Liver Biochemistries in Hospitalized Patients With COVID-19
Liver Biochemistries in Hospitalized Patients With COVID-19
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DOI：
10.1002/hep.31326
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发表时间：
2020-11-04
期刊：
影响因子：
13.5
通讯作者：
Chung, Raymond T.
中科院分区：
文献类型：
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作者：
Bloom, Patricia P.;Meyerowitz, Eric A.;Chung, Raymond T.
背景和目的2019冠状病毒病（COVID-19）导致大约一半的患者在就诊时肝脏生物化学升高。迄今为止，关于疾病过程中肝脏生物化学变化趋势的数据有限。我们的目的是评估与COVID-19肝脏生化相关的趋势、病因学和结局。方法与结果2020年3月21日至3月28日共收治60例新冠肺炎患者。平均年龄为57岁，65%为男性，28%为西班牙裔。研究结束时，死亡6例，出院28例，留院26例。继续住院的患者随访时间中位数为12天。在60例患者中，41例（69%）在入院时至少有一项肝脏生化异常。入院时和住院期间，中位天冬氨酸转氨酶（AST）高于丙氨酸转氨酶（ALT） （46 U/L vs 30 U/L）。54例（93%）患者的转氨酶高于正常水平，而碱性磷酸酶和总胆红素升高则罕见。10例（17%）患者的转氨酶超过正常值上限的5倍。在整个病程中，AST与ALT高度相关（r = 0.97; P < 0.0001），而与肌肉损伤和炎症标志物的相关性较弱。在我们的中心，他汀类药物的使用在入院前（40%）和入院期间（80%）很常见，在使用和未使用之间肝脏生物化学峰值没有差异。没有人口统计学或合并症与肝损伤相关。插管患者入院时AST（69比49，P < 0.05）、AST峰值（364比77，P = 0.003）和ALT峰值（220比52，P = 0.002）较高。结论ast -显性转氨酶升高在COVID-19中很常见，反映了疾病的严重程度，似乎反映了真正的肝损伤。
Background and Aims Coronavirus disease 2019 (COVID-19) leads to elevated liver biochemistries in approximately half of patients on presentation. To date, data are limited regarding the trend of liver biochemistries over the course of illness. We aimed to evaluate the trend, etiology, and outcomes associated with liver biochemistries in COVID-19.Approach and Results A total of 60 patients with COVID-19 were admitted between March 21 and March 28, 2020. The mean age was 57 years, 65% were male, and 28% were Hispanic. At the study conclusion, 6 patients were deceased, 28 were discharged, and 26 remained admitted. Patients who remained admitted were followed for a median of 12 days. Of 60 patients, 41 (69%) had at least one abnormal liver biochemistry on admission. Median aspartate aminotransferase (AST) was higher than alanine aminotransferase (ALT) at admission (46 vs. 30 U/L) and during the hospital course. Aminotransferases rose above normal in 54 (93%) patients, whereas alkaline phosphatase and total bilirubin elevations were rare. Ten (17%) patients developed aminotransferases more than 5 times the upper limit of normal. AST highly correlated with ALT throughout the illness course (r = 0.97; P < 0.0001), whereas correlations with markers of muscle injury and inflammation were weak. Statin use was common before (40%) and during admission (80%) at our center, with no difference in peak liver biochemistries between users and nonusers. No demographic or comorbid illness was associated with liver injury. Admission AST (69 vs. 49; P < 0.05), peak AST (364 vs. 77; P = 0.003), and peak ALT (220 vs. 52; P = 0.002) were higher in intubated patients.Conclusions AST-dominant aminotransferase elevation is common in COVID-19, mirrors disease severity, and appears to reflect true hepatic injury.