摘要
Background: There is increasing evidence suggesting that liver dysfunction is a risk factor for severe COVID-19 illness However, due to the low prevalence of liver disease and cirrhosis in the general population, larger studies looking at the impact of these conditions have utilized data from international registries which do not necessarily reflect the US population. Our study aims to assess the association between chronic liver disease and COVID-19 clinical outcomes across a single large inpatient cohort Methods: We performed a retrospective single-center study at a large tertiary care hospital All index admissions of adult patients with confirmed COVID-19 between 3/1/2020 and 4/30/2020 were included A manual chart review was performed to collect data on baseline patient characteristics, medical comorbidities, and clinical outcomes Patients with chronic liver disease (CLD) and cirrhosis were compared to the control group, who had no known underlying liver disease SAS 9 4 was used for analysis Results: A total of 1935 patients met our inclusion criteria of which 1869 (96 6%) had no underlying liver disease, 66 (3 4%) had CLD, and 21 (1 1%) had cirrhosis Table 1 shows baseline patient characteristics There were a higher proportion of males in the CLD and cirrhosis cohorts compared to the control group (67% and 76% vs 50%;p=0 0105) Patients with cirrhosis and chronic liver disease also had a significantly lower average BMI compared to the control group (25 8 and 27 3 vs 31 8;p=0 002) There was no difference in comorbidities between all three cohorts. Patients with cirrhosis had a significantly higher mortality (RR 2 1 [95% CI 1 33-3 62;p=0 0022]) compared to non-cirrhotics There was also a trend towards increased 30-day readmission in the cirrhotic cohort (RR 2 35 [95% CI 0 86-6 42];p=0 0950) however no difference in rate of ICU admission or intubation Patients with CLD did not have an increase in mortality, ICU admission, intubation, or 30-day re-admission compared to the control group Conclusion: Our study demonstrates that cirrhosis is associated with increased mortality in COVID-19 while chronic liver disease in the absence of cirrhosis does not confer the same degree of clinical risk Future studies performed on a larger scale should evaluate how decompensated disease and MELD score may impact this risk profile.(Table Presented).
摘要
Background: Based on current literature there appears to be a high prevalence of liver injury (LI) in patients with COVID-19 However, there are limited large scale studies on risk factors, morbidity, and mortality associated with LI in these patients We aim to determine risk factors and outcomes of patients hospitalized with COVID-19 and LI Methods: We performed a retrospective single-center study at a large tertiary care hospital. All index admissions of adult patients with confirmed COVID19 between 3/1 to 4/30/2020 were included Data on baseline characteristics and clinical outcomes was collected during manual chart review Mild elevation in LFTs (MEL), defined as peak levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TB) above upper limit of normal (ULN) but lower than the threshold for LI. LI was defined as peak ALT/AST three times ULN and/or peak ALP/TB two times ULN ULN threshold values of ALT 52, AST 35, TB 1 2, ALP 140 were used Both cohorts were compared with our control group, who had normal LFTs at presentation and throughout the hospitalization SAS 9 4 was used for analysis Results: A total of 1935 patients were included of which 507 (26 2%) had normal LFTs, 1030 (53 2%) had MEL, and 397 (20 5%) had LI Males were more commonly found in the MEL (p=0 0004) and LI groups compared to control (p< 0001) Patients in the MEL cohort were older (p=0 0005) African Americans were more likely to develop LI (p=0 0318) There was no difference in comorbidities between all groups Among patients with LI, 241 (61%) had a hepatocellular pattern, 20 (5%) had a cholestatic pattern, and 135 (34%) had a mixed pattern Patients with LI had an increased risk of mortality (RR 4 26 [95% CI 3 12, 5 81;p< 0001]), ICU admission (RR 5 52 [95% CI 4 07, 7 49;p< 0001]), intubation (RR 11 01 [95% CI 6 97, 17 34]);p< 0001) and 30-day readmission (1 81 [95% CI 1 17, 2 80;p< 0076]) (Table 2, Figure 1) compared to the control group Conclusion: Our study demonstrates that patients with COVID-19 who present with LI have a significantly increased risk of mortality, mechanical ventilation, ICU admission, and 30-day re-admission compared to patients with MEL and normal LFTs This information is important to appropriately manage COVID-19 patients Further research looking at risk prediction models and pooling multi-center data should include liver injury as a key variable.