Matsumoto Kengo, Nishida Tsutomu, Nakamatsu Dai, Yamamoto Masashi, Fukui Koji, Morimura Osamu, Abe Kinya, Okauchi Yukiyoshi, Iwahashi Hiromi, Inada Masami
Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka 560-8565, Osaka, Japan.
Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka 560-8565, Osaka, Japan.
Clin Pract. 2024 Aug 20;14(4):1601-1614. doi: 10.3390/clinpract14040129.
The prognostic significance of liver dysfunction in COVID-19 patients remains unclear. In this study, we investigated the association between liver function test results and severe disease progression in COVID-19 patients.
This retrospective study included consecutive Japanese COVID-19 patients admitted between February 2020 and July 2021. Predictive variables for severe disease progression were identified by multivariate logistic regression analysis. Severe disease-free survival was estimated with the Kaplan-Meier method and Cox regression analysis. Aspartate aminotransferase (AST) was divided into three grades: grade 1, AST < 30 U/L; grade 2, 30 U/L ≤ AST < 60 U/L; and grade 3, AST > 60 U/L.
Among 604 symptomatic patients, 141 (23.3%) developed severe disease at a median of 2 days postadmission. The median hospital stay was 10 days, and 43 patients (7.1%) died during hospitalization. Multivariate regression analysis revealed that hypertension, decreased lymphocyte count, and elevated LDH, CRP, and AST levels (grade 2 and grade 3 relative to grade 1) were the significant predictive variables. Severe disease-free survival time was significantly different between the different AST grades (hazard ratio (HR): grade 2 vs. grade 1, 4.07 (95% confidential interval (CI): 2.06-8.03); grade 3 vs. grade 1, 7.66 (95% CI: 3.89-15.1)).
The AST level at admission was an independent risk factor for severe disease in hospitalized Japanese patients with COVID-19.
新型冠状病毒肺炎（COVID-19）患者肝功能障碍的预后意义尚不清楚。在本研究中，我们调查了COVID-19患者肝功能检查结果与严重疾病进展之间的关联。
这项回顾性研究纳入了2020年2月至2021年7月期间连续收治的日本COVID-19患者。通过多因素逻辑回归分析确定严重疾病进展的预测变量。采用Kaplan-Meier法和Cox回归分析评估无严重疾病生存期。天冬氨酸转氨酶（AST）分为三个等级：1级，AST<30 U/L；2级，30 U/L≤AST<60 U/L；3级，AST>60 U/L。
在604例有症状的患者中，141例（23.3%）在入院后中位2天出现严重疾病。中位住院时间为10天，43例（7.1%）患者在住院期间死亡。多因素回归分析显示，高血压、淋巴细胞计数减少以及乳酸脱氢酶（LDH）、C反应蛋白（CRP）和AST水平升高（2级和3级相对于1级）是显著的预测变量。不同AST等级之间的无严重疾病生存期有显著差异（风险比（HR）：2级与1级，4.07（95%置信区间（CI）：2.06-8.03）；3级与1级，7.66（95%CI：3.89-15.1））。
入院时的AST水平是日本住院COVID-19患者发生严重疾病的独立危险因素。
