Haijun Huang1, Hong Li1,2, Shanshan Chen1,3, Xianlong Zhou4,5, Xuan Dai1,6, Jia Wu7, Jun Zhang8, Lina Shao9, Rong Yan1, Mingshan Wang1, Jiafeng Wang10, Yuexing Tu11, Minghua Ge10. 1. Department of Infectious Disease, Zhejiang Provincial People's Hospital, People's Hospital Affiliated of Hangzhou Medical College, Hangzhou, China. 2. Medical College of Qingdao University, Qingdao, China. 3. Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, China. 4. Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, China. 5. Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan, China. 6. Hangzhou Medical College, Hangzhou, China. 7. Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital affiliated of Hangzhou Medical College, Hangzhou, China. 8. Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital affiliated of Hangzhou Medical College, Hangzhou, China. 9. Department of Nephrology, Zhejiang Provincial People's Hospital, People's Hospital affiliated of Hangzhou Medical College, Hangzhou, China. 10. Department of Head, Neck and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital affiliated of Hangzhou Medical College, Hangzhou, China. 11. Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, People's Hospital affiliated of Hangzhou Medical College, Hangzhou, China.
Abstract
Purpose: Coronavirus disease 2019 (COVID-19) has been associated with acute liver injury in reports worldwide. But no studies to date have described hypoxic hepatitis (HH) in patients with COVID-19. We aim to identify the prevalence of and possible mechanisms of HH in COVID-19 patients in the Intensive Care Unit (ICU). Methods: This retrospective study was conducted on 51 patients with confirmed SARS-CoV-2 infection in the ICU at Zhongnan Hospital of Wuhan University from December 21, 2019, to March 11, 2020. Information on clinical features of enrolled patients was collected for analysis. Results: HH was observed in 5.88% of the ICU patients with SARS-CoV-2 infection. All HH patients were progressing to respiratory failure and peak alanine aminotransferase (ALT) values were 1665, 1414, and 1140 U/L during hospitalization, respectively. All patients with HH died as a result of the deterioration of multiple organ failure (MOF). The dynamic changes of ALT, aspartate transaminase (AST), and total bilirubin (TBIL) levels were more dramatic in HH groups. Levels of TBIL, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6(IL-6) showed statistically significant elevation in HH cases compared with that in non-HH cases (P < 0.001). Besides, the median survival time of the HH group was significantly shorter than the non-HH group (P < 0.05). Conclusions: In ICU, HH was not a rare condition in patients with severe COVID-19 and has a high mortality. The main causes of HH are respiratory and cardiac failure and may be associated with the immune-mediated inflammatory response. Clinicians should search for any underlying hemodynamic or respiratory instability even in patients with normal ALT levels on admission.
Purpose: Coronavirus disease 2019 (COVID-19) has been associated with acute liver injury in reports worldwide. But no studies to date have described hypoxic hepatitis (HH) in patients with COVID-19. We aim to identify the prevalence of and possible mechanisms of HH in COVID-19patients in the Intensive Care Unit (ICU). Methods: This retrospective study was conducted on 51 patients with confirmed SARS-CoV-2 infection in the ICU at Zhongnan Hospital of Wuhan University from December 21, 2019, to March 11, 2020. Information on clinical features of enrolled patients was collected for analysis. Results:HH was observed in 5.88% of the ICU patients with SARS-CoV-2 infection. All HHpatients were progressing to respiratory failure and peak alanine aminotransferase (ALT) values were 1665, 1414, and 1140 U/L during hospitalization, respectively. All patients with HH died as a result of the deterioration of multiple organ failure (MOF). The dynamic changes of ALT, aspartate transaminase (AST), and total bilirubin (TBIL) levels were more dramatic in HH groups. Levels of TBIL, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6(IL-6) showed statistically significant elevation in HH cases compared with that in non-HH cases (P < 0.001). Besides, the median survival time of the HH group was significantly shorter than the non-HH group (P < 0.05). Conclusions: In ICU, HH was not a rare condition in patients with severe COVID-19 and has a high mortality. The main causes of HH are respiratory and cardiac failure and may be associated with the immune-mediated inflammatory response. Clinicians should search for any underlying hemodynamic or respiratory instability even in patients with normal ALT levels on admission.
Authors: José C Páez-Franco; José L Maravillas-Montero; Nancy R Mejía-Domínguez; Jiram Torres-Ruiz; Karla M Tamez-Torres; Alfredo Pérez-Fragoso; Juan Manuel Germán-Acacio; Alfredo Ponce-de-León; Diana Gómez-Martín; Alfredo Ulloa-Aguirre Journal: PLoS One Date: 2022-09-20 Impact factor: 3.752