Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Saturday, 10 / 24 / 2020

Articles

ORIGINAL ARTICLE

Liver Dysfunction and Its Association with the Risk of Death in COVID-19 Patients: A Prospective Cohort Study

Lin Fu†,1,2, Jun Fei†,1, Shen Xu†,1, Hui-Xian Xiang1, Ying Xiang1, Biao Hu1, Meng-Die Li1, Fang-Fang Liu1, Ying Li3, Xiu-Yong Li4, Hui Zhao*,1and De-Xiang Xu*,2

1  Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
2  School of Public Health, Anhui Medical University, Hefei, Anhui, China
3  Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
4  The Second People’s Hospital of Fuyang City, Fuyang, Anhui, China
† These authors contributed equally to this work.
*Correspondence to: De-Xiang Xu and Hui Zhao, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China. Tel: +86-551-65167923, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. This email address is being protected from spambots. You need JavaScript enabled to view it. This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2020;8(3):246-254 DOI: 10.14218/JCTH.2020.00043
Received: May 10, 2020 Accepted: August 4, 2020 Published onlineAugust 20, 2020

Abstract

Background and Aims: Coronavirus disease 2019 (COVID-19) is a new respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2 (commonly known as SARS-CoV-2) with multiple organ injuries. The aim of this study was to analyze COVID-19-associated liver dysfunction (LD), its association with the risk of death and prognosis after discharge.

Methods: Three-hundred and fifty-five COVID-19 patients were recruited. Clinical data were collected from electronic medical records. LD was evaluated and its prognosis was tracked. The association between LD and the risk of death was analyzed.

Results: Of the 355 COVID-19 patients, 211 had mild disease, 88 had severe disease, and 51 had critically ill disease. On admission, 223 (62.8%) patients presented with hypoproteinemia, 151(42.5%) with cholestasis, and 101 (28.5%) with hepatocellular injury. As expected, LD was more common in critically ill patients. By multivariate logistic regression, male sex, older age and lymphopenia were three important independent risk factors predicting LD among COVID-19 patients. Risk of death analysis showed that the fatality rate was higher in patients with hypoproteinemia than in those without hypoproteinemia (relative risk=9.471, p<0.01). Moreover, the fatality rate was higher in patients with cholestasis than those without cholestasis (relative risk=2.182, p<0.05). Follow-up observation found that more than one hepatic functional index of two-third patients remained abnormal at 14 days after discharge.

Conclusions: LD at early disease stage elevates the risk of death of COVID-19 patients. COVID-19-associated LD does not recover completely by 14 days after discharge.

Keywords

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), Coronavirus disease 2019 (COVID-19), liver dysfunction (LD), Hepatocellular, Hypoproteinemia

Journal of Clinical and Translational Hepatology 2020 vol. 8, 246-254  [ Html  ] [ PDF Full-text ]

© The Authors 2020. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

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