Abstract
Objective: Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear.
Design: This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death.
Results: We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation.
Conclusion: ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.
Keywords: cholestasis; hepatitis; liver function test.
【저자키워드】 Hepatitis, cholestasis, Liver function test, 【초록키워드】 Corticosteroid, COVID-19, coronavirus disease, Coronavirus disease 2019, Corticosteroids, Biochemistry, intensive care, Lopinavir, Ritonavir, intensive care unit, interferon, Diagnosis, diabetes, hypertension, ribavirin, database, ICU, Clinical outcome, Severe acute respiratory syndrome, Hepatitis, HCoV, Patient, albumin, death, Aspartate aminotransferase, Liver function, Liver injury, AST, Beta, age, Hong Kong, Admission, liver, patients, COVID-19 patients, cholestasis, Lopinavir-ritonavir, Invasive mechanical ventilation, COVID-19 patient, alanine aminotransferase, interferon beta, Liver function test, retrospective cohort study, acute respiratory syndrome, Virological, 95% CI, aspartate, Alanine, primary end point, HCoVs, SARS patients, ALT/AST, men, limit, human coronavirus, defined, SARS patient, occurred, died, adjusted, diabete, admitted to ICU, 【제목키워드】 Clinical outcome, Injury, patients with COVID-19,