患有COVID-19的住院患者的肝损伤:国际观察队列研究
Bharath Kumar Tirupakuzhi Vijayaraghavan1,2, Saptarshi Bishnu3, Joaquin Baruch2
1Department of Critical Care Medicine, Apollo Main Hospital, Chennai, India and Honorary Senior Fellow, The George Institute for Global Health, New Delhi, India.
PloS one
|September 13, 2023
概括
肝酶异常在COVID-19患者中很常见,超过一半的人经历轻度肝损伤,超过8%的严重损伤. 这些异常显著增加了死亡和并发症的风险,突出显示了感染期间监测肝功能的重要性.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
背景情况:
- COVID-19 (冠状病毒疾病2019) 与各种器官特异性并发症有关.
- 在COVID-19患者中经常观察到肝酶的变化.
- 肝酶异常的患病率和严重程度以及它们对患者结局的影响需要进一步调查.
研究的目的:
- 评估住院COVID-19患者肝酶变化的流行和严重程度.
- 评估肝酶异常与以患者为中心的结果之间的关联.
- 建立基于酶水平的肝损伤分类系统.
主要方法:
- 利用了国际严重急性呼吸道和新兴感染联盟 (ISARIC) 数据库的数据,包括17531名已确认或怀疑感染SARS-CoV-2的住院患者.
- 评估了基线肝酶 (AST,ALT, bilirubin) 并将患者分类为正常,第一阶段 (1-3x ULN) 或第二阶段 (≥3x ULN) 肝损伤.
- 采用后勤回归来分析肝损伤阶段和结果之间的关联,报告调整的几率比率 (OR) 与95%置信区间 (CI).
主要成果:
- 46.2%的患者患有I期肝损伤,8.2%患有II期肝损伤.
- 第一阶段和第二阶段的肝损伤都与医院死亡率增加的几率显著相关 (分别为1.53和2.50).
- 肝损伤阶段与更高的ICU入院几率,侵入性机械呼吸,败血症,急性损伤和急性呼吸困扰综合征相关.
结论:
- 肝酶异常是COVID-19患者的常见发现.
- 肝酶变化的严重程度与患者不良结果直接相关,包括死亡率和主要器官并发症.
- 监测肝功能对于管理COVID-19患者和预测疾病严重程度至关重要.
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