Clinical features of liver injury in patients with coronavirus disease 2019: An analysis of 201 cases

Long Dan; Qin LingHui; Gao Shan

doi:10.3969/j.issn.1001-5256.2020.07.023

Volume 36 Issue 7

Jul. 2020

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2020 > 36(7): 1567-1570

PDF( 2082 KB)

Clinical features of liver injury in patients with coronavirus disease 2019: An analysis of 201 cases

DOI: 10.3969/j.issn.1001-5256.2020.07.023

a. Department of Gastroenterology, b. Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, China

Published Date: 2020-07-20

Abstract

Abstract

Objective To investigate the features of liver injury in patients with coronavirus disease 2019( COVID-19),and to provide a reference for clinical diagnosis and treatment. Methods Medical records were collected from 201 patients with COVID-19 who were admitted to Xiangyang Central Hospital from January 19 to March 5,2020,and these patients were divided into non-critical( mild/common type) group with 173 patients and critical( severe/critical type) group with 28 patients. The data on alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( TBil),direct bilirubin( DBil),and albumin( Alb) were collected. The t-test was used for comparison of normally distributed continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and the Wilcoxon rank-sum test was used for comparison of ranked data between groups. Results Among the 201 patients,37( 18. 4%) had liver injury,with 19 in the critical group and 18 in the non-critical group,and there was a significant difference in the incidence rate of liver injury between the two groups( 67. 9% vs 10. 4%,χ2= 52. 963,P < 0. 05). There were significant differences between the 19 patients with liver injury in the critical group and the 18 patients with liver injury in the non-critical group in the duration of abnormal ALT and/or AST( on admission and during hospitalization)( χ2= 11. 906,P < 0. 05) and the increase in ALT and/or AST( Z =-2. 869,P < 0. 05),and most patients had mild or moderate liver injury. Among the 201 patients,only one patient had elevated bilirubin( TBil < 2 × upper limit of normal,mainly indirect bilirubin) and had non-critical liver injury. The critical group had a significantly lower level of Alb than the non-critical group( t =-8. 002,P < 0. 05). Among the 201 patients,75 had a reduction in Alb,among whom 50( 50/201,24. 9%) had a reduction on admission and 25( 25/201,12. 4%) had a reduction during hospitalization,and there were significant differences in Alb( t =-4. 967,P < 0. 05) and hypoalbuminemia( χ2= 26. 645,P < 0. 05) between the two periods of time. Conclusion Liver injury is relatively common in patients with COVID-19,mainly mild or moderate liver injury. There is a low incidence rate of abnormal bilirubin and a high incidence rate of the reduction in Alb. There are significant differences in the incidence rate and severity of liver injury between the crucial and non-critical patients. Alb level can be used as one of the indicators to evaluate and predict the severity of COVID-19 patients.
- coronavirus disease 2019,
- liver injury,
- serum albumin

FullText(HTML)

References(19)

References

[1] HUI DS,I AZHAR E,MADANI TA,et al.The continuing 2019-n Co Vepidemic threat of novel coronaviruses to global health-The latest 2019novel coronavirus outbreak in Wuhan,China[J].Int J Infect Dis,2020,91:264-266．

[2] National Health Commission of the People's Republic of China.Law on the Prevention and Control of Infectious Diseases of the People's Republic of China(Order of the President No.5)[EB/OL].(2020-03-02)[2020-03-02].https://www.chashebao.com/yiliaobaoxian/19628.html.(in Chinese)中华人民共和国国家卫生健康委员会．中华人民共和国传染病防治法_主席令第5号[EB/OL].(2020-03-02)[2020-03-02].https://www.chashebao.com/yiliaobaoxian/19628.html．

[3] International Committee on Taxonomy of Viruses.The virus causing the current outbreak of coronavirus disease has been named“severe acute respiratory syndrome coronavirus 2”(SARS-Co V-2)[EB/OL].(2020-02-13)[2020-02-12].https://talk.ictvonline.org/．

[4] National Health Commission of the People's Republic of China.Real-time update:Epidemic map of coronavirus disease 2019[EB/OL].(2020-03-14)[2020-03-14].https://voice.baidu.com/act/newpneumonia/newpneumonia/?from=osari_pc_3.(in Chinese)中华人民共和国国家卫生健康委员会．实时更新:新型冠状病毒肺炎疫情地图[EB/OL].(2020-03-14)[2020-03-14].https://voice.baidu.com/act/newpneumonia/newpneumonia/?from=osari_pc_3．

[5] HUANG C,WANG Y,LI X,et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan,China[J].Lancet,2020,395(10223):497-506．

[6] WANG D,HU B,HU C,et al.Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan,China[J].JAMA,2020,323(11):1061-1069．

[7] General Office of National Health Commission of the People's Republic of China,General Office of State Administration of Traditional Chinese Medicine.Diagnostic and treatment protocol for novel coronavirus pneumonia(Trial version 7)[EB/OL].(2020-03-03)[2020-03-03].http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf.(in Chinese)国家卫生健康委办公厅，国家中医药管理局办公室．新型冠状病毒感染的肺炎诊疗方案(试行第七版)[EB/OL].(2020-03-03)[2020-03-03].http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf．

[8] CHENG H,PAN J,YAO TT,et al.Current status of the research on clinical features and mechanism of liver injury caused by systemic inflammatory response[J].Int J Virol,2019,26(5):354-357.(in Chinese)程浩，潘静，姚甜甜，等．全身炎症反应导致肝损害的临床特点和机制研究现状[J]．国际病毒学杂志，2019,26(5):354-357．

[9] FANG D,MA JD,GUAN JL,et al.Manifestations of digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan,China:A single-center,descriptive study[J].Chin J Dig,2020,40(3):151-156.(in Chinese)方丹，马敬东，官佳轮，等．武汉地区新型冠状病毒肺炎住院患者消化系统表现的单中心描述性研究[J]．中华消化杂志，2020,40(3):151-156．

[10] CHEN N,ZHOU M,DONG X,et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan,China:A descriptive study[J].Lancet,2020,395(10223):507-513．

[11] GUAN WJ,NI ZY,HU Y,et al.Clinical characteristics of 2019 novel coronavirus infection in China?[J].New England J Med,2020.[Online ahead of print]

[12] WANG SH,HAN P,XIAO F,et al.Manifestations of liver injury in333 hospitalized patients with coronavirus disease 2019[J].Chin JDig,2020,40(3):157-161.(in Chinese)汪姝惠，韩平，肖芳，等．新型冠状病毒肺炎住院患者333例的肝损害表现[J]．中华消化杂志，2020,40(3):157-161．

[13] HU LL,WANG WJ,ZHU QJ,et al.Novel coronavirus pneumonia related liver injury:Etiological analysis and treatment strategy[J].Chin JHepatol,2020,28(2):97-99.(in Chinese)胡利琳，王玮珺，朱清静，等．新型冠状病毒肺炎相关肝损害:病因分析及治疗策略[J]．中华肝脏病杂志，2020,28(2):97-99．

[14] XU H,ZHONG L,DENG J,et al.High expression of ACE2 receptor of 2019-n Co V on the epithelial cells of oral mucosa[J].Int J Oral Sci,2020,12(1):8．

[15] CHAI X,HU L,ZHANG Y,et al.Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-n Co V infection[J].bioRxiv,2020.[Online ahead of print]

[16] XU Z,SHI L,WANG YJ,et al.Pathological findings of COVID-19associated with acute respiratory distress syndrome[J].Lancet,2020.[Online ahead of print]

[17] HUANG A,YANG XR,SUN HC,et al.Mechanisms and control measures of COVID-19 relatedliver injuries[J].Chin J Dig Surg,2020,19(3):248-250.(in Chinese)黄傲，杨欣荣，孙惠川，等．新型冠状病毒肺炎相关肝损伤的发生机制及防治措施[J]．中华消化外科杂志，2020,19(3):248-250．

[18] An interview with Zhong Ming:Inflammatory storm suddenly occurs in most critically ill patients[EB/OL].(2020-02-03)[2020-02-21].http://www.infzm.com/contents/175754.(in Chinese)独家专访钟鸣:多数重症病人体内突然启动炎症风暴[EB/OL].(2020-02-03)[2020-02-21].http://www.infzm.com/contents/175754．

[19]VINCENT JL,DUBOIS MJ,NAVICKIS RJ,et al.Hypoalbuminemia in acute illness:Is there a rationale for intervention?A meta-analysis of cohort studies and controlled trials[J].Ann Surg,2003,237(3):319-334.

Relative Articles

[1]	Binbin LIU, Wen GAO, Xiaoyuan XU, Jianxiang LIU. Abnormal liver biochemical parameters in pregnancy during the epidemic of coronavirus disease 2019[J]. Journal of Clinical Hepatology, 2024, 40(1): 104-109. doi: 10.12449/JCH240118
[2]	Yu TIAN, Meili DONG, Yu ZHANG, Diandian HAO, Jialin DU, Xiaoyu WEN. Clinical features of bacterial liver abscess in the context of coronavirus disease 2019 in Changchun， China[J]. Journal of Clinical Hepatology, 2023, 39(10): 2390-2395. doi: 10.3969/j.issn.1001-5256.2023.10.017
[3]	Lu YANG, Ye XIONG, Jianrong HUANG. Application of human serum albumin in the management of end-stage liver disease[J]. Journal of Clinical Hepatology, 2022, 38(4): 936-941. doi: 10.3969/j.issn.1001-5256.2022.04.040
[4]	Hao CUI, Jing LIANG, Huiling XIANG. Research advances in coronavirus disease 2019-related liver injury[J]. Journal of Clinical Hepatology, 2022, 38(4): 931-935. doi: 10.3969/j.issn.1001-5256.2022.04.039
[5]	Lu LI, Shuang LI, Yu CHEN. Pathogenesis of coronavirus disease 2019 with liver injury[J]. Journal of Clinical Hepatology, 2021, 37(1): 209-211. doi: 10.3969/j.issn.1001-5256.2021.01.046
[6]	Xu LuYao, Li ChangXu, Tang ChaoHui, Wang ShouQian, Wang YingChao. Management of patients with gallstones and acute cholecystitis during the epidemic of coronavirus disease 2019[J]. Journal of Clinical Hepatology, 2020, 36(6): 1420-1422. doi: 10.3969/j.issn.1001-5256.2020.06.051
[7]	Lai ShuJie, Cui HongLi, Chen DongFeng, Kuang Yi. Liver injury in coronavirus disease 2019[J]. Journal of Clinical Hepatology, 2020, 36(5): 1004-1007. doi: 10.3969/j.issn.1001-5256.2020.05.011
[8]	Yang YaFan, Ge ZhangQing, Yan Jun, Li QuanFu, Zhong YongGang, Zhang Yan, Chen Yang, Xu Xu, Hou GuangBin, Yu Qing. Experience in the diagnosis and treatment of acute biliary tract infection during the epidemic of novel coronavirus pneumonia[J]. Journal of Clinical Hepatology, 2020, 36(7): 1588-1590. doi: 10.3969/j.issn.1001-5256.2020.07.027
[9]	Zheng KeXin, Yang Ling, Qi XingShun. An excerpt of care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID expert consensus(2020)[J]. Journal of Clinical Hepatology, 2020, 36(5): 989-990. doi: 10.3969/j.issn.1001-5256.2020.05.007
[10]	Li LiangLiang, Yu YanYan. Management strategies for patients with chronic viral hepatitis during the coronavirus disease 2019 epidemic[J]. Journal of Clinical Hepatology, 2020, 36(5): 1000-1003. doi: 10.3969/j.issn.1001-5256.2020.05.010
[11]	Lei SiYi, Peng Hong, Luo XinHua. Pathogenic mechanism of liver injury caused by coronavirus disease 2019 and protective strategies for patients with viral hepatitis cirrhosis[J]. Journal of Clinical Hepatology, 2020, 36(7): 1619-1622. doi: 10.3969/j.issn.1001-5256.2020.07.037
[12]	Tan YunHua, Li JianBo, Shang YangYang, Zhang Tao, Zheng MingYou. Challenges and countermeasures for diagnosis and treatment work in hepatobiliary surgery in the epidemic of novel coronavirus pneumonia[J]. Journal of Clinical Hepatology, 2020, 36(4): 775-777. doi: 10.3969/j.issn.1001-5256.2020.04.013
[13]	Li GuangMing, Pan Xin. Features of liver injury in patients with coronavirus disease 2019 in Bozhou,China[J]. Journal of Clinical Hepatology, 2020, 36(4): 772-774. doi: 10.3969/j.issn.1001-5256.2020.04.012
[14]	China Digestion Association, Chinese Medical Doctor Association; Chinese Society of Hepatology, Chinese Medical Association. The protocol for prevention,diagnosis and treatment of liver injury in coronavirus disease 2019[J]. Journal of Clinical Hepatology, 2020, 36(4): 754-757. doi: 10.3969/j.issn.1001-5256.2020.04.008
[15]	National Clinical Research Center for Infectious DiseasesState Key Laboratory for Diagnosis and Treatment of Infectious Diseases. Expert consensus on the application of artificial liver blood purification system in the treatment of severe and critical COVID-19[J]. Journal of Clinical Hepatology, 2020, 36(6): 1228-1229. doi: 10.3969/j.issn.1001-5256.2020.06.008
[17]	Chen ChengLiang, Song Wei, Meng XiuNa, Tian Xing, Jiao Jian. Significance of serum ischemia-modified albumin level in evaluating liver function in patients with liver cirrhosis of various causes[J]. Journal of Clinical Hepatology, 2016, 32(8): 1534-1537. doi: 10.3969/j.issn.1001-5256.2016.08.020
[18]	Huang DongHai, Shi JianShe, Zhang ChengHua. Usage analysis of human serum albumin in patients with liver cancer and liver cirrhosis after hepatectomy[J]. Journal of Clinical Hepatology, 2015, 31(6): 910-914. doi: 10.3969/j.issn.1001-5256.2015.06.020

Supplements(0)

Cited By

Cited by

Periodical cited type(4)

1.	龚晓红，李松伟，崔应麟，李桓，黄琳，陈乾. 新冠病毒Delta株感染患者中医证型与实验室指标及肺部CT表现相关性研究. 山东中医杂志. 2023(06): 583-591 .
2.	崔浩，梁静，向慧玲. 新型冠状病毒肺炎相关肝损伤研究进展. 临床肝胆病杂志. 2022(04): 931-935 . 本站查看
3.	陆光辉，褚志华，田娅玲，周发为，王姣平，曾守逵，柳青子. 新型冠状病毒肺炎常见实验室指标与病情严重程度相关性的回顾性分析. 检验医学与临床. 2021(13): 1965-1968 .
4.	赵晓飞，段斌炜，刘召波，张静，郭庆良，栗光明. 新型媒介网络直播在肝移植受者宣教中的作用. 器官移植. 2020(06): 719-723 .

Other cited types(0)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (1535) PDF downloads(158)

Clinical features of liver injury in patients with coronavirus disease 2019: An analysis of 201 cases

DOI: 10.3969/j.issn.1001-5256.2020.07.023