Hepatic Surgery Center, and Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
J Hepatol. 2021 Jun;74(6):1295-1302. doi: 10.1016/j.jhep.2020.12.012. Epub 2020 Dec 19.
BACKGROUND & AIMS: The evolution and clinical significance of abnormal liver chemistries and the impact of hepatitis B infection on outcome in patients with COVID-19 is not well characterized. This study aimed to explore these issues.
This large retrospective cohort study included 2,073 patients with coronavirus disease 2019 (COVID-19) and definite outcomes in Wuhan, China. Longitudinal liver function tests were conducted, with associated factors and risk of death determined by multivariate regression analyses. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. The characteristics of liver abnormalities and outcomes of patients with COVID-19, with and without hepatitis B, were compared after 1:3 propensity score matching.
Of the 2,073 patients, 1,282 (61.8%) had abnormal liver chemistries during hospitalization, and 297 (14.3%) had a liver injury. The mean levels of aspartate aminotransferase (AST) and direct bilirubin (D-Bil) increased early after symptom onset in deceased patients and showed disparity compared to levels in discharged patients throughout the clinical course of the disease. Abnormal AST (adjusted hazard ratio [HR] 1.39; 95% CI 1.04-1.86, p = 0.027) and D-Bil (adjusted HR 1.66; 95% CI 1.22-2.26; p = 0.001) levels at admission were independent risk factors for mortality due to COVID-19. A nomogram was established based on the results of multivariate analysis and showed sufficient discriminatory power and good consistency between the prediction and the observation. HBV infection in patients did not increase the risk of poor COVID-19-associated outcomes.
Abnormal AST and D-Bil levels at admission were independent predictors of COVID-19-related mortality. Therefore, monitoring liver chemistries, especially AST and D-Bil levels, is necessary in hospitalized patients with COVID-19.
Liver test abnormalities (in particular elevations in the levels of aspartate aminotransferase [AST] and direct bilirubin [D-Bil]) were observed after symptom onset in patients who went on to die of coronavirus disease 2019 (COVID-19). Abnormal levels of AST and D-Bil at admission were independent predictors of COVID-19-related mortality. HBV infection in patients did not increase the risk of poor COVID-19-associated outcomes.
乙型肝炎病毒（HBV）感染对新型冠状病毒肺炎（COVID-19）患者结局的影响及其导致的肝功能异常的演变和临床意义尚不清楚。本研究旨在探讨这些问题。
这是一项在中国武汉进行的大型回顾性队列研究，共纳入 2073 例 COVID-19 确诊患者。对患者进行了多次肝功能检测，采用多变量回归分析确定相关因素和死亡风险。制定了一个预后列线图来预测 COVID-19 患者的生存率。在 1:3 倾向评分匹配后，比较了 COVID-19 患者伴或不伴 HBV 感染时的肝功能异常特征和结局。
2073 例患者中，1282 例（61.8%）住院期间肝功能异常，297 例（14.3%）发生肝损伤。死亡患者在症状出现后早期即出现天门冬氨酸氨基转移酶（AST）和直接胆红素（D-Bil）水平升高，与疾病整个临床过程中出院患者的水平相比存在差异。异常 AST（校正后的危险比 [HR] 1.39；95%CI 1.04-1.86，p=0.027）和 D-Bil（校正 HR 1.66；95%CI 1.22-2.26；p=0.001）水平是 COVID-19 死亡的独立危险因素。根据多变量分析结果建立了一个列线图，该列线图具有足够的区分能力，且预测值与观察值之间具有良好的一致性。HBV 感染并未增加 COVID-19 相关不良结局的风险。
入院时异常 AST 和 D-Bil 水平是 COVID-19 相关死亡的独立预测因素。因此，在 COVID-19 住院患者中，有必要监测肝功能，尤其是 AST 和 D-Bil 水平。
在 COVID-19 患者中，在出现症状后观察到肝功能异常（尤其是天门冬氨酸氨基转移酶[AST]和直接胆红素[D-Bil]水平升高）。入院时 AST 和 D-Bil 水平异常是 COVID-19 相关死亡的独立预测因素。HBV 感染并未增加 COVID-19 相关不良结局的风险。
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