tetano
Editor, Senior Moderator
World J Gastroenterol
. 2021 Mar 7;27(9):835-853.
doi: 10.3748/wjg.v27.i9.835.
Progressive liver injury and increased mortality risk in COVID-19 patients: A retrospective cohort study in China
Shui-Sheng Zhang[SUP] 1 [/SUP], Li Dong[SUP] 2 [/SUP], Gao-Ming Wang[SUP] 1 [/SUP], Yuan Tian[SUP] 3 [/SUP], Xiao-Fang Ye[SUP] 4 [/SUP], Yue Zhao[SUP] 1 [/SUP], Zheng-Yin Liu[SUP] 5 [/SUP], Jia-Yu Zhai[SUP] 6 [/SUP], Zhi-Ling Zhao[SUP] 7 [/SUP], Jun-Hong Wang[SUP] 8 [/SUP], Hui-Min Zhang[SUP] 9 [/SUP], Xiao-Long Li[SUP] 10 [/SUP], Chang-Xin Wu[SUP] 2 [/SUP], Cai-Ting Yang[SUP] 2 [/SUP], Li-Juan Yang[SUP] 11 [/SUP], Hai-Xia Du[SUP] 12 [/SUP], Hui Wang[SUP] 13 [/SUP], Qing-Gang Ge[SUP] 7 [/SUP], Dian-Rong Xiu[SUP] 14 [/SUP], Ning Shen[SUP] 15 [/SUP]
Affiliations
Abstract
Background: Liver injury is common and also can be fatal, particularly in severe or critical patients with coronavirus disease 2019 (COVID-19).
Aim: To conduct an in-depth investigation into the risk factors for liver injury and into the effective measures to prevent subsequent mortality risk.
Methods: A retrospective cohort study was performed on 440 consecutive patients with relatively severe COVID-19 between January 28 and March 9, 2020 at Tongji Hospital, Wuhan, China. Data on clinical features, laboratory parameters, medications, and prognosis were collected.
Results: COVID-19-associated liver injury more frequently occurred in patients aged ? 65 years, female patients, or those with other comorbidities, decreased lymphocyte count, or elevated D-dimer or serum ferritin (P < 0.05). The disease severity of COVID-19 was an independent risk factor for liver injury (severe patients: Odds ratio [OR] = 2.86, 95% confidence interval [CI]: 1.78-4.59; critical patients: OR = 13.44, 95%CI: 7.21-25.97). The elevated levels of on-admission aspartate aminotransferase and total bilirubin indicated an increased mortality risk (P < 0.001). Using intravenous nutrition or antibiotics increased the risk of COVID-19-associated liver injury. Hepatoprotective drugs tended to be of assistance to treat the liver injury and improve the prognosis of patients with COVID-19-associated liver injury.
Conclusion: More intensive monitoring of aspartate aminotransferase or total bilirubin is recommended for COVID-19 patients, especially patients aged ? 65 years, female patients, or those with other comorbidities. Drug hepatotoxicity of antibiotics and intravenous nutrition should be alert for COVID-19 patients.
Keywords: Alanine aminotransferase; COVID-19; Drugs; Liver injury; Prognosis; Risk factors.
. 2021 Mar 7;27(9):835-853.
doi: 10.3748/wjg.v27.i9.835.
Progressive liver injury and increased mortality risk in COVID-19 patients: A retrospective cohort study in China
Shui-Sheng Zhang[SUP] 1 [/SUP], Li Dong[SUP] 2 [/SUP], Gao-Ming Wang[SUP] 1 [/SUP], Yuan Tian[SUP] 3 [/SUP], Xiao-Fang Ye[SUP] 4 [/SUP], Yue Zhao[SUP] 1 [/SUP], Zheng-Yin Liu[SUP] 5 [/SUP], Jia-Yu Zhai[SUP] 6 [/SUP], Zhi-Ling Zhao[SUP] 7 [/SUP], Jun-Hong Wang[SUP] 8 [/SUP], Hui-Min Zhang[SUP] 9 [/SUP], Xiao-Long Li[SUP] 10 [/SUP], Chang-Xin Wu[SUP] 2 [/SUP], Cai-Ting Yang[SUP] 2 [/SUP], Li-Juan Yang[SUP] 11 [/SUP], Hai-Xia Du[SUP] 12 [/SUP], Hui Wang[SUP] 13 [/SUP], Qing-Gang Ge[SUP] 7 [/SUP], Dian-Rong Xiu[SUP] 14 [/SUP], Ning Shen[SUP] 15 [/SUP]
Affiliations
- PMID: 33727773
- PMCID: PMC7941865
- DOI: 10.3748/wjg.v27.i9.835
Abstract
Background: Liver injury is common and also can be fatal, particularly in severe or critical patients with coronavirus disease 2019 (COVID-19).
Aim: To conduct an in-depth investigation into the risk factors for liver injury and into the effective measures to prevent subsequent mortality risk.
Methods: A retrospective cohort study was performed on 440 consecutive patients with relatively severe COVID-19 between January 28 and March 9, 2020 at Tongji Hospital, Wuhan, China. Data on clinical features, laboratory parameters, medications, and prognosis were collected.
Results: COVID-19-associated liver injury more frequently occurred in patients aged ? 65 years, female patients, or those with other comorbidities, decreased lymphocyte count, or elevated D-dimer or serum ferritin (P < 0.05). The disease severity of COVID-19 was an independent risk factor for liver injury (severe patients: Odds ratio [OR] = 2.86, 95% confidence interval [CI]: 1.78-4.59; critical patients: OR = 13.44, 95%CI: 7.21-25.97). The elevated levels of on-admission aspartate aminotransferase and total bilirubin indicated an increased mortality risk (P < 0.001). Using intravenous nutrition or antibiotics increased the risk of COVID-19-associated liver injury. Hepatoprotective drugs tended to be of assistance to treat the liver injury and improve the prognosis of patients with COVID-19-associated liver injury.
Conclusion: More intensive monitoring of aspartate aminotransferase or total bilirubin is recommended for COVID-19 patients, especially patients aged ? 65 years, female patients, or those with other comorbidities. Drug hepatotoxicity of antibiotics and intravenous nutrition should be alert for COVID-19 patients.
Keywords: Alanine aminotransferase; COVID-19; Drugs; Liver injury; Prognosis; Risk factors.