Department of Medicine, National University Health System, Singapore.
Department of Cardiology, National University Heart Centre Singapore, Singapore.
Medicine (Baltimore). 2021 Jul 30;100(30):e26719. doi: 10.1097/MD.0000000000026719.
Liver dysfunction in patients with COVID-19 (coronavirus disease 2019) has been described. However, it is not clear if the presence of abnormal liver function tests at presentation was related to underlying undiagnosed liver disease, or a result of the viral infection.We retrospectively examined the first 554 consecutive polymerase chain reaction positive SARS-CoV-2 patients admitted from February 2020 to April 2020 to our academic medical centre. We reviewed their clinical data, chest radiography and laboratory studies obtained within 24 hour of admission.Despite similar hemodynamic parameters, we found significant aspartate transaminase elevation (64 ± 141 vs 35 ± 23 U/L, P < .001) in those with pneumonia compared to those without. Elevated liver enzymes were seen in 102 patients (18.4%). They presented with higher temperatures (38.5 ± 0.9 vs 37.5 ± 0.8 degC, P = .011), higher total white cell counts (6.95 ± 2.29 vs 6.39 ± 2.19 x109/L, P = .021), serum ferritin (240 ± 274 vs 165 ± 198 ng/ml, P = .002) and lactate dehydrogenase (632 ± 912 vs 389 ± 107 U/L, P < .001). These patients were more likely to require intensive care (6.9% vs 2.7% P = .036) and mechanical ventilation (5.9% vs 2.2%, P = .046). Migrant workers from dormitories had a higher rate of baseline liver function test abnormalities (88/425 vs 14/129, P = .01), which were more likely to persist at the time of discharge.Despite relatively mild COVID-19 disease, there was a significant prevalence of liver dysfunction, particularly amongst migrant workers. Elevated liver enzymes were associated with more severe disease, despite similar haemodynamic characteristics. Future studies should explore whether pre-existing liver disease may predispose to more severe COVID-19 disease.
尽管 COVID-19 患者存在肝功能异常的情况，但目前尚不清楚患者在就诊时的肝功能异常是由未确诊的基础肝病引起的，还是由病毒感染引起的。我们回顾性地检查了 2020 年 2 月至 4 月期间我院收治的前 554 名连续聚合酶链反应阳性 SARS-CoV-2 患者的临床资料、入院 24 小时内的胸部 X 线和实验室研究结果。尽管血流动力学参数相似，但我们发现肺炎患者的天门冬氨酸转氨酶显著升高（64±141 vs 35±23 U/L，P<0.001）。102 例（18.4%）患者出现肝酶升高。这些患者的体温较高（38.5±0.9 vs 37.5±0.8℃，P=0.011），总白细胞计数较高（6.95±2.29 vs 6.39±2.19×109/L，P=0.021），血清铁蛋白（240±274 vs 165±198 ng/ml，P=0.002）和乳酸脱氢酶（632±912 vs 389±107 U/L，P<0.001）较高。这些患者更有可能需要入住重症监护病房（6.9% vs 2.7%，P=0.036）和机械通气（5.9% vs 2.2%，P=0.046）。来自宿舍的农民工基础肝功能检查异常率较高（425 例中有 88 例 vs 129 例中有 14 例，P=0.01），且在出院时肝功能异常更有可能持续存在。尽管 COVID-19 病情相对较轻，但仍有相当高的肝功能障碍患病率，特别是在农民工中。尽管血液动力学特征相似，但肝酶升高与更严重的疾病相关。未来的研究应该探讨是否预先存在的肝病可能使 COVID-19 病情恶化。
