Clinical characteristics of non-ICU hospitalized patients with coronavirus disease 2019 and liver injury: A retrospective study.
冠状病毒病 2019 合并肝损伤的非ICU住院患者的临床特征: 一项回顾性研究。
- 作者列表："Xie H","Zhao J","Lian N","Lin S","Xie Q","Zhuo H
BACKGROUND & AIMS:Coronavirus disease 2019 (COVID-19) has raised world concern for global epidemic since December, 2019. Limited data are available for liver function in COVID-19 patients. We aimed to investigate the risk factors related to liver injury in the COVID-19 patients. METHODS:A retrospective study was performed in non-ICU Ward at Jinyintan Hospital from February 2, 2020 to February 23, 2020. Consecutively confirmed COVID-19 discharged cases were enrolled. The clinical characteristics of patients with liver injury and without liver injury were compared. RESULTS:A total of 79 COVID-19 patients were included. 31.6%, 35.4% and 5.1% COVID-19 patients had elevated levels of alanine transaminase (ALT), aspartate aminotransferase (AST) and bilirubin respectively. Median value of ALT, AST and bilirubin for entire cohort was 36.5 (17.5 ~ 71.5) U/L, 34.5 (25.3 ~ 55.3) U/L and 12.7 (8.1 ~ 15.4) mmol/L respectively. There were no significant differences in age, previous medical history and symptoms between the two groups. Males were more likely to have liver injury when infected with COVID-19 (P < .05); compared with patients without liver injury, patients with liver injury had increased levels of white blood cell counts, neutrophils, CRP and CT score (P < .05) and had a longer length of stay (P < .05). Logistic regression analyses suggested that the extent of pulmonary lesions on CT was a predictor of liver function damage (P < .05). CONCLUSIONS:Liver injury is common in non-ICU hospitalized COVID-19 patients. It may be related to systemic inflammation. Intense monitoring and evaluation of liver function in patients with severe pulmonary imaging lesions should be considered.
背景与目的: 自 2019 年 12 月以来，冠状病毒疾病 2019 (新型冠状病毒肺炎) 已经引起了全世界对全球流行的关注。新型冠状病毒肺炎患者的肝功能数据有限。本研究旨在探讨新型冠状病毒肺炎患者肝损伤的相关危险因素。 方法: 回顾性研究 2 0 0 年 2 月 ~ 2 0 0 年 2 月在金银滩医院非ICU病房进行。连续确诊新型冠状病毒肺炎例出院病例入组。比较有肝损伤与无肝损伤患者的临床特点。 结果: 共纳入 79 例新型冠状病毒肺炎患者。新型冠状病毒肺炎患者丙氨酸转氨酶 (ALT) 、天冬氨酸转氨酶 (AST) 和胆红素水平升高分别为 31.6% 、 35.4% 和 5.1%。整个队列ALT、AST和bilir u bin的中位val u e为 36.5 (17.5 ~ 71.5) U/L，34.5 (25.3 ~ 55.3) U/L和 12.7 (8.1 ~ 15.4) mmol/L分别。两组患者在年龄、既往病史、症状等方面差异无统计学意义。男性在感染新型冠状病毒肺炎时更易发生肝损伤 (P < .05); 与无肝损伤患者相比，肝损伤患者白细胞计数、中性粒细胞、CRP和CT评分 (P <.05)，住院时间较长 (P <.05)。Logistic回归分析提示CT肺部病变程度是肝功能损害的预测因子 (P <.05)。 结论: 肝损伤常见于非ICU住院新型冠状病毒肺炎患者。可能与全身炎症有关。应考虑对肺部严重影像学病变患者进行强烈的肝功能监测和评估。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.