Liver Diseases Center, Sheba Medical Center.
Sackler Faculty of Medicine, Tel-Aviv University.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e313-e319. doi: 10.1097/MEG.0000000000002048.
The ongoing outbreak of COVID-19 is associated with higher levels of morbidity and mortality among patients with comorbidities, including the metabolic syndrome. Liver impairment has been reported in up to 54% of hospitalized patients with COVID-19. The impact of COVID-19 on a preexisting chronic liver disease is an actively studied area of research. The contribution of our study is towards determining the predictors of severity and the outcome of liver injury among hospitalized patients with COVID-19 infection, including patients with a preexisting liver disease and COVID-19.
This single center retrospective cohort study included all patients ≥18 years, admitted in Sheba Medical Center with confirmed COVID-19 infection. Demographic, clinical and laboratory data were obtained using the MDClone platform and rechecked after data decryption using electronic health records.
Of 382 patients with COVID-19, 66.4% had increased liver biochemistry. Mild increase was observed in 76.7%. The higher level of fibrosis-4 (FIB-4) at admission was independently associated with higher mortality rate. Preexisting liver disease was detected in 15.4% patients. Most common etiology was nonalcoholic fatty liver disease (78.7%). The mortality of hospitalized patients with preexisting liver disease was 16.7% compared to 6.8% in patients without preexisting liver disease (RR = 2.792, P = 0.01). In multivariate analysis, liver disease adjusted to age and BMI was associated with mortality with high statistical significance.
Patients with preexisting chronic liver disease were at a higher risk of mortality. The FIB-4 level at admission was associated with worse prognosis. These findings should be reevaluated in a larger cohort of patients.
COVID-19 持续爆发与合并症患者（包括代谢综合征）的发病率和死亡率升高有关。多达 54%的 COVID-19 住院患者出现肝损伤。COVID-19 对现有慢性肝病的影响是一个正在积极研究的领域。我们的研究旨在确定 COVID-19 感染住院患者（包括患有现有肝病和 COVID-19 的患者）肝损伤严重程度和结局的预测因素。
本单中心回顾性队列研究纳入了所有在谢巴医疗中心住院且确诊 COVID-19 感染的年龄≥18 岁的患者。使用 MDClone 平台获取人口统计学、临床和实验室数据，在对数据进行解密后使用电子健康记录对数据进行再次核对。
在 382 例 COVID-19 患者中，66.4%的患者肝功能生化指标升高。其中 76.7%为轻度升高。入院时较高的纤维化-4 （FIB-4）水平与较高的死亡率独立相关。15.4%的患者存在原有肝脏疾病。最常见的病因是非酒精性脂肪性肝病（78.7%）。与无原有肝脏疾病的患者（6.8%）相比，原有肝脏疾病患者的住院死亡率为 16.7%（RR=2.792，P=0.01）。在多变量分析中，调整年龄和 BMI 后的肝病与死亡率具有高度统计学意义。
患有原有慢性肝脏疾病的患者的死亡率更高。入院时的 FIB-4 水平与预后较差相关。这些发现应在更大的患者队列中进行重新评估。
