Bilirubin Levels as Potential Indicators of Disease Severity in Coronavirus Disease Patients: A Retrospective Cohort Study.
Front Med (Lausanne)
; 7: 598870, 2020.
Article
in English
| MEDLINE | ID: covidwho-948038
ABSTRACT
Objectives:
The coronavirus disease (COVID-19) pandemic has caused a large number of deaths. Some patients with severe or critical COVID-19 have been observed to have elevated bilirubin levels. Studies on the association of bilirubin level and mortality in patients with COVID-19 are limited. This study aimed to examine the role of bilirubin levels in COVID-19 severity and mortality.Methods:
A retrospective cohort study was conducted in patients hospitalized with COVID-19 in Leishenshan Hospital in Wuhan, China. Cox regression analyses and logistic regression analyses were conducted to investigate the risks for mortality and disease severity, respectively. Kaplan-Meier analyses with log-rank tests were performed to assess the association between bilirubin level and survival.Results:
In total, 1,788 patients with COVID-19 were included in the analysis. 5.8% (4/69) of patients in the elevated serum total bilirubin (STB) group died, compared to 0.6% (11/1,719) of patients in the non-elevated STB group. The median alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities in the elevated STB group were 29 U/L [interquartile range (IQR) 16-45 U/L] and 22 U/L (IQR 13-37 U /L), respectively, which were significantly higher than the median ALT (median 23, IQR 15-37) and AST (median 20, IQR 16-26) activities in the non-elevated STB group (both p < 0.05). Patients with an elevated STB level showed increased mortality [hazard ratio (HR) 9.45, P = 0.002], elevated conjugated bilirubin (CB) levels (HR 4.38, P = 0.03), and an elevated ratio of CB to unconjugated bilirubin (UCB, CB/UCB) (HR 2.49, P = 0.01). CB/UCB was positively correlated with disease severity (odds ratio 2.21, P = 0.01).Conclusions:
COVID-19 patients with elevated STB and CB levels had a higher mortality, and CB/UCB was predictive of disease severity and mortality. Thus, it is necessary to pay special attention to COVID-19 patients with elevated bilirubin levels in clinical management.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Language:
English
Journal:
Front Med (Lausanne)
Year:
2020
Document Type:
Article
Affiliation country:
Fmed.2020.598870
Similar
MEDLINE
...
LILACS
LIS