Department of Hepatology and Gastroenterology, Service Expert de Lutte contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Institut des Maladies Virales et Hépatiques, Inserm U1110, Strasbourg, France.
Head of Emergency Department, Regenerative Nanomedicine, INSERM UMR 1260 Fédération de Médecine Translationelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, University of Strasbourg, France.
Clin Res Hepatol Gastroenterol. 2022 May;46(5):101894. doi: 10.1016/j.clinre.2022.101894. Epub 2022 Feb 25.
Coronavirus disease 2019 (COVID-19) is a serious public health issue that became rapidly pandemic. Liver injury and comorbidities, including metabolic syndrome, are associated with severe forms of the disease. This study sought to investigate liver injury, clinical features, and risk factors in patients with mild, moderate, and severe COVID-19.
We retrospectively included all consecutive patients hospitalized with laboratory-confirmed COVID-19 between February, 22 and May 15, 2020 at the emergency rooms of a French tertiary hospital. Medical history, symptoms, biological and imaging data were collected.
Among the 1381 hospitalizations for COVID-19, 719 patients underwent liver tests on admission and 496 (68.9%) patients displayed abnormal liver tests. Aspartate aminotransferase was most commonly abnormal in 57% of cases, followed by gamma-glutamyl transferase, alanine aminotransferase, albumin, alkaline phosphatase, and total bilirubin in 56.5%, 35.9%, 18.4%, 11.4%, and 5.8%. The presence of hepatocellular type more than 2xULN was associated with a higher risk of hospitalization and a worse course of severe disease (odd ratio [OR] 5.599; 95%CI: 1.27-23.86; p = 0.021; OR 3.404; 95% CI: 2.12-5.47; p < 0.001, respectively). A higher NAFLD fibrosis score was associated with a higher risk of hospitalization (OR 1.754; 95%CI: 1.27-2.43, p < 0.001). In multivariate analyses, patients with high fibrosis-4 index had a 3-fold greater risk of severe disease (p < 0.001).
Abnormal liver tests are common in patients with COVID-19 and could predict the outcome. Patients with non-alcoholic fatty liver disease and liver fibrosis are at higher risk of progressing to severe COVID-19.
2019 年冠状病毒病（COVID-19）是一个严重的公共卫生问题，迅速成为大流行。肝脏损伤和合并症，包括代谢综合征，与疾病的严重形式有关。本研究旨在探讨轻症、中症和重症 COVID-19 患者的肝脏损伤、临床特征和危险因素。
我们回顾性纳入了 2020 年 2 月 22 日至 5 月 15 日期间在法国一家三级医院急诊室住院的所有经实验室确诊的 COVID-19 连续患者。收集了病史、症状、生物学和影像学数据。
在 1381 例 COVID-19 住院患者中，719 例患者在入院时进行了肝功能检查，496 例（68.9%）患者肝功能检查异常。57%的病例最常见的异常是天门冬氨酸氨基转移酶，其次是γ-谷氨酰转移酶、丙氨酸氨基转移酶、白蛋白、碱性磷酸酶和总胆红素，分别为 56.5%、35.9%、18.4%、11.4%和 5.8%。肝损伤类型超过 2xULN 与住院风险增加和严重疾病病程恶化相关（比值比[OR] 5.599；95%CI：1.27-23.86；p=0.021；OR 3.404；95%CI：2.12-5.47；p<0.001）。较高的非酒精性脂肪性肝病纤维化评分与住院风险增加相关（OR 1.754；95%CI：1.27-2.43，p<0.001）。在多变量分析中，高纤维化-4 指数患者患严重疾病的风险增加 3 倍（p<0.001）。
肝功能异常在 COVID-19 患者中很常见，可预测结局。非酒精性脂肪性肝病和肝纤维化患者发生严重 COVID-19 的风险更高。
