BACKGROUND Coronavirus disease 2019(COVID-19)infection is known to cause abnormal hepatic enzymes.The long term consequences of such elevations are uncertain.AIM To assessed the prevalence and prognostic value of init...BACKGROUND Coronavirus disease 2019(COVID-19)infection is known to cause abnormal hepatic enzymes.The long term consequences of such elevations are uncertain.AIM To assessed the prevalence and prognostic value of initial liver enzymes in a large cohort of COVID-19 patients.METHODS We reviewed electronic medical records of 10614 COVID-19 patients without known chronic liver disease who were admitted to our health system from March 1,2020,to April 30,2020.We analyzed baseline demographics and liver chemistries.The primary outcome was in-hospital mortality,and the secondary outcome was a composite of in-hospital mortality or need for mechanical ventilation.RESULTS Subjects with abnormal liver tests had increased risks of mortality and composite outcome when compared to patients with normal measurements on unadjusted analysis and after adjustment for demographic factors.CONCLUSION In our diverse patient population,liver enzyme abnormalities are associated with increased mortality and the need for mechanical ventilation in subjects without chronic liver disease.Cholestasis patients are at the greatest risk for poor outcomes.展开更多
The increased incidence of hepatocellular carcinoma(HCC)in the last several decades in the United States and worldwide has partly resulted from an increase in hepatitis C virus(HCV)infection.HCV carcinogenesis is spec...The increased incidence of hepatocellular carcinoma(HCC)in the last several decades in the United States and worldwide has partly resulted from an increase in hepatitis C virus(HCV)infection.HCV carcinogenesis is speculated to be indirectly related to multiple steps from inflammation to fibrosis and advanced fibrosis/cirrhosis over 20 or more years.However,the direct carcinogenic potential from HCV may explain HCC occurring in non-cirrhotic HCV patients.Highly potent direct-acting antivirals(DAAs)in recent years have changed hepatitis C treatment significantly and have resulted in the sustained virologic response(SVR)rate exceeding 90%.Although initial reports concerned the increase in de novo and recurrent HCC associated with DAAs,more recent studies showed that DAA-induced SVR on the contrary reduced risk of HCV-associated HCC without increasing its recurrence.The International Consortium of Hepatitis C Therapeutic Registry and Research Network(HCV-TARGET)database and other resources of HCV patients treated with DAA collectively in the near future most likely will be able to show definitive evidence on the risk of HCC occurrence and recurrence after DAA with SVR.The long-term risk of HCC in chronic hepatitis C patients with advanced fibrosis or cirrhosis remains high after DAAs with SVR.Thus,HCC surveillance on this sub-group of patients is important for early detection and intervention of HCC.展开更多
基金by National Institute on Aging of the National Institute of Health,No.R24AG06419National Library of Medicine of the National Institutes of Health,No.R01LM012836.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)infection is known to cause abnormal hepatic enzymes.The long term consequences of such elevations are uncertain.AIM To assessed the prevalence and prognostic value of initial liver enzymes in a large cohort of COVID-19 patients.METHODS We reviewed electronic medical records of 10614 COVID-19 patients without known chronic liver disease who were admitted to our health system from March 1,2020,to April 30,2020.We analyzed baseline demographics and liver chemistries.The primary outcome was in-hospital mortality,and the secondary outcome was a composite of in-hospital mortality or need for mechanical ventilation.RESULTS Subjects with abnormal liver tests had increased risks of mortality and composite outcome when compared to patients with normal measurements on unadjusted analysis and after adjustment for demographic factors.CONCLUSION In our diverse patient population,liver enzyme abnormalities are associated with increased mortality and the need for mechanical ventilation in subjects without chronic liver disease.Cholestasis patients are at the greatest risk for poor outcomes.
文摘The increased incidence of hepatocellular carcinoma(HCC)in the last several decades in the United States and worldwide has partly resulted from an increase in hepatitis C virus(HCV)infection.HCV carcinogenesis is speculated to be indirectly related to multiple steps from inflammation to fibrosis and advanced fibrosis/cirrhosis over 20 or more years.However,the direct carcinogenic potential from HCV may explain HCC occurring in non-cirrhotic HCV patients.Highly potent direct-acting antivirals(DAAs)in recent years have changed hepatitis C treatment significantly and have resulted in the sustained virologic response(SVR)rate exceeding 90%.Although initial reports concerned the increase in de novo and recurrent HCC associated with DAAs,more recent studies showed that DAA-induced SVR on the contrary reduced risk of HCV-associated HCC without increasing its recurrence.The International Consortium of Hepatitis C Therapeutic Registry and Research Network(HCV-TARGET)database and other resources of HCV patients treated with DAA collectively in the near future most likely will be able to show definitive evidence on the risk of HCC occurrence and recurrence after DAA with SVR.The long-term risk of HCC in chronic hepatitis C patients with advanced fibrosis or cirrhosis remains high after DAAs with SVR.Thus,HCC surveillance on this sub-group of patients is important for early detection and intervention of HCC.
