新冠肺炎患者肝肾功能损害的临床特征及其与重症及死亡的相关性分析

Clinical characteristics of liver and kidney injuries and correlation with severity and mortality in patients with COVID-19

目的描述新型冠状病毒肺炎(COVID-19)患者肝肾功能损害的临床特征及其对重症化和病死率的影响。方法以2020年2月4日至2020年4月16日在火神山医院、金银潭医院、泰康同济医院确诊,且无肝肾基础疾病的3548例COVID-19患者为分析对象,通过病历提取患者一般资料、临床特征、实验室结果及死亡等信息,采用SPSS 23.0进行数据描述和分析。结果3548例COVID-19患者纳入研究,重症及以上病例875例(24.7%),死亡91例(2.6%);丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和肌酐(Cr)升高比例分别为14.6%(513/3548)、3.4%(119/3548)、2.8%(101/3548);与ALT、AST、Cr正常的COVID-19患者相比,ALT升高的患者发生重症化和死亡的风险均未显著增加,AST、Cr升高的患者发生重症和死亡的风险均显著升高(P<0.05);肝或肾功能损伤者和肝肾功能均损伤者发生重症的风险分别是肝肾功能正常者的2.32倍(95%CI:1.73-3.10)和11.40倍(95%CI:2.36-54.98),发生死亡的风险分别是肝肾功能正常者的5.21倍(95%CI:3.10-8.75)和13.53倍(95%CI:2.76-66.32);采用Logistic回归筛选出重症及死亡的独立相关因素作为校正因素后发现,肝或肾功能损伤的人群重症及死亡发生的风险分别是肝肾功能正常人群的1.612倍(95%CI:1.168-2.224)、2.907倍(95%CI:1.612-5.242)。结论COVID-19患者若出现肝功能损害和肾功能损害,其重症化倾向和死亡风险明显升高,应进行早期干预。

Objective To describe the clinical characteristics of liver and kidney injuries and investigate its effect on the severity and mortality in the COVID-19 patients.Methods A total of 3548 patients diagnosed with COVID-19 but without liver and kidney diseases admitted in the Huoshenshan Hospital,Jinyintan Hospital and Taikang Tongji Hospital from February 4,2020 to April 16,2020 were recruited in this study.Their clinical data were extracted from medical database,including general information,clinical features,laboratory results and outcomes such as death were collected and analyzed.SPSS statistics 23.0 was used to perform the statistical description and analysis.Results Among the 3548 patients with COVID-19,875(24.7%)cases were severe illness and above and 91(2.6%)died during hospitalization.The proportions of the patients with higher alanine amiotransferase(ALT),aspartate aminotransferase(AST)and creatinine(Cr)were 14.6%(513/3548),3.4%(119/3548)and 2.8%(101/3548),respectively.Compared with the patients with normal ALT,AST and Cr,the patients with elevated ALT did not have a significantly increased risk of severe illness or death(P>0.05),and the risk of severe illness and death was significantly increased in those with elevated AST and Cr(P<0.05).The risk of severe disease was 2.32 times(95%CI:1.73-3.10)and 11.40 times(95%CI:2.36-54.98)for those with single or both liver and kidney injuries,and the risk of death was 5.21 times(95%CI:3.10-8.75)and 13.53 times(95%CI:2.76-66.32)for those with normal liver and kidney function,respectively.Logistic regression analysis indicated that after independent factors related to severe illness and death screened out as correction factors,the risk of severe illness and death was 1.612 times(95%CI:1.17-2.22)and 2.907 times(95%CI:1.61-5.24)of patients with liver or kidney injuries when compared with those with normal function,respectively.Conclusion The COVID-19 patients with liver and renal injuries have a significantly increased tendency to become severity and mortality,and should undergo early intervention.