COVID-19 Sırasında Gelişen Karaciğer Hasarı Ne Kadar Önemli?

Abstract

Amaç: Bu çalışma, koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) nedeniyle hastaneye yatırılan hastalarda karaciğer fonksiyon bozukluğu prevalansını incelemeyi ve yoğun bakım ünitesine yatış ve mortaliteyi öngörmede karaciğer fonksiyon bozukluğunun rolünü araştırmayı amaçlamaktadır. Gereç ve Yöntemler: Önceden bilinen bir kronik karaciğer hastalığı olmayan ve polimeraz zincir reaksiyonu testi ile doğrulanmış COVID-19 pozitif olan toplam 2168 hasta, hafif ve şiddetli COVID-19 olarak gruplara ayrıldı. Karaciğer hasarı gelişiminin COVID-19’un seyrine ve prognozuna etkisi araştırıldı. Bulgular: Hafif COVID-19’lu hastaların %26,3’ünde (n=461) ve şiddetli COVID-19’lu hastaların %45,3’ünde (n=189) karaciğer enzimlerinde yükselme meydana geldi. En yüksek ALT ve AST artışları, antibiyotikler ile birlikte birden fazla ilaç kullanan hastalarda tespit edildi (p<0,001). Hafif COVID-19’lu hastaların %1,4’ünde (n=25) ve şiddetli COVID-19’lu hastaların %6,5’inde (n=27) şiddetli hepatit gelişti (p<0,001). Şiddetli COVID-19’lu hastalarda, ALT ile albumin arasında zayıf düzeyde negatif bir korelasyon (p=0,017; r=-0,497) saptanırken, bilirubin ile zayıf düzeyde pozitif bir korelasyon (p=0,024; r=0,352), ferritin ile orta düzeyde pozitif bir korelasyon (p=0,016; r=0,504) ve INR ile zayıf düzeyde pozitif bir korelasyon (p=0,022; r=0,383) olduğu saptandı. Sonuç: Sonuçlar, COVID-19 hastalarının %30’unda farklı şiddette karaciğer fonksiyon testlerinde bozulma meydana geldiğini ve şiddetli COVID-19 hastalarında karaciğer hasarının daha yaygın olduğunu göstermektedir. Ayrıca COVID-19 sırasında meydana gelen karaciğer hasarının yoğun bakım gereksinimi ve ölüm riskini artıran bir etken olduğu da belirlenmiştir.

Keywords

• COVID-19
• karaciğer
• prognoz

How Important Is Liver Damage During COVID-19?

Abstract

Aim: The present study aimed to examine the prevalence of liver dysfunction in patients hospitalized due to coronavirus disease 2019 (COVID-19) and to investigate the role of liver dysfunction in predicting intensive care unit admission and mortality. Material and Methods: A total of 2168 patients who had no previously known chronic liver disease and were found to be COVID-19 positive on polymerase chain reaction test were divided into mild and severe COVID-19 groups. The effect of the development of liver damage on the course and prognosis of COVID-19 was investigated. Results: Elevated liver enzymes developed in 26.3% (n=461) of the patients with mild COVID-19 and in 45.3% (n=189) of the patients with severe COVID-19. The highest ALT and AST elevation was detected in patients using more than one drug with antibiotics (p<0.001). Severe hepatitis developed in 1.4% (n=25) of the patients with mild COVID-19 and 6.5% (n=27) of the patients with severe COVID-19 (p<0.001). There was a weak negative correlation between ALT and albumin (p=0.017, r=-0.497), while a weak positive correlation with bilirubin (p=0.024, r=0.352), a moderate positive correlation with ferritin (p=0.016, r=0.504), and a weak positive correlation with INR (p=0.022, r=0.383) were found in patients with severe COVID-19. Conclusion: The results showed that 30% of COVID-19 patients had impaired liver function of varying severity and that liver damage was more common in patients with severe COVID-19. It was also determined that liver damage occurring during COVID-19 was an indicator of intensive care requirement and the mortality risk.

Keywords

• COVID-19
• liver
• prognosis

References

1. Rahimi B, Vesal A, Edalatifard M. Coronavirus and its effect on the respiratory system: Is there any association between pneumonia and immune cells. J Family Med Prim Care. 2020;9(9):4729-35.
2. Niu P, Shen J, Zhu N, Lu R, Tan W. Two-tube multiplex real-time reverse transcription PCR to detect six human coronaviruses. Virol Sin. 2016;31(1):85-8.
3. Brüssow H. COVID-19 by numbers - infections, cases and deaths. Environ Microbiol. 2021;23(3):1322-33.
4. Liu J, Li S, Liu J, Liang B, Wang X, Wang H, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55:102763.
5. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020. doi: 10.1101/2020.02.03.931766.
6. Mantovani A, Beatrice G, Dalbeni A. Coronavirus disease 2019 and prevalence of chronic liver disease: a meta-analysis. Liver Int. 2020;40(6):1316-20.
7. Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, et al. COVID-19: Abnormal liver function tests. J Hepatol. 2020;73(3):566-74.
8. Tan YJ, Fielding BC, Goh PY, Shen S, Tan TH, Lim SG, et al. Overexpression of 7a, a protein specifically encoded by the severe acute respiratory syndrome coronavirus, induces apoptosis via a caspase-dependent pathway. J Virol. 2004;78(24):14043-7.

9. Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Lumbreras-Bermejo C, Ramos-Rincón JM, Roy-Vallejo E, et al. Clinical characteristics of patients hospitalized with COVID-19 in Spain: results from the SEMI-COVID-19 Registry. Rev Clin Esp (Barc). 2020;220(8):480-94.
10. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. European Association for the Study of the Liver. J Hepatol. 2015;63(1):237-64.
11. Kulkarni AV, Kumar P, Tevethia HV, Premkumar M, Arab JP, Candia R, et al. Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19. Aliment Pharmacol Ther. 2020;52(4):584-99.
12. Zhao D, Yao F, Wang L, Zheng L, Gao Y, Ye J, et al. A comparative study on the clinical features of coronavirus 2019 (COVID-19) pneumonia with other pneumonias. Clin Infect Dis. 2020;71(15):756-61.
13. Del Zompo F, De Siena M, Ianiro G, Gasbarrini A, Pompili M, Ponziani FR. Prevalence of liver injury and correlation with clinical outcomes in patients with COVID-19: systematic review with meta-analysis. Eur Rev Med Pharmacol Sci. 2020;24(24):13072-88.
14. Sharma A, Jaiswal P, Kerakhan Y, Saravanan L, Murtaza Z, Zergham A, et al. Liver disease and outcomes among COVID-19 hospitalized patients – A systematic review and meta-analysis. Ann Hepatol. 2021;21:100273.
15. Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998‐1004.
16. Alqahtani SA, Schattenberg JM. Liver injury in COVID-19: The current evidence. United European Gastroenterol J. 2020;8(5):509-19.