Foroghi Biland Luca, Di Lorenzo Andrea, De Maria Francesco, Muratore Gianmarco, Compagno Mirko, Campogiani Laura, Coppola Luigi, Teti Elisabetta, Malagnino Vincenzo, Iannetta Marco, Sarmati Loredana
Department of System Medicine, Tor Vergata University, Rome, Italy.
Unit of Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy.
J Viral Hepat. 2025 Jul;32(7):e70039. doi: 10.1111/jvh.70039.
A liver involvement in Coronavirus disease 19 (COVID-19) has been frequently observed in patients hospitalised for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection during 2020; in such cases, the clinical and prognostic relevance of hepatocellular damage has been widely acknowledged. On the other hand, there is less extensive evidence of liver injury (LI) in the subsequent waves of the COVID-19 pandemic. The aim of this study was to assess the prevalence of LI and to determine the clinical, biochemical, and immune-virologic characteristics associated with its development in SARS-CoV-2-positive patients hospitalised in 2021-2022. This single-centre retrospective study included 455 patients with confirmed SARS-CoV-2 infection and respiratory failure. LI was defined by the detection of transaminase levels exceeding three times the upper limit of normality (ULN) and was further classified as early or late liver injury based on whether the peak transaminase value occurred within or after 7 days from hospital admission. LI was found in 17.6% (80/455) of the overall cohort, while early liver injury (ELI) and late liver injury (LLI) were detected in 10.4% and 11.5%, respectively. LI was associated with younger age, elevated inflammatory and tissue damage markers, with the presence of chronic liver disease (CLD), and with the use of interleukin-6 (IL-6) inhibitors. Patients with LI had a higher probability of severe COVID-19, transfer to intensive care unit, and in-hospital death than those without. In multivariable analysis, younger age, administration of IL-6 inhibitors, and the presence of higher gammaglutamyl transferase (GGT) levels were independently related to the development of overall LI, whereas in-hospital mortality was independently correlated with the occurrence of LLI. The occurrence of hepatocellular damage therefore has been associated with a pro-inflammatory profile and with worse overall outcomes but not with increased likelihood of liver failure or liver-related mortality.
2020年，因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染住院的患者中，经常观察到肝脏受累于冠状病毒病19（COVID-19）；在这种情况下，肝细胞损伤的临床和预后相关性已得到广泛认可。另一方面，在COVID-19大流行的后续浪潮中，肝损伤（LI）的证据较少。本研究的目的是评估LI的患病率，并确定2021 - 2022年住院的SARS-CoV-2阳性患者中与LI发生相关的临床、生化和免疫病毒学特征。这项单中心回顾性研究纳入了455例确诊SARS-CoV-2感染并伴有呼吸衰竭的患者。LI通过检测转氨酶水平超过正常上限（ULN）的三倍来定义，并根据转氨酶峰值出现在入院后7天内还是7天后进一步分为早期或晚期肝损伤。在整个队列中，17.6%（80/455）的患者发现有LI，而早期肝损伤（ELI）和晚期肝损伤（LLI）分别在10.4%和11.5%的患者中被检测到。LI与年轻、炎症和组织损伤标志物升高、慢性肝病（CLD）的存在以及白细胞介素-6（IL-6）抑制剂的使用有关。与没有LI的患者相比，有LI的患者发生重症COVID-19、转入重症监护病房和院内死亡的可能性更高。在多变量分析中，年轻、使用IL-6抑制剂以及较高的γ-谷氨酰转移酶（GGT）水平与总体LI的发生独立相关，而院内死亡率与LLI的发生独立相关。因此，肝细胞损伤的发生与促炎状态和更差的总体结局相关，但与肝衰竭或肝脏相关死亡率增加无关。
