Rajaram Ruveena Bhavani, Jayaraman Thevaraajan, Khoo Xin-Hui, Saravanaa Nalliah, Kukreja Anjanna, Johari Bushra Megat, Fareeda Muhammad Gowdh Nadia, Lee Wai-Kin, Sooi Choong-Yeong, Basri Sazali, Ng Rong-Xiang, Ong Hang-Cheng, Wong Pui-Li, Syed Omar Sharifah Faridah, Mahadeva Sanjiv
Gastroenterology Unit, Medical Department Universiti Malaya Medical Centre Kuala Lumpur Malaysia.
Gastroenterology Unit, Department of Medicine, Faculty of Medicine Universiti Teknologi MARA Sungai Buloh Malaysia.
JGH Open. 2024 Aug 7;8(8):e13118. doi: 10.1002/jgh3.13118. eCollection 2024 Aug.
Abnormal liver biochemistry (ALB) is common among patients with COVID-19 infection due to various factors. It is uncertain if it persists after the acute infection. We aimed to investigate this.
A multicenter study of adult patients hospitalized for COVID-19 infection, with at least a single abnormal liver function test, was conducted. Detailed laboratory and imaging tests, including transabdominal ultrasound and FibroScan, were performed at assessment and at 6-month follow-up after hospital discharge.
From an initial cohort of 1246 patients who were hospitalized, 731 (58.7%) had ALB. A total of 174/731 patients fulfilled the inclusion criteria with the following characteristics: 48.9% patients had severe COVID-19; 62.1% had chronic liver disease (CLD); and 56.9% had metabolic-associated fatty liver disease (MAFLD). ALB was predominantly of a mixed pattern (67.8%). Among those (55.2%) who had liver injury (aspartate aminotransferase/alanine aminotransferase >3 times the upper limit of normal, or alkaline phosphatase/γ-glutamyl transferase/bilirubin >2 times the upper limit of normal), a mixed pattern was similarly predominant. Approximately 52.3% had normalization of the liver lunction test in the 6-month period post discharge. Patients with persistent ALB had significantly higher mean body mass index (BMI) and serum low-density lipoprotein (LDL), higher rates of MAFLD and CLD, higher mean liver stiffness measurement and continuous attenuated parameter score on FibroScan, and higher rates of liver injury on univariate analysis. Multivariate analysis was not statistically significant.
Approximately 47.7% of COVID-19 patients were found to have persistent ALB up to 6 months following the acute infection, and it was associated with raised BMI, elevated serum LDL, increased rates of MAFLD and CLD, and higher rates of liver injury on univariate analysis, but not on multivariate analysis.
由于多种因素，新冠病毒感染患者中肝生化指标异常（ALB）较为常见。急性感染后其是否持续尚不确定。我们旨在对此进行研究。
对因新冠病毒感染住院且至少有一次肝功能检查异常的成年患者进行了一项多中心研究。在评估时以及出院后6个月随访时进行了详细的实验室和影像学检查，包括经腹超声和FibroScan。
在最初住院的1246例患者中，731例（58.7%）有ALB。共有174/731例患者符合纳入标准，具有以下特征：48.9%的患者患有重症新冠；62.1%患有慢性肝病（CLD）；56.9%患有代谢相关脂肪性肝病（MAFLD）。ALB主要为混合模式（67.8%）。在那些有肝损伤的患者中（天冬氨酸转氨酶/丙氨酸转氨酶>正常上限3倍，或碱性磷酸酶/γ-谷氨酰转移酶/胆红素>正常上限2倍），混合模式同样占主导。约52.3%的患者在出院后6个月内肝功能检查恢复正常。持续存在ALB的患者在单因素分析中平均体重指数（BMI）和血清低密度脂蛋白（LDL）显著更高，MAFLD和CLD的发生率更高，FibroScan检查时平均肝脏硬度测量值和连续衰减参数评分更高，肝损伤发生率更高。多因素分析无统计学意义。
在急性感染后长达6个月的时间里，约47.7%的新冠患者被发现存在持续性ALB，且在单因素分析中其与BMI升高、血清LDL升高、MAFLD和CLD发生率增加以及肝损伤发生率更高有关，但在多因素分析中并非如此。
