Yao Ruoyu, Xu Guofen, Fu Xiujuan, Zhang Wenrui, Wang Han, Chen Yu, Yao Jia
Department of Gastroenterology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China.
Fourth Department of Liver Disease (Difficult and Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, China.
Front Cell Infect Microbiol. 2025 Jan 10;14:1471974. doi: 10.3389/fcimb.2024.1471974. eCollection 2024.
The impact of coronavirus disease 2019 (COVID-19) on patients with acute-on-chronic liver failure (ACLF) remains unclear. To investigate the clinical characteristics of patients with ACLF complicated with COVID-19 in order to provide evidence for the precise treatment of this patient population.
A total of 34 ACLF patients with COVID-19 admitted to these three hospitals from December 2022 to August 2023 were included as the ACLF+COVID-19 group. Additionally, 34 age-, gender-, etiology-, and Model for End-Stage Liver Disease-Sodium (MELD-Na) score-matched ACLF patients were screened from 286 ACLF patients as the ACLF group. From 382 COVID-19 patients, 34 were selected as the COVID-19 group, matching the ACLF+COVID-19 group in age, gender, and illness severity. Clinical features of these three groups were compared, with the primary measure being the 28-day mortality rate in the ACLF patients and the secondary measures including clinical symptoms, laboratory tests, comorbidities, and complications in three groups.
Compared with the ACLF group, the ACLF+COVID-19 group had significantly higher incidence rates of fever, cough, sputum production, fatigue, and hypoxemia (all p<0.01). Patients in the ACLF+COVID-19 group were more likely to have hepatic encephalopathy (p=0.015), lower platelet count (p=0.016) and elevated IL-6 level (p=0.026), and higher MELD-Na score (p=0.041) one week after admission, but without a significant increase in 28-day mortality rate (p=0.16).
ACLF patients with COVID-19 have increased risk for thrombocytopenia, more obvious inflammatory response, and rapid disease progression 1 week after admission, but the 28-day mortality rate is similar to that of ACLF patients without COVID-19.
2019冠状病毒病（COVID-19）对慢性急性肝衰竭（ACLF）患者的影响尚不清楚。旨在研究合并COVID-19的ACLF患者的临床特征，为该患者群体的精准治疗提供依据。
选取2022年12月至2023年8月在这三家医院收治的34例合并COVID-19的ACLF患者作为ACLF+COVID-19组。此外，从286例ACLF患者中筛选出34例年龄、性别、病因及终末期肝病钠模型（MELD-Na）评分相匹配的ACLF患者作为ACLF组。从382例COVID-19患者中选取34例作为COVID-19组，在年龄、性别和疾病严重程度方面与ACLF+COVID-19组相匹配。比较三组的临床特征，主要指标为ACLF患者的28天死亡率，次要指标包括三组的临床症状、实验室检查、合并症及并发症。
与ACLF组相比，ACLF+COVID-19组发热、咳嗽、咳痰、乏力及低氧血症的发生率显著更高（均p<0.01）。ACLF+COVID-19组患者在入院1周后更易发生肝性脑病（p=0.015）、血小板计数更低（p=0.016）、白细胞介素-6水平升高（p=0.026）及MELD-Na评分更高（p=0.041），但28天死亡率无显著升高（p=0.16）。
合并COVID-19的ACLF患者血小板减少风险增加、炎症反应更明显且入院1周后疾病进展迅速，但28天死亡率与未合并COVID-19的ACLF患者相似。
