The association between markers of liver injury and clinical outcomes in patients with COVID-19 in Wuhan
The association between markers of liver injury and clinical outcomes in patients with COVID-19 in Wuhan
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武汉市 COVID-19 患者肝损伤标志物与临床结果的相关性
DOI：
10.1111/apt.15962
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发表时间：
2020-07-22
影响因子：
7.6
通讯作者：
Ge, Minghua
中科院分区：
文献类型：
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作者：
Huang, Haijun;Chen, Shanshan;Ge, Minghua
背景2019冠状病毒病（COVID-19）的爆发是公共卫生面临的重大挑战。COVID-19对肝损伤的影响尚未完全呈现。目的探讨COVID-19患者肝功能的动态变化及其与预后的关系。方法回顾性分析武汉大学中南医院2020年1月3日至3月8日收治的675例新冠肺炎患者的临床资料。患者分为肝功能正常、肝功能异常和肝损伤。结果675例患者中，住院期间肝功能异常253例（37.5%），肝损伤52例（7.7%）。ALT和AST水平的动态变化在肝损伤患者和死亡患者中更为显著。AST >3倍ULN者死亡和机械通气的风险最高。与AST水平正常的患者相比，AST高于3倍ULN的患者的死亡率和机械通气风险分别显著增加19.27倍（95%置信区间[CI]，4.89-75.97;P < 0.0001）和116.72倍（95% CI，31.58-431.46;P < 0.0001）。白细胞增加、淋巴细胞减少和女性性别与肝损伤独立相关。结论肝功能的动态变化可能与COVID-19的严重程度和预后有显著相关性。肝损伤指数增加与死亡率和机械通气需求密切相关。因此，在住院期间应密切监测这些指标。
Background The outbreak of coronavirus disease 2019 (COVID-19) is a critical challenge for public health. The effect of COVID-19 on liver injury has not been fully presented. Aims To evaluate the dynamic changes in liver function and the relationship between liver function damage and prognosis in patients with COVID-19. Methods Retrospective analysis of clinical data of 675 patients with COVID-19 in Zhongnan Hospital of Wuhan University from January 3 to March 8, 2020. Patients were classified as normal, abnormal liver function and liver injury. Results Of 675 patients, 253 (37.5%) had abnormal liver function during hospitalisation, and 52 (7.7%) had liver injury. The dynamic changes of ALT and AST levels were more significant in patients with liver injury and in those who died. AST >3-fold ULN had the highest risk of death and mechanical ventilation. Compared to patients with normal AST levels, mortality and risk of mechanical ventilation significantly increased 19.27-fold (95% confidence interval [CI], 4.89-75.97;P < 0.0001) and 116.72-fold (95% CI, 31.58-431.46;P < 0.0001), respectively, in patients with AST above 3-fold ULN. Increased leucocytes, decreased lymphocytes and female sex were independently associated with liver injury. Conclusions The dynamic changes in liver function may have a significant correlation with the severity and prognosis of COVID-19. Increased index of liver injury was closely related to mortality and need for mechanical ventilation. Therefore, these indicators should be closely monitored during hospitalisation.