Association of liver abnormalities with in-hospital mortality in patients with COVID-19
| العنوان: | Association of liver abnormalities with in-hospital mortality in patients with COVID-19 |
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| المؤلفون: | Yong Li, Zeyang Ding, Yang Yang, Binhao Zhang, Chang Shu, Wei Wang, Yuwei Wang, Wei Zhu, Wanguang Zhang, Huaqiu Zhang, Jihong Liu, Tongtong Liu, Guannan Jin, Junbo Hu, Jia Song, Lin Chen, Wen-kui Yu, Ping Yin, Huan Feng, Hui Wang, Junnan Liang, Ganxun Li, Qian Chen, Zhouping Tang, Bixiang Zhang, Xiaoping Chen, Peng Zhu, Zhen-Yu Yin |
| المصدر: | Journal of Hepatology |
| بيانات النشر: | Elsevier BV, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Male, 0301 basic medicine, Multivariate analysis, BMI, body mass index, EASL, European Association for the Study of the Liver, ALP, Alkaline phosphatase, CTP, Child-Turcotte-Pugh, D-Bil, Direct bilirubin, 0302 clinical medicine, aspartate aminotransferase, ACG, American College of Gastroenterology, ALI, acute liver injury, Hospital Mortality, IL-6, interleukin-6, MAFLD, metabolic associated fatty liver disease, COVID-19, Coronavirus disease 2019, TCM, Traditional Chinese Medicine, medicine.diagnostic_test, Liver Diseases, Hazard ratio, ARDS, Acute Respiratory Distress Syndrome, Middle Aged, Hepatitis B, direct bilirubin, PCT, procalcitonin, CT, computed tomography, ULN, upper limit of normal value, BSG, British Society of Gastroenterology, Female, 030211 gastroenterology & hepatology, AST, Aspartate aminotransferase, liver injury, LA, liver abnormalities, medicine.medical_specialty, LI, liver injury, T-Bil, Total bilirubin, ESCMID, European Society of Clinical Microbiology and Infectious Diseases, ORs, odd ratios, I-Bil, indirect bilirubin, CRP, C-reaction protein, CPGs, clinical practice guidelines, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, cTnI, cardiac troponin I, 03 medical and health sciences, ALF, acute liver failure, GGT, γ-glutamyl transpeptidase, Internal medicine, medicine, Humans, Clinical significance, CRRT, continuous renal replacement therapy, Aspartate Aminotransferases, NSAIDs, Nonsteroidal Anti-inflammatory Drugs, Propensity Score, ALT, Alanine aminotransferases, IQR, interquartile range, Aged, Retrospective Studies, Hepatology, SARS-CoV-2, business.industry, COVID-19, Bilirubin, Retrospective cohort study, LDH, lactose dehydrogenase, Nomogram, medicine.disease, APASL, Asian Pacific Association for the Study of the Liver, HR, hazard ratio, CI, confidence interval, PT, Prothrombin time, HBV, hepatitis B virus, 030104 developmental biology, mLA, mild liver abnormalities, ACLF, acute-on-chronic liver failure, Propensity score matching, Liver function tests, business, ECMO, extracorporeal membrane oxygenation |
| الوصف: | Background and Aims The evolution and clinical significance of abnormal liver chemistries and the impact of hepatitis B infection on outcome in patients with COVID-19 is not well characterized. This study aimed to explore these issues. Methods This large retrospective cohort study included 2073 patients with COVID-19 having definite outcomes in Wuhan, China. Longitudinal liver function tests were conducted and determined their associated factors and death risk by multivariate regression analyses. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. The characteristics of liver abnormalities and outcomes of patients with COVID-19 with and without hepatitis B were compared after 1:3 propensity score matching. Results Of the 2073 patients, 1282 (61.8%) had abnormal liver chemistries during hospitalization, and 297 (14.3%) had a liver injury. The mean levels of AST and D-Bil increased early after symptom onset in deceased patients and showed disparity compared with that in discharged patients throughout the clinical course of the disease. Abnormal admission AST (adjusted hazard ratio [HR]: 1.39, 95%CI: 1.04-1.86, P=0.027) and D-Bil (adjusted HR: 1.66, 95%CI: 1.22-2.26, P=0.001) levels were independent risk factors for mortality due to COVID-19. A nomogram was established based on the results of multivariate analysis and showed sufficient discriminatory power and good consistency between the prediction and the observation. HBV infection in patients did not increase the risk of COVID-19-associated poor outcomes. Conclusions Abnormal AST and D-Bil levels at admission were independent predictors of COVID-19 mortality. Therefore, monitoring liver chemistries, especially AST and D-Bil levels, in hospitalized patients with COVID-19, is necessary. Graphical abstract Highlights 1. Levels of AST and D-Bil elevated early after the symptom onset in deceased patients and showed disparity compared with that in discharged patients throughout the clinical course of COVID-19. 2. Abnormal admission AST and D-Bil levels at admission were independent predictors of COVID-19 mortality. 3. A novel nomogram was built based on admission AST and D-Bil levels as well as other baseline characteristics to predict the in-hospital mortality of COVID-19. 4. Hepatitis B infection was not found to be associated with the risk of lethal outcome in patients with COVID-19. Lay Summary The AST and D-Bil levels increased early after symptom initiation in deceased patients of COVID-19 and showed disparity compared with that in discharged patients throughout the clinical course of the disease. Abnormal AST and D-Bil levels at admission were independent predictors for COVID-19 mortality. HBV infection in patients did not increase the risk of COVID-19-associated poor outcomes. |
| تدمد: | 0168-8278 |
| DOI: | 10.1016/j.jhep.2020.12.012 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c3543f445abe1f64f8ff7d1ae96bd264 https://doi.org/10.1016/j.jhep.2020.12.012 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....c3543f445abe1f64f8ff7d1ae96bd264 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 01688278 |
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| DOI: | 10.1016/j.jhep.2020.12.012 |