Dataset Information

Multicenter Analysis of Liver Injury Patterns and Mortality in COVID-19.

ABSTRACT: Background and Aim: Liver test abnormalities are common in COVID-19 patients. The aim of our study was to determine risk factors for different liver injury patterns and to evaluate the relationship between liver injury patterns and prognosis in patients with COVID-19. Methods: We retrospectively analyzed patients admitted between January 1st to March 10th, with laboratory-confirmed COVID-19 and followed them up to April 20th, 2020. Information of clinical features of patients was collected for analysis. Results: As a result, a total of 838 hospitalized patients with confirmed COVID-19, including 48.8% (409/838) patients with normal liver function and 51.2% (429/838) patients with liver injury were analyzed. Abnormal liver function tests are associated with organ injuries, hypoxia, inflammation, and the use of antiviral drugs. Hepatocellular injury pattern was associated with hypoxia. The mortality of the hepatocellular injury pattern, cholestatic pattern and mixed pattern were 25, 28.2, and 22.3%, respectively, while the death rate was only 6.1% in the patients without liver injury. Multivariate analyses showed that liver injury with cholestatic pattern and mixed pattern were associated with increased mortality risk. Conclusions: Our study confirmed that hepatocellular injury pattern that may be induced by hypoxia was not risk factor for mortality in SARS-COV-2 infection, while liver injury with mixed pattern and cholestatic pattern that might be induced by SARS-CoV-2 directly might be potential risk factors for increased mortality in COVID-19 patients.

SUBMITTER: Chu H

PROVIDER: S-EPMC7606271 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Multicenter Analysis of Liver Injury Patterns and Mortality in COVID-19.

Chu Huikuan H Bai Tao T Chen Liuying L Hu Lilin L Xiao Li L Yao Lin L Zhu Rui R Niu Xiaohui X Li Zhonglin Z Zhang Lei L Han Chaoqun C Song Shuangning S He Qi Q Zhao Ying Y Zhu Qingjing Q Chen Hua H Schnabl Bernd B Yang Ling L Hou Xiaohua X

Frontiers in medicine 20201020

<b>Background and Aim:</b> Liver test abnormalities are common in COVID-19 patients. The aim of our study was to determine risk factors for different liver injury patterns and to evaluate the relationship between liver injury patterns and prognosis in patients with COVID-19. <b>Methods:</b> We retrospectively analyzed patients admitted between January 1st to March 10th, with laboratory-confirmed COVID-19 and followed them up to April 20th, 2020. Information of clinical features of patients was c ...[more]

PMID: 33195339

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Project description:Background and aimsCoronavirus disease 2019 (COVID-19) is associated with liver injury, but the prevalence and patterns of liver injury in liver transplantation (LT) recipients with COVID-19 are open for study.Approach and resultsWe conducted a multicenter study in the United States of 112 adult LT recipients with COVID-19. Median age was 61 years (interquartile range, 20), 54.5% (n = 61) were male, and 39.3% (n = 44) Hispanic. Mortality rate was 22.3% (n = 25); 72.3% (n = 81) were hospitalized and 26.8% (n = 30) admitted to the intensive care unit (ICU). Analysis of peak values of alanine aminotransferase (ALT) during COVID-19 showed moderate liver injury (ALT 2-5× upper limit of normal [ULN]) in 22.2% (n = 18) and severe liver injury (ALT > 5× ULN) in 12.3% (n = 10). Compared to age- and sex-matched nontransplant patients with chronic liver disease and COVID-19 (n = 375), incidence of acute liver injury was lower in LT recipients (47.5% vs. 34.6%; P = 0.037). Variables associated with liver injury in LT recipients were younger age (P = 0.009; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), Hispanic ethnicity (P = 0.011; OR, 6.01; 95% CI, 1.51-23.9), metabolic syndrome (P = 0.016; OR, 5.87; 95% CI, 1.38-24.99), vasopressor use (P = 0.018; OR, 7.34; 95% CI, 1.39-38.52), and antibiotic use (P = 0.046; OR, 6.93; 95% CI, 1.04-46.26). Reduction in immunosuppression (49.4%) was not associated with liver injury (P = 0.156) or mortality (P = 0.084). Liver injury during COVID-19 was significantly associated with mortality (P = 0.007; OR, 6.91; 95% CI, 1.68-28.48) and ICU admission (P = 0.007; OR, 7.93; 95% CI, 1.75-35.69) in LT recipients.ConclusionsLiver injury is associated with higher mortality and ICU admission in LT recipients with COVID-19. Hence, monitoring liver enzymes closely can help in early identification of patients at risk for adverse outcomes. Reduction of immunosuppression during COVID-19 did not increase risk for mortality or graft failure.

Project description:Background: Liver injury commonly occurs in patients with COVID-19. There is limited data describing the course of liver injury occurrence in patients with different disease severity, and the causes and risk factors are unknown. We aim to investigate the incidence, characteristics, risk factors, and clinical outcomes of liver injury in patients with COVID-19. Methods: This retrospective observational study was conducted in three hospitals (Zhejiang, China). From January 19, 2020 to February 20, 2020, patients confirmed with COVID-19 (≥18 years) and without liver injury were enrolled and divided into non-critically ill and critically ill groups. The incidence and characteristics of liver injury were compared between the two groups. Demographics, clinical characteristics, treatments, and treatment outcomes between patients with or without liver injury were compared within each group. The multivariable logistic regression model was used to explore the risk factors for liver injury. Results: The mean age of 131 enrolled patients was 51.2 years (standard deviation [SD]: 16.1 years), and 70 (53.4%) patients were male. A total of 76 patients developed liver injury (mild, 40.5%; moderate, 15.3%; severe, 2.3%) with a median occurrence time of 10.0 days. Critically ill patients had higher and earlier occurrence (81.5 vs. 51.9%, 12.0 vs. 5.0 days; p < 0.001), greater injury severity (p < 0.001), and slower recovery (50.0 vs. 61.1%) of liver function than non-critically ill patients. Multivariable regression showed that the number of concomitant medications (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.05-1.21) and the combination treatment of lopinavir/ritonavir and arbidol (OR: 3.58, 95% CI: 1.44-9.52) were risk factors for liver injury in non-critically ill patients. The metabolism of arbidol can be significantly inhibited by lopinavir/ritonavir in vitro (p < 0.005), which may be the underlying cause of drug-related liver injury. Liver injury was related to increased length of hospital stay (mean difference [MD]: 3.2, 95% CI: 1.3-5.2) and viral shedding duration (MD: 3.0, 95% CI: 1.0-4.9). Conclusions: Critically ill patients with COVID-19 suffered earlier occurrence, greater injury severity, and slower recovery from liver injury than non-critically ill patients. Drug factors were related to liver injury in non-critically ill patients. Liver injury was related to prolonged hospital stay and viral shedding duration in patients with COVID-19. Clinical Trial Registration: World Health Organization International Clinical Trials Registry Platform, ChiCTR2000030593. Registered March 8, 2020.

Dataset Information

Multicenter Analysis of Liver Injury Patterns and Mortality in COVID-19.

Publications

Multicenter Analysis of Liver Injury Patterns and Mortality in COVID-19.

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