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Clinical significance of hepatic derangement in severe acute respiratory syndrome

World Journal of Gastroenterology 2005年第14期11卷 2148-2153页

作者： Henry Lik-Yuen Chan ambrose chi-pong kwan Ka-Fai To Sik-To Lai Paul Kay-Sheung Chan Wai-Keung Leung Nelson Lee Alan Wu Joseph Jao-Yiu Sung Department of Medicine and Therapeutics chinese University of Hong Kong Hong Kong SARChina Department of Medicine Princess Margaret Hospital Hong Kong SARChina Department of Anatomical and Cellular Pathology chinese University of Hong Kong Hong Kong SARChina Department of Microbiology chinese University of Hong Kong Hong Kong SARChina

AIM:Elevation of alanine aminotransferase (ALT) level is commonly seen among patients suffering from severe acute respiratory syndrome (SARS). We report the progression and clinical significance of liver derangement in a large cohort of SARS patient. METHODS: Serial assay of serum ALT was followed in patients who fulfilled the WHO criteria of SARS. Those with elevated ALT were compared with those with normal liver functions for clinical outcome. Serology for hepatitis B virus (HBV) infection was checked. Adverse outcomes were defined as oxygen desaturation, need of intensive care unit (ICU) and mechanical ventilation and death. RESULTS: Two hundred and ninety-four patients were included in this study. Seventy (24%) patients had elevated serum ALT on admission and 204 (69%) patients had elevated ALT during the subsequent course of illness. Using peak ALT >5xULN as a cut-off and after adjusting for potential confounding factors, the odds ratio of peak ALT >5x ULN for oxygen desaturation was 3.24 (95%CI 1.23-8.59, P= 0.018), ICU care was 3.70 (95%CI 1.38-9.89, P= 0.009), mechanical ventilation was 6.64 (95%CI 2.22-19.81, P = 0.001) and death was 7.34 (95%CI 2.28-24.89, P= 0.001). Ninety-three percent of the survived patients had ALT levels normalized or were on the improving trend during follow-up. Chronic hepatitis B was not associated with worse clinical outcomes. CONCLUSION: Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severe hepatitis had worse clinical outcome.

关键词： SARS Hepatitis Hepatitis B virus Coronavirus

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