Abstract Background and Aim While many studies have reported on liver injury in patients with coronavirus disease 2019 (COVID‐19), none have specifically addressed the significance of hepatic jaundice. We aimed to determine the clinical consequences and etiologies of jaundice in patients with COVID‐19. Methods We retrospectively analyzed clinical features, laboratory abnormalities, and rates of survival and intensive care unit admission in 551 patients with COVID‐19, hospitalized between 1 March 2020, and 31 May 2020 at a tertiary care academic medical center. Hepatic jaundice was defined as a serum total bilirubin concentration >2.5 mg/dL and a direct bilirubin concentration >0.3 mg/dL that was >25% of the total. Liver injury was characterized as cholestatic, mixed, or hepatocellular at the time of peak serum total bilirubin concentration by calculating the R factor. Results Hepatic jaundice was present in 49 (8.9%) patients and associated with a mortality rate of 40.8% and intensive care unit admission rate of 69.4%, both significantly higher than for patients without jaundice. Jaundiced patients had an increased frequency of fever, leukopenia, leukocytosis, thrombocytopenia, hypotension, hypoxemia, elevated serum creatinine concentration, elevated serum procalcitonin concentration, and sepsis. Nine jaundiced patients had isolated hyperbilirubinemia. Of the 40 patients with abnormally elevated serum alanine aminotransferase or alkaline phosphatase activities, 62.5% had a cholestatic, 20.0% mixed, and 17.5% hepatocellular pattern of liver injury. Conclusion Hepatic jaundice in patients with COVID‐19 is associated with high mortality. The main etiologies of liver dysfunction leading to jaundice appear to be sepsis, severe systemic inflammation, and hypoxic/ischemic hepatitis. Jaundice is a hallmark of liver dysfunction. We show that hepatic jaundice in patients with COVID‐19 is associated with high mortality, similar to that observed with invasive mechanical ventilation. The main etiologies of liver dysfunction leading to jaundice appear to be sepsis, severe systemic inflammation, and hypoxic/ischemic hepatitis.
【저자키워드】 severe acute respiratory syndrome coronavirus 2, COVID‐19, Liver injury, liver, Bilirubin, jaundice, 【초록키워드】 coronavirus disease, Hospitalized, intensive care, procalcitonin, Sepsis, Clinical features, COVID‐19, serum, survival, Hepatitis, Fever, Hypoxemia, Patient, systemic inflammation, mortality rate, etiology, Admission, Care, liver dysfunction, Leukocytosis, Invasive mechanical ventilation, Frequency, Concentration, Injury, alanine aminotransferase, alkaline phosphatase, serum creatinine, total bilirubin, leukopenia, high mortality, activities, hallmark, laboratory abnormalities, while, hepatic, hepatocellular, Result, defined, analyzed, reported, elevated, characterized, determine, significantly higher, addressed, clinical consequence, 【제목키워드】 COVID, Patient,