Liver Transplantation and Research Center, The 5th Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).
Research Centre for Clinical and Translational Medicine, The 5th Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland).
Med Sci Monit. 2020 Dec 19;26:e928849. doi: 10.12659/MSM.928849.
BACKGROUND Emerging studies noted that liver injury in coronavirus disease 2019 (COVID-19) patients may be induced by virus-mediated inflammation, which was confirmed by liver pathology. The aim of this study was to observe clinical characteristics and explore risk factors in COVID-19 patients with liver injury. MATERIAL AND METHODS In this retrospective study, 40 confirmed COVID-19 patients with normal alanine transaminase (ALT) on admission were divided into a group of normal ALT patients whose ALT was always less than 40 U/l during hospitalization and a group of elevated ALT patients whose ALT was at least once more than 40 U/l after admission. Clinical data, especially virus-induced inflammatory parameters, were analyzed for risk factors and predictive value. The Mann-Whitney U test and t test for comparing means and logistic regression were performed for analysis of risk factors. Area under the ROC curve was used for predictive values. RESULTS Sixteen of 40 (40.0%) patients developed elevated ALT, many of them with more severe COVID-19. The highest ALT level was 101 U/l. The risk factors for liver injury were C-reactive protein (CRP), interleukin 6 (IL6), erythrocyte sedimentation rate (ESR), CD8+T cell count, and severity of disease, and CRP (OR 1.13, 95% CI 1.045-1.222, p=0.002) was the independent risk factor. CONCLUSIONS Liver injury in COVID-19 patients was mild and associated with inflammatory markers, especially CRP, which suggests that liver injury may be induced by virus-mediated inflammation in COVID-19 patients.
新出现的研究表明，新型冠状病毒病 2019（COVID-19）患者的肝损伤可能是由病毒介导的炎症引起的，这已被肝病理所证实。本研究旨在观察 COVID-19 患者肝损伤的临床特征，并探讨其危险因素。
在这项回顾性研究中，将 40 名入院时丙氨酸转氨酶（ALT）正常的确诊 COVID-19 患者分为正常 ALT 组，即入院期间 ALT 一直低于 40U/L 和 ALT 升高组，即入院后至少有一次 ALT 高于 40U/L。分析临床数据，特别是病毒诱导的炎症参数，以确定危险因素和预测价值。采用 Mann-Whitney U 检验和 t 检验比较均值，采用逻辑回归分析危险因素。采用 ROC 曲线下面积评估预测价值。
40 例患者中 16 例（40.0%）发生 ALT 升高，其中许多患者 COVID-19 更为严重。ALT 最高值为 101U/L。肝损伤的危险因素是 C 反应蛋白（CRP）、白细胞介素 6（IL6）、红细胞沉降率（ESR）、CD8+T 细胞计数和疾病严重程度，CRP（OR 1.13，95%CI 1.045-1.222，p=0.002）是独立危险因素。
COVID-19 患者的肝损伤较轻，与炎症标志物有关，尤其是 CRP，提示 COVID-19 患者的肝损伤可能是由病毒介导的炎症引起的。
