Significant Liver Injury During Hospitalization for COVID-19 Is Not Associated With Liver Insufficiency or Death
| Autor: | Michael Chew, Maria M. Ciarleglio, Guadalupe Garcia-Tsao, Dennis Caruana, Yanhong Deng, Natty Doilicho, Zeyu Tang, Christopher Radcliffe |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
BMI body mass index Ischemia Disease AST aspartate aminotransferase Liver Injury Gastroenterology SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 Article law.invention Hepatitis COVID-19 coronavirus-19 disease 03 medical and health sciences 0302 clinical medicine ULN upper limit of normal law Internal medicine ALT alanine aminotransferase medicine TBIL total bilirubin Liver injury Hepatology business.industry INR international normalized ratio COVID-19 Odds ratio medicine.disease Intensive care unit ICU intensive care unit IL interleukin hs-CRP high-sensitivity C-reactive protein AP alkaline phosphatase 030220 oncology & carcinogenesis Concomitant 030211 gastroenterology & hepatology business Body mass index |
| Zdroj: | Clinical Gastroenterology and Hepatology |
| ISSN: | 1542-7714 1542-3565 |
| Popis: | Background & Aims Coronavirus-19 disease (COVID-19) is associated with hepatocellular liver injury of uncertain significance. We aimed to determine whether development of significant liver injury during hospitalization is related to concomitant medications or processes common in COVID-19 (eg, ischemia, hyperinflammatory, or hypercoagulable states), and whether it can result in liver failure and death. Methods There were 834 consecutive patients hospitalized with COVID-19 who were included. Clinical, medication, and laboratory data were obtained at admission and throughout hospitalization using an identified database. Significant liver injury was defined as an aspartate aminotransferase (AST) level 5 or more times the upper limit of normal; ischemia was defined as vasopressor use for a minimum of 2 consecutive days; hyperinflammatory state was defined as high-sensitivity C-reactive protein value of 100 mg/L or more, and hypercoagulability was defined as D-dimer 5 mg/L or more at any time during hospitalization. Results A total of 105 (12.6%) patients developed significant liver injury. Compared with patients without significant liver injury, ischemia (odds ratio [OR], 4.3; 2.5–7.4; P < .0001) and tocilizumab use (OR, 3.6; 1.9–7.0; P = .0001) were independent predictors of significant liver injury. Although AST correlated closely with alanine aminotransferase (R = 0.89) throughout hospitalization, AST did not correlate with the international normalized ratio (R = 0.10) or with bilirubin level (R = 0.09). Death during hospitalization occurred in 136 (16.3%) patients. Multivariate logistic regression showed that significant liver injury was not associated with death (OR, 1.4; 0.8–2.6; P = .2), while ischemic (OR, 2.4; 1.4–4.0; P = .001), hypercoagulable (OR, 1.7; 1.1–2.6; P = .02), and hyperinflammatory (OR, 1.9; 1.2–3.1; P = .02) disease states were significant predictors of death. Conclusions Liver test abnormalities known to be associated with COVID-19 are secondary to other insults, mostly ischemia or drug-induced liver injury, and do not lead to liver insufficiency or death. Graphical abstract |
| Databáze: | OpenAIRE |
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