Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Ganzhou, China.
Department of Gastroenterology, Ganzhou People's Hospital, Ganzhou, China.
Medicine (Baltimore). 2023 Jul 21;102(29):e34320. doi: 10.1097/MD.0000000000034320.
The coronavirus disease 2019 (COVID-19) is a major public health problem threatening human health. It can lead to multiple system complications, among which liver damage is also a common complication of COVID-19. The pathogenesis of liver injury is complex and involves the interaction of multiple factors. This study aims to investigate the incidence and risk factors of liver injury in COVID-19 patients and analyze the impact of liver injury on clinical prognosis of patients, so as to provide corresponding basis for clinical diagnosis and treatment.
PubMed and Cochrane Library were searched in computer to collect original studies on liver injury cases, laboratory indicators and clinical outcomes in COVID-19 patients. Articles were screened according to inclusion and exclusion criteria, and data were meta-analyzed using Stata12.0 software.
A total of 49 studies, including 23,611 patients with COVID-19, had a prevalence of liver injury of 39.63%. Subgroup analysis found that patients in the Americas had the highest incidence of liver injury at 43.7% and lowest in Africa (25.99%). The vast majority of liver injury is manifested by aminotransferase or bilirubin levels greater than 1 times the upper limit of normal (49.16%). The older the age, the male, the associated chronic liver disease, and the higher the levels of white blood cells, neutrophils, and C-reactive protein, the higher the risk of liver injury. The use of hormones, hydroxychloroquine, and tocilizumab increases the risk of liver injury. Patients with concurrent liver injury have longer hospital stays, are more likely to progress to severe cases, and have a higher risk of death than patients without liver injury.
The incidence of liver injury in COVID-19 patients was high, affected by age, gender, chronic liver disease, inflammatory state and medication, and patients with liver injury were hospitalized longer and were more likely to have a poor prognosis. Therefore, clinical attention should be paid to early intervention.
2019 年冠状病毒病（COVID-19）是威胁人类健康的重大公共卫生问题。它可导致多系统并发症，其中肝损伤也是 COVID-19 的常见并发症。肝损伤的发病机制复杂，涉及多种因素的相互作用。本研究旨在探讨 COVID-19 患者肝损伤的发生率及相关危险因素，并分析肝损伤对患者临床预后的影响，为临床诊断和治疗提供相应依据。
计算机检索 PubMed 和 Cochrane Library 中有关 COVID-19 患者肝损伤病例、实验室指标和临床结局的原始研究，根据纳入和排除标准筛选文献，采用 Stata12.0 软件进行数据荟萃分析。
共纳入 49 项研究，包含 23611 例 COVID-19 患者，肝损伤发生率为 39.63%。亚组分析显示，美洲患者肝损伤发生率最高，为 43.7%，非洲最低，为 25.99%。绝大多数肝损伤表现为转氨酶或胆红素水平大于正常值上限 1 倍（49.16%）。年龄越大、男性、合并慢性肝病，以及白细胞、中性粒细胞和 C 反应蛋白水平越高，肝损伤风险越高。使用激素、羟氯喹和托珠单抗增加肝损伤风险。合并肝损伤的患者住院时间更长，更易进展为重症，死亡风险高于无肝损伤患者。
COVID-19 患者肝损伤发生率较高，受年龄、性别、慢性肝病、炎症状态和药物影响，合并肝损伤的患者住院时间更长，预后更差。因此，临床应重视早期干预。
