Severity of liver test abnormalities in coronavirus disease 2019 depends on comorbidities and predicts early in-hospital mortality.
Severity of liver test abnormalities in coronavirus disease 2019 depends on comorbidities and predicts early in-hospital mortality.
复制标题
2019 年冠状病毒病肝脏检测异常的严重程度取决于合并症并预测早期院内死亡率。
DOI：
10.1097/meg.0000000000002055
复制
发表时间：
2021
影响因子：
2.1
通讯作者：
NorthwellHealthCOVID-19ResearchConsortium
中科院分区：
文献类型：
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作者：
Satapathy,SanjayaK;Kuntzen,Christian;Qiu,He;Jiang,Yu;Bodenheimer,HenryC;Roth,NitzanC;Lee,Tai-Ping;Hirsch,JamieS;Trindade,ArvindJ;Bernstein,DavidE;NorthwellHealthCOVID-19ResearchConsortium
方法对2020年3月1日至4月27日在纽约13家医院住院的10856例成人新冠肺炎患者进行回顾性分析。入院时肝生化指标[门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)或总胆红素]为无、轻-中度(至少1项升高4倍)或重度。男性和慢性肝病是重度LCA的危险因素。相反，高血压和糖尿病不太可能与严重的LCA相关。AST升高与炎症标志物呈弱至中度相关。经校正分析，轻至中度和重度LCA患者的住院死亡率分别增加了1.56倍和1.87倍。糖尿病、高血压、男性和年龄大于60岁与死亡风险增加有关，随着LCA严重程度的增加，尤其是在住院的第一周。除非存在终末期冠状动脉，否则高血压性肾炎与院内死亡率增加无关。结论入院时终末期冠状动脉严重程度的增加预示着新冠肺炎患者的早期住院死亡率。与已知危险因素、高血压、糖尿病、男性和老年相关的死亡率在LCA的存在下显著增加。AST与炎症标志物有一定的相关性。
MethodsTen thousand eight hundred fifty-six adult patients with COVID-19 hospitalized in 13 hospitals in New York (1 March to 27 April 2020) were analyzed retrospectively. Abnormalities of liver chemistries [aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, or total bilirubin] were defined as absent, mild-moderate (at least one value up to four times elevated), or severe.ResultsLCA were mild-moderate in 63.9% and severe in 7.6% at admission. Risk factors for severe LCA were male sex and chronic liver disease. Conversely, hypertension and diabetes mellitus were less likely associated with severe LCA. AST elevation correlated weakly to modestly with inflammatory markers. On adjusted analysis, in-hospital mortality was 1.56 times and 1.87 times increased in patients with mild-to-moderate and severe LCA, respectively. Diabetes, hypertension, male sex, and age greater than 60 years was associated with incremental risk of mortality with increase severity of LCA, especially in the first week of hospitalization. HTN was not associated with increased in-hospital mortality unless LCA was present.ConclusionIncreasing severity of LCA on hospital admission predicts early in-hospital mortality in COVID-19 patients. Mortality associated with the known risk factors, hypertension, diabetes, male sex, and old age was accentuated in the presence of LCA. AST correlated modestly with inflammatory markers.