Grigoras Mirela Loredana, Citu Ioana Mihaela, Citu Cosmin, Chiriac Veronica Daniela, Gorun Florin, Levai Mihaela Codrina, Manolescu Diana, Rosca Ovidiu, Bratosin Felix, Gurumurthy Srivathsava, Wulandari Prima Hapsari, Cretu Octavian Marius
Department of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
J Clin Med. 2022 Aug 31;11(17):5149. doi: 10.3390/jcm11175149.
Several investigations have revealed that COVID-19 causes a significant death rate due to acute respiratory distress syndrome, alterations in the quantity of ACE2 receptor expression, or the intensity of cytokine storm. Similarly, patients with hepatic impairment that are co-infected with SARS-CoV-2 are more likely to display upregulations of ACE2 receptors and cytokine storm overload, which exacerbates hepatic impairment, potentially increasing the death rate. Moreover, it is expected that the aging population develops a higher degree of hepatic fibrosis in association with other comorbid conditions that are likely to influence the course of COVID-19. Therefore, this research was developed to describe the differences in liver test parameters in elderly individuals with COVID-19 in relation to other inflammatory markers and outcomes. This current observational single-center research followed a case-control design of elderly patients hospitalized for SARS-CoV-2 infection. The research was conducted at a tertiary emergency hospital in western Romania during a two-year period. There were 632 patients included in the analysis that were split into two equal groups matched 1:1 based on gender and body mass index. Three hundred sixteen patients made the group of cases with COVID-19 patients older than 65 years, while the other half were the 316 patient controls with COVID-19 that were younger than 65 years old. Disease outcomes showed a higher prevalence of ICU admissions (22.8% vs. 12.7%, p-value < 0.001) and in-hospital mortality (17.1% vs. 8.9%, p-value = 0.002) in the group of cases. Specific and non-specific liver biomarkers were identified as risk factors for mortality in the elderly, such as ALP (OR = 1.26), LDH (OR = 1.68), AST (OR = 1.98), and ALT (OR = 2.34). Similarly, patients with APRI and NFS scores higher than 1.5 were, respectively, 2.69 times and, 3.05 times more likely to die from COVID-19, and patients with FIB-4 scores higher than 3.25 were 3.13 times more likely to die during hospitalization for SARS-CoV-2 infection. Our research indicates that abnormally increased liver biomarkers and high liver fibrosis scores are related to a worse prognosis in SARS-CoV-2 infected individuals.
多项调查显示，新型冠状病毒肺炎（COVID-19）由于急性呼吸窘迫综合征、血管紧张素转换酶2（ACE2）受体表达量的改变或细胞因子风暴的强度而导致显著的死亡率。同样，合并感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的肝功能损害患者更有可能出现ACE2受体上调和细胞因子风暴过载，这会加剧肝功能损害，可能会增加死亡率。此外，预计老年人群会出现更高程度的肝纤维化，并伴有其他可能影响COVID-19病程的合并症。因此，开展本研究以描述COVID-19老年患者的肝功能检查参数与其他炎症标志物及转归之间的差异。这项当前的观察性单中心研究采用了因SARS-CoV-2感染住院的老年患者的病例对照设计。该研究在罗马尼亚西部的一家三级急诊医院进行，为期两年。纳入分析的632例患者被分为两组，根据性别和体重指数按1:1匹配，每组人数相等。316例患者构成年龄大于65岁的COVID-19病例组，另一半是316例年龄小于65岁的COVID-19患者对照组。疾病转归显示，病例组入住重症监护病房（ICU）的患病率更高（22.8%对12.7%，p值<0.001），院内死亡率更高（17.1%对8.9%，p值=0.002）。特异性和非特异性肝脏生物标志物被确定为老年人死亡的危险因素，如碱性磷酸酶（ALP，比值比[OR]=1.26）、乳酸脱氢酶（LDH，OR=1.68）、天门冬氨酸氨基转移酶（AST，OR=1.98）和丙氨酸氨基转移酶（ALT，OR=2.34）。同样，天冬氨酸氨基转移酶与血小板比值指数（APRI）和纤维化-4（FIB-4）评分高于1.5的患者死于COVID-19的可能性分别是正常患者的2.69倍和3.05倍，FIB-4评分高于3.25的患者在因SARS-CoV-2感染住院期间死亡的可能性是正常患者的3.13倍。我们的研究表明，肝脏生物标志物异常升高和高肝纤维化评分与SARS-CoV-2感染个体的预后较差有关。
