Rajbhandari Bibek, Pant Suman, Hamal Achyut B, Thapa Ashish, Shrestha Apurba, Shrestha Saurav, Shrestha Anil, Panta Niranjan, Pandey Udesh, Nepal Mukul Upadhyay, Shilpakar Olita
Department of Emergency Medicine and General Practice, Nepal Police Hospital.
Nepal Health Research Council.
Ann Med Surg (Lond). 2023 May 3;85(6):2522-2527. doi: 10.1097/MS9.0000000000000767. eCollection 2023 Jun.
Liver impairment has been reported as a common clinical manifestation in patients with Severe Acute Respiratory Syndrome Coronavirus 2 infection, with varying degrees of severity ranging from a mild elevation of liver enzymes to acute liver failure. However, the prevalence and clinical significance of liver injury in Coronavirus Disease 2019 (COVID-19) patients, particularly in low- and middle-income countries such as Nepal, remains poorly understood. To investigate the hepatic injury related to this disease and its clinical significance, the authors conducted a retrospective study that included adult patients with COVID-19 infection in security hospitals of Nepal.
The authors performed a retrospective chart review on 1007 COVID-19-positive patients who underwent a liver function test during their admission in two COVID-19 dedicated hospitals in Nepal from April 2021 to January 2022. The data were collected and entered into Microsoft Excel before being exported to SPSS version 24 for analysis. Univariate and multivariate logistic regression were used to determine factors associated with liver injury. We reported adjusted odds ratios (aOR) with 95% CI.
Of the total, 549 (54.5%) patients had an acute liver injury. Among 549 patients, 68.1% were mild, 27.9% were moderate, and 5.0% were severe. Out of 1007 patients, 1.4% had cholestatic liver injury. Most patients with mild, moderate, and severe liver injury had greater than or equal to 10 C-reactive proteins (CRP). In multivariate logistic regression, sex, and CRP were significantly associated with the presence of liver injury. Males had 1.78 times higher odds of having a liver injury compared to females (aOR:1.78; 95% CI: 1.37-2.30, -value:<0.001). Similarly, patients who had CRP greater than 10 had higher odds of having liver injury compared to those who had CRP less than 10 (aOR: 1.84; 95% CI: 1.41-2.39; -value: <0.001).
The present study reveals that COVID-19 infection is commonly associated with mild increased liver enzymes. However, the likelihood of developing acute liver injury was found to be higher in patients with an inflammatory state indicated by CRP levels greater than 10. Furthermore, the study highlights the sex-based difference in the prevalence of liver injury, with males demonstrating a higher predisposition.
据报道，肝损伤是严重急性呼吸综合征冠状病毒2感染患者的常见临床表现，严重程度各不相同，从肝酶轻度升高到急性肝衰竭。然而，2019冠状病毒病（COVID-19）患者肝损伤的患病率及其临床意义，尤其是在尼泊尔等低收入和中等收入国家，仍知之甚少。为了调查与该疾病相关的肝损伤及其临床意义，作者进行了一项回顾性研究，纳入了尼泊尔安全医院的成年COVID-19感染患者。
作者对2021年4月至2022年1月期间在尼泊尔两家COVID-19专科医院住院期间接受肝功能检查的1007例COVID-19阳性患者进行了回顾性病历审查。数据收集后录入Microsoft Excel，然后导出到SPSS 24版进行分析。单因素和多因素逻辑回归用于确定与肝损伤相关的因素。我们报告了调整后的比值比（aOR）及95%置信区间。
总共有549例（54.5%）患者发生急性肝损伤。在549例患者中，68.1%为轻度，27.9%为中度，5.0%为重度。在1007例患者中，1.4%发生胆汁淤积性肝损伤。大多数轻度、中度和重度肝损伤患者的C反应蛋白（CRP）水平大于或等于10。在多因素逻辑回归中，性别和CRP与肝损伤的存在显著相关。男性发生肝损伤的几率是女性的1.78倍（aOR：1.78；95%置信区间：1.37-2.30，P值：<0.001）。同样，CRP大于10的患者发生肝损伤的几率高于CRP小于10的患者（aOR：1.84；95%置信区间：1.41-2.39；P值：<0.001）。
本研究表明，COVID-19感染通常与肝酶轻度升高有关。然而，发现CRP水平大于10所表明的炎症状态患者发生急性肝损伤的可能性更高。此外，该研究突出了肝损伤患病率的性别差异，男性表现出更高的易感性。
