Farias João Pedro, Codes Liana, Vinhaes Diana, Amorim Ana Paula, D'Oliveira Ricardo Cruz, Farias Alberto Queiroz, Bittencourt Paulo Lisboa
University of Salvador-Unifacs, Salvador, Bahia, Brazil.
Portuguese Hospital of Bahia, Salvador, Bahia, Brazil.
Transl Gastroenterol Hepatol. 2023 Jan 25;8:5. doi: 10.21037/tgh-22-41. eCollection 2023.
Little is known about the significance of liver function tests (LFT) abnormalities in COVID-19 and their impact on disease outcomes. The aims of the study were to evaluate abnormalities of LFT in patients with COVID-19 and their impact on disease severity, mortality, and correlation with leukocyte markers of inflammation.
All patients with COVID-19 admitted to the emergency department (ED) of a single reference center were retrospectively evaluated. Data were collected using an electronic medical database covering the following variables: demographics, baseline complete blood count (CBC) and ratios, neutrophil-lymphocyte (NLR) and monocyte-lymphocyte ratios (MLR), systemic immune-inflammation index (SII), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Disease severity was defined by the presence of organ failure (OF) or requirement for intensive care unit (ICU) support. Mortality was considered as patient death during hospitalization.
A total of 1,539 subjects (799 women, mean age 57±18 years) with COVID-19 were evaluated. Abnormal AST and/or ALT were seen in 50% of them, with a frequency and magnitude that significantly correlated with leukocyte count and ratios. Both LFT were significantly associated with requirement for hospital and ICU admission and mortality. High AST levels were significantly associated with the presence, number, and types of OFs and in-hospital length of stay (LOS). Elevated ALT was also significantly associated with the aforementioned variables, with the exception of OFs presence, circulatory failure and LOS.
LFT abnormalities are frequently seen in COVID-19 patients, reflect SARS-CoV-2 associated inflammation and may predict adverse outcomes. LFT may be useful to aid decision-making in the ED for hospital admission or scheduled outpatient reevaluation.
关于新型冠状病毒肺炎（COVID-19）患者肝功能检查（LFT）异常的意义及其对疾病预后的影响，目前所知甚少。本研究的目的是评估COVID-19患者的LFT异常情况及其对疾病严重程度、死亡率的影响，以及与炎症白细胞标志物的相关性。
对一家单一参考中心急诊科收治的所有COVID-19患者进行回顾性评估。使用电子医疗数据库收集以下变量的数据：人口统计学资料、基线全血细胞计数（CBC）及比值、中性粒细胞与淋巴细胞比值（NLR）和单核细胞与淋巴细胞比值（MLR）、全身免疫炎症指数（SII）、天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平。疾病严重程度根据是否存在器官衰竭（OF）或是否需要重症监护病房（ICU）支持来定义。死亡率定义为患者住院期间死亡。
共评估了1539例COVID-19患者（799例女性，平均年龄57±18岁）。其中50%的患者出现AST和/或ALT异常，其频率和幅度与白细胞计数及比值显著相关。LFT与住院和入住ICU的需求及死亡率均显著相关。高AST水平与OF的存在、数量和类型以及住院时间（LOS）显著相关。ALT升高也与上述变量显著相关，但OF的存在、循环衰竭和LOS除外。
COVID-19患者中经常出现LFT异常，反映了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关炎症，可能预示不良预后。LFT可能有助于急诊科做出住院或安排门诊复诊的决策。
