归类为轻度、中度和重度组。AST 和 ALT 水平的峰值与这一标准显著分层（轻度[AST 中位数 28 IU/L，ALT 中位数 33 IU/L]、中度[AST 中位数 48 IU/L，ALT 中位数 47.5 IU/L]和重度[AST 中位数 109 IU/L，ALT 中位数 106 IU/L]；P<0.001 和 P=0.0114）。
根据 GS 和肺炎严重程度，COVID-19 相关肝损伤得到显著分层。
