Altaf Abeer, Abbas Zaigham, Mandviwalla Haider A, Qadeer Muhammad Ali, Siyal Mehreen, Tariq Mahnoor, Ghafoor Asmara, Karamat Muniba, Shahid Bushra, Ali Mahnoor
Gastroenterology and Hepatology, Dr. Ziauddin Hospital, Karachi, PAK.
Internal Medicine, Dr. Ziauddin Hospital, Karachi, PAK.
Cureus. 2021 Apr 26;13(4):e14705. doi: 10.7759/cureus.14705.
Coronavirus disease 2019 (COVID-19) is known to disturb liver function tests (LFTs). Not much literature is available regarding the effect of COVID-19 on LFTs in patients without preexisting liver disease. The study aimed to find the effect of COVID-19 in these patients.
This was a single-center, observational study with 142 patients who were admitted with COVID-19 during three months. Seven patients were excluded due to the presence of chronic liver disease. Results: A total of 135 patients were included in the study aged between 18 and 95 years (mean 57.7 ± 15.6); among them, 93 were males (68.9%). Hypertension was present in 74 patients (54.8%), and diabetes was present in 48 patients (35.6%). Fever was the chief complaint in 112 patients (83%), followed by dyspnea in 93 patients (68.9%) and cough in 79 patients (58.5%). Elevated aspartate aminotransferase (AST) was seen in 35 patients (26%), gamma-glutamyl transferase (GGT) in 43 patients (32%), alanine transaminase (ALT) in 18 patients (24%), alkaline phosphatase in 19 patients (14%), bilirubin in six patients (4%), and low albumin in 27 patients (20%). Severe COVID-19, when compared with mild to moderate disease, was associated with elevated AST > two-time upper limit normal (2ULN) (p = 0.002), GGT > 2ULN (0.026), and lower albumin (p = 0.020), higher systemic inflammatory response syndrome (SIRS) (0.045), raised procalcitonin (p = 0.045), higher ferritin (p = 0.005), lower pO2 (p = 0.044), and higher Sequential Organ Failure Assessment score (SOFA) (p = 0.002) pointing to the inflammatory response as cause of liver injury. Factors predicting mortality with COVID-19 were assessed, which showed that direct bilirubin (p = 0.001), low albumin (p = 0.013), tachypnea (0.002), and leukocytosis (<0.001) were independently associated with increased COVID-19-related mortality.
Patients suffering from COVID-19 have evidence of liver injury, which appears to be secondary to an inflammatory response that correlates with the severity of COVID-19.
已知2019冠状病毒病（COVID-19）会干扰肝功能检查（LFTs）。关于COVID-19对无既往肝病患者LFTs的影响，现有文献不多。本研究旨在探究COVID-19对这些患者的影响。
这是一项单中心观察性研究，纳入了三个月内收治的142例COVID-19患者。7例因患有慢性肝病被排除。结果：共135例患者纳入研究，年龄在18至95岁之间（平均57.7±15.6岁）；其中，93例为男性（68.9%）。74例患者（54.8%）患有高血压，48例患者（35.6%）患有糖尿病。112例患者（83%）以发热为主诉，其次是93例患者（68.9%）出现呼吸困难，79例患者（58.5%）出现咳嗽。35例患者（26%）天门冬氨酸氨基转移酶（AST）升高，43例患者（32%）γ-谷氨酰转移酶（GGT）升高，18例患者（24%）丙氨酸氨基转移酶（ALT）升高，19例患者（14%）碱性磷酸酶升高，6例患者（4%）胆红素升高，27例患者（20%）白蛋白降低。与轻度至中度疾病相比，重症COVID-19患者AST>两倍正常上限（2ULN）（p = 0.002）、GGT>2ULN（0.026）、白蛋白降低（p = 0.020）、全身炎症反应综合征（SIRS）升高（0.045）、降钙素原升高（p = 0.045）、铁蛋白升高（p = 0.005）、动脉血氧分压降低（p = 0.044）以及序贯器官衰竭评估（SOFA）评分升高（p = 0.002），提示炎症反应是肝损伤的原因。评估了预测COVID-19患者死亡率的因素，结果显示直接胆红素（p = 0.001）、低白蛋白（p = 0.013）、呼吸急促（0.002）和白细胞增多（<0.001）与COVID-19相关死亡率增加独立相关。
COVID-19患者有肝损伤证据，这似乎是继发于与COVID-19严重程度相关的炎症反应。
