Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Endocrinology and Nephrology, Chongqing General Hospital, Chongqing, China.
Ren Fail. 2024 Dec;46(2):2425069. doi: 10.1080/0886022X.2024.2425069. Epub 2024 Nov 18.
There is ample evidence to suggest that patients infected with SARS-CoV-2 Omicron variant may experience liver dysfunction. However, the impact of pre-infection liver function on postinfection mortality rates remains inadequately researched.
Data from 847 hemodialysis (HD) patients, diagnosed with Omicron across six HD centers between December 2022 and February 2023, were analyzed. Initial liver function assessments were conducted, following which patients were monitored for mortality outcomes. The stepwise multivariable Cox regression analysis and receiver operating characteristic (ROC) curves were utilized to identify the predictors of mortality.
From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month postinfection. The deceased patients were observed to be mostly older males with an increased prevalence of diabetes and tumors, signifying higher AST and C-reactive protein levels. These patients also exhibited lower hemoglobin, albumin, and prealbumin levels. An elevated AST [per 1 IU increment; HR 1.04 (95% CI 1-1.04), = 0.026], AST/ALT ratio [per 1 increment; HR 1.52 (95% CI 1.27-2.36), = 0.004], and reduced prealbumin [per 10 mg/L increment; HR 0.93 (95% CI 0.9-0.96), < 0.001] were discovered to be independent indicators of an increased mortality risk. Notably, AST, AST/ALT ratio, and prealbumin proved significant predictors of mortality (AUC values were 0.59, 0.65, and 0.79 respectively).
This study underscores that pre-infection liver function, specifically AST, AST/ALT ratio, and prealbumin levels, substantially influence the mortality rates in HD patients following Omicron infection. Therefore, careful consideration of these liver function parameters could guide superior patient management strategies and potentially decrease mortality rates within this at-risk population.
有充分的证据表明，感染 SARS-CoV-2 奥密克戎变异株的患者可能出现肝功能障碍。然而，对于感染前的肝功能对感染后死亡率的影响，研究还不够充分。
对 2022 年 12 月至 2023 年 2 月期间在 6 家血液透析（HD）中心被诊断为奥密克戎感染的 847 名 HD 患者的数据进行了分析。对患者进行初始肝功能评估，然后监测死亡率结果。采用逐步多变量 Cox 回归分析和受试者工作特征（ROC）曲线来确定死亡率的预测因素。
在总人数中，有 98 人（11.6%）死亡，其中大多数（80/98）在感染后一个月内死亡。死亡患者主要为年龄较大的男性，糖尿病和肿瘤的患病率较高，AST 和 C 反应蛋白水平升高。这些患者的血红蛋白、白蛋白和前白蛋白水平也较低。AST 升高[每增加 1 IU；HR 1.04（95%CI 1-1.04），=0.026]、AST/ALT 比值升高[每增加 1 个单位；HR 1.52（95%CI 1.27-2.36），=0.004]和前白蛋白降低[每增加 10 mg/L；HR 0.93（95%CI 0.9-0.96），<0.001]被发现是死亡风险增加的独立指标。值得注意的是，AST、AST/ALT 比值和前白蛋白是死亡率的显著预测指标（AUC 值分别为 0.59、0.65 和 0.79）。
本研究强调，感染奥密克戎前的肝功能，特别是 AST、AST/ALT 比值和前白蛋白水平，对 HD 患者感染后死亡率有显著影响。因此，仔细考虑这些肝功能参数可以指导更好的患者管理策略，并可能降低这一高危人群的死亡率。
