UGC de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, España.
Aparato Digestivo, Hospital Universitario Virgen del Rocio, España.
Rev Esp Enferm Dig. 2021 Feb;113(2):125-135. doi: 10.17235/reed.2020.7397/2020.
SARS-CoV-2 is mainly a respiratory virus that has relevant systemic effects. We assessed the impact of baseline liver function (aspartate aminotransferase [AST], alanine aminotransferase [ALT], bilirubin) on COVID-19-related outcomes, including mortality, intensive care unit (ICU) admissions, and non-fatal severe complications.
after a systematic review of the relevant studies the odds ratio (OR), mean difference, sensitivity, specificity, and both positive and negative likelihood ratios were calculated for the prediction of relevant COVID-19 outcomes by performing a meta-analysis using fixed and random effects models. A Fagan nomogram was used to assess clinical usefulness. Heterogeneity was explored by sensitivity analysis and univariate meta-regression.
twenty-six studies were included (22 studies and 5,271 patients for AST, 20 studies and 5,440 subjects for ALT, and nine studies and 3,542 patients for bilirubin). The outcomes assessed by these studies were: survival (n = 8), ICU admission (n = 4), and non-fatal severe complications (n = 16). AST > upper limit of normal (ULN) (OR: 3.10 [95 % CI, 2.61-3.68]), ALT > ULN (OR: 2.15 [95 % CI, 1.43-3.23]), and bilirubin > ULN (OR: 2.78 [95 % CI, 1.88-4.13]) were associated with an increased prevalence of severe complications with a specificity of 78 %, 77 %, and 94 %, respectively. The mean difference between mild and severe COVID-19 was 10.7 U/l (95 % CI, 5.8-15.6) for AST, 8 U/l (95 % CI, 1.0-15) for ALT, and 0.3 mg/dl (95 % CI, 0.16-0.45) for bilirubin.
patients showing liver injury had a significantly higher risk of developing severe COVID-19 as compared to those with normal liver function tests at admission. We should include the assessment of AST, ALT, and total bilirubin (TB) routinely in the workup of patients affected by SARS-CoV-2 in order to predict those at risk of developing COVID-19-related outcomes.
SARS-CoV-2 主要是一种呼吸道病毒，它具有相关的全身效应。我们评估了基线肝功能（天冬氨酸氨基转移酶[AST]、丙氨酸氨基转移酶[ALT]、胆红素）对 COVID-19 相关结局的影响，包括死亡率、重症监护病房（ICU）入院和非致命性严重并发症。
通过系统回顾相关研究，使用固定和随机效应模型进行荟萃分析，计算预测 COVID-19 相关结局的比值比（OR）、均数差、灵敏度、特异性以及阳性和阴性似然比。使用 Fagan 列线图评估临床有用性。通过敏感性分析和单变量荟萃回归探索异质性。
共纳入 26 项研究（22 项研究，5271 例患者 AST，20 项研究，5440 例患者 ALT，9 项研究，3542 例患者胆红素）。这些研究评估的结局包括：生存（n=8）、ICU 入院（n=4）和非致命性严重并发症（n=16）。AST>正常值上限（ULN）（OR：3.10[95%CI，2.61-3.68]）、ALT>ULN（OR：2.15[95%CI，1.43-3.23]）和胆红素>ULN（OR：2.78[95%CI，1.88-4.13]）与严重并发症的发生率增加相关，特异性分别为 78%、77%和 94%。AST 轻度和重度 COVID-19 之间的平均差值为 10.7U/L（95%CI，5.8-15.6），ALT 为 8U/L（95%CI，1.0-15），总胆红素（TB）为 0.3mg/dl（95%CI，0.16-0.45）。
与入院时肝功能正常的患者相比，肝功能受损的患者发生严重 COVID-19 的风险显著增加。我们应该在 SARS-CoV-2 患者的常规检查中纳入 AST、ALT 和总胆红素（TB）的评估，以预测发生 COVID-19 相关结局的风险。
