Clinical Characteristics of Non-ICU Hospitalized Patients With Coronavirus Disease 2019 and Liver Injury

A Retrospective Study

Hansheng Xie; Jianming Zhao; Ningfang Lian; Su Lin; Qunfang Xie; Huichang Zhuo

Disclosures

Liver International. 2020;40(6):1321-1326. 

In This Article

Materials and Methods

Patients

The retrospective study was conducted in non-ICU Ward at Wuhan Jinyintan Hospital. All consecutive discharged patients treated by Fujian Medical Team to aid Hubei province were enrolled in the study between February 2, 2020 and February 23, 2020. Jinyintan Hospital, located in Wuhan, Hubei Province is responsible for the treatments for COVID-19 assigned by the government. Including criteria: (a) All patients enrolled were diagnosed according to World Health Organization interim guidance with laboratory-identified COVID-19,[5] (b) with completed clinical data. Patients with viral hepatitis, alcoholic liver disease, liver malignancy or other known chronic liver disease were excluded from this study. This retrospective study was approved by the Ethics Committee of the Jinyintan Hospital, Wuhan province.

The clinical data were collected from electronic medical records of Jinyintan Hospital. The clinical data were collected as follows: age, gender, chronic medical illness, symptoms, laboratory findings, chest computed tomographic (CT) scans and the duration of hospital stays. The data were collected and reviewed by a trained team of physicians.

Experimental Grouping

The patients were divided into moderate group and severe group according to the criteria of the diagnosis and treatment programme of novel coronavirus pneumonia (Trial sixth Edition).[6] If the clinical dates met any of the following: (a) Respiratory distress, breathing frequency ≥ 30 breaths/min; (b) In resting state, means oxygen saturation ≤93% and (c) Arterial blood oxygen partial pressure/oxygen concentration ≤300 mm Hg (1 mm Hg = 0.133 kPa), the patient were included in severe group. Others were included in moderate group.

The clinical characteristics of patients with liver injury and those without liver injury were compared. All the patients with elevated levels of alanine transaminase (ALT), aspartate aminotransferase (AST) or bilirubin were defined as liver injury.

CT Image Acquisition and Scoring

All Patients completed lung CT scan within 2 days after admission. CT scans were reviewed and findings were scored prospectively by two respiratory and critical care physician in consensus. CT scores were assessed based on previous reports.[7] To quantify the extent of pneumonia, CT scores were assigned on the basis of the area involved (Table 1). There was a score of 0–5 for each lobe, with a total possible score of 0–25.

Statistical Analysis

Categorical variables were described as percentages, and continuous variables were described using mean ± SD or median (interquartile range) value. Means for continuous variables were compared using independent group t tests when the data were normally distributed; otherwise, the Mann–Whitney test was used. Categorical variables were compared using the χ 2 test; Fisher exact test was used when the data were limited. Furthermore, stepwise logistic regression models were built to identify independent risks of liver injury. All statistical analyses were performed using SPSS 22.0. The significance was recognized at a P < .05.

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