BACKGROUND Coronavirus disease 2019(COVID-19)has become a worldwide pandemic.We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing th...BACKGROUND Coronavirus disease 2019(COVID-19)has become a worldwide pandemic.We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing the epidemiological,clinical,and laboratory data for 218 COVID-19 patients and identifying the risk factors for liver injury by multivariate analysis.AIM To investigate the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.METHODS The 218 patients included 94 males(43.1%),aged 22 to 94(50.1±18.4)years.Elevated aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were present in 42(53.2%)and 36(45.6%)cases,respectively,and 79(36.2%)patients had abnormally elevated transaminase levels at admission.Patients with liver injury were older than those with normal liver function by a median of 12 years,with a significantly higher frequency of males(68.4%vs 28.8%,P<0.001)and more coexisting illnesses(48.1%vs 27.3%,P=0.002).Significantly more patients had fever and shortness of breath(87.3%vs 69.8%and 29.1%vs 14.4%,respectively)in the liver injury group.Only 12(15.2%)patients had elevated total bilirubin.ALT and AST levels were mildly elevated[1-3×upper limit of normal(ULN)]in 86.1%and 92.9%of cases,respectively.Only two(2.5%)patients had an ALT or AST level>5×ULN.Elevatedγ-glutamyl transpeptidase was present in 45(57.0%)patients,and 86.7%of these had aγ-glutamyl-transpeptidase level<135 U/L(3×ULN).Serum alkaline phosphatase levels were almost normal in all patients.Patients with severe liver injury had a significantly higher frequency of abnormal transaminases than non-severe patients,but only one case had very high levels of aminotransferases.RESULTS Multivariate analysis revealed that male sex,high D-dimer level,and high neutrophil percentage were linked to a higher risk of liver injury.The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels in patients in Wuhan.Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.CONCLUSION Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.展开更多
目的 探讨窒息相关新生儿急性肾损伤(AKI)的危险因素及临床特征。方法 回顾性分析2020年1月—2023年12月于南京医科大学第一附属医院新生儿重症监护室(NICU)住院的窒息相关AKI患儿(AKI组,n=100)及窒息但无AKI的患儿(对照组,n=228)的临...目的 探讨窒息相关新生儿急性肾损伤(AKI)的危险因素及临床特征。方法 回顾性分析2020年1月—2023年12月于南京医科大学第一附属医院新生儿重症监护室(NICU)住院的窒息相关AKI患儿(AKI组,n=100)及窒息但无AKI的患儿(对照组,n=228)的临床资料,分析窒息相关新生儿AKI的危险因素及临床特征。结果 AKI组与对照组乳酸、碱剩余(BE)、血钾、血肌酐、尿素氮等指标水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,低5 min Apgar评分、高乳酸水平、高血糖是窒息相关新生儿AKI发生的独立危险因素。5 min Apgar评分、乳酸及血糖预测AKI发生的曲线下面积(AUC)分别为0.825(95%CI:0.767~0.882)、0.968(95%CI:0.942~0.993)及0.845(95%CI:0.795~0.894)。2组产妇妊娠高血压发生率比较,差异有统计学意义(P<0.05)。AKI组与对照组1 min Apgar评分、5 min Apgar评分以及宫内窘迫发生率比较,差异有统计学意义(P<0.05)。AKI组呼吸窘迫综合征(RDS)、呼吸衰竭、坏死性小肠结肠炎(NEC)、颅内出血重度、肺出血、利尿剂使用、血液净化等指标与对照组比较,差异均有统计学意义(P<0.05)。AKI组死亡24例,其中16例为AKI 3期,8例为AKI 2期,对照组死亡3例,2组死亡人数占比差异有统计学意义(P<0.05)。结论 低5 min Apgar评分、高乳酸水平、高血糖是AKI发生的独立危险因素。AKI患儿易合并多器官功能障碍,窒息相关新生儿AKI可导致患儿的病死率升高,因此采取综合防治措施至关重要。展开更多
基金Supported by the Health and Family Planning Commission of Wuhan,No.WX18Y04.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has become a worldwide pandemic.We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing the epidemiological,clinical,and laboratory data for 218 COVID-19 patients and identifying the risk factors for liver injury by multivariate analysis.AIM To investigate the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.METHODS The 218 patients included 94 males(43.1%),aged 22 to 94(50.1±18.4)years.Elevated aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were present in 42(53.2%)and 36(45.6%)cases,respectively,and 79(36.2%)patients had abnormally elevated transaminase levels at admission.Patients with liver injury were older than those with normal liver function by a median of 12 years,with a significantly higher frequency of males(68.4%vs 28.8%,P<0.001)and more coexisting illnesses(48.1%vs 27.3%,P=0.002).Significantly more patients had fever and shortness of breath(87.3%vs 69.8%and 29.1%vs 14.4%,respectively)in the liver injury group.Only 12(15.2%)patients had elevated total bilirubin.ALT and AST levels were mildly elevated[1-3×upper limit of normal(ULN)]in 86.1%and 92.9%of cases,respectively.Only two(2.5%)patients had an ALT or AST level>5×ULN.Elevatedγ-glutamyl transpeptidase was present in 45(57.0%)patients,and 86.7%of these had aγ-glutamyl-transpeptidase level<135 U/L(3×ULN).Serum alkaline phosphatase levels were almost normal in all patients.Patients with severe liver injury had a significantly higher frequency of abnormal transaminases than non-severe patients,but only one case had very high levels of aminotransferases.RESULTS Multivariate analysis revealed that male sex,high D-dimer level,and high neutrophil percentage were linked to a higher risk of liver injury.The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels in patients in Wuhan.Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.CONCLUSION Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.
文摘目的 探讨窒息相关新生儿急性肾损伤(AKI)的危险因素及临床特征。方法 回顾性分析2020年1月—2023年12月于南京医科大学第一附属医院新生儿重症监护室(NICU)住院的窒息相关AKI患儿(AKI组,n=100)及窒息但无AKI的患儿(对照组,n=228)的临床资料,分析窒息相关新生儿AKI的危险因素及临床特征。结果 AKI组与对照组乳酸、碱剩余(BE)、血钾、血肌酐、尿素氮等指标水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,低5 min Apgar评分、高乳酸水平、高血糖是窒息相关新生儿AKI发生的独立危险因素。5 min Apgar评分、乳酸及血糖预测AKI发生的曲线下面积(AUC)分别为0.825(95%CI:0.767~0.882)、0.968(95%CI:0.942~0.993)及0.845(95%CI:0.795~0.894)。2组产妇妊娠高血压发生率比较,差异有统计学意义(P<0.05)。AKI组与对照组1 min Apgar评分、5 min Apgar评分以及宫内窘迫发生率比较,差异有统计学意义(P<0.05)。AKI组呼吸窘迫综合征(RDS)、呼吸衰竭、坏死性小肠结肠炎(NEC)、颅内出血重度、肺出血、利尿剂使用、血液净化等指标与对照组比较,差异均有统计学意义(P<0.05)。AKI组死亡24例,其中16例为AKI 3期,8例为AKI 2期,对照组死亡3例,2组死亡人数占比差异有统计学意义(P<0.05)。结论 低5 min Apgar评分、高乳酸水平、高血糖是AKI发生的独立危险因素。AKI患儿易合并多器官功能障碍,窒息相关新生儿AKI可导致患儿的病死率升高,因此采取综合防治措施至关重要。
