Krishnasamy Narayanasamy, Rajendran Karthick, Barua Parimita, Ramachandran Arunkumar, Panneerselvam Priyadarshini, Rajaram Muthukumaran
Institute of Hepatobiliary Sciences, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
Multidisciplinary Research Unit (MRU), Madras Medical College, Chennai, Tamil Nadu, India.
J Clin Transl Hepatol. 2022 Feb 28;10(1):120-127. doi: 10.14218/JCTH.2020.00100. Epub 2021 Jun 16.
Liver enzyme abnormalities in coronavirus 2019 (COVID-19) are being addressed in the literature. The predictive risk of elevated liver enzymes has not been established for COVID-19 mortality. In this study, we hypothesized that elevated liver enzymes at admission can predict the outcome of COVID-19 disease with other known indicators, such as comorbidities.
This retrospective study included all the consecutive hospitalized patients with confirmed COVID-19 disease from March 4 to May 31, 2020. The study was conducted in Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. We assessed demography, clinical variables, COVID-19 severity, laboratory parameters, and outcome.
We included 1,512 patients, and median age was 47 years (interquartile range: 34-60) with 36.9% being female. Liver enzyme level (aspartate aminotransferase and/or alanine aminotransferase) was elevated in 450/1,512 (29.76%) patients. Comorbidity was present in 713/1,512 (47.16%) patients. Patients with liver enzymes' elevation and presence of comorbidity were older, more frequently hospitalized in ICU and had more severe symptoms of COVID-19 at the time of admission. Presence of liver enzymes' elevation with comorbidity was a high risk factor for death (OR: 5.314, 95% CI: 2.278-12.393), as compared to patients with presence of comorbidity (OR: 4.096, 95% CI: 1.833-9.157).
Comorbidity combined with liver enzymes' elevation at presentation independently increased the risk of death in COVID-19 by at least 5-fold.
2019冠状病毒病（COVID-19）中的肝酶异常问题已有文献报道。肝酶升高对COVID-19死亡率的预测风险尚未明确。在本研究中，我们假设入院时肝酶升高可与其他已知指标（如合并症）一起预测COVID-19疾病的转归。
这项回顾性研究纳入了2020年3月4日至5月31日期间所有连续住院的确诊COVID-19患者。研究在印度泰米尔纳德邦金奈的拉吉夫·甘地政府综合医院进行。我们评估了人口统计学、临床变量、COVID-19严重程度、实验室参数和转归情况。
我们纳入了1512例患者，中位年龄为47岁（四分位间距：34 - 60岁），女性占36.9%。450/1512（29.76%）例患者肝酶水平（天冬氨酸转氨酶和/或丙氨酸转氨酶）升高。713/1512（47.16%）例患者存在合并症。肝酶升高且有合并症的患者年龄更大，更频繁入住重症监护病房，入院时COVID-19症状更严重。与有合并症的患者相比，肝酶升高合并合并症是死亡的高风险因素（比值比：5.314，95%置信区间：2.278 - 12.393），有合并症的患者比值比为4.096（95%置信区间：1.833 - 9.157）。
合并症与就诊时肝酶升高共同作用使COVID-19患者死亡风险至少增加5倍。
