Significance of liver dysfunction associated with decreased hepatic CT attenuation values in Japanese patients with seve
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ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT
Significance of liver dysfunction associated with decreased hepatic CT attenuation values in Japanese patients with severe COVID-19 Yoshihito Uchida1 • Hayato Uemura1 • Shinpei Yamaba1 • Daisuke Hamada1 Norihito Tarumoto2 • Shigefumi Maesaki2 • Satoshi Mochida1
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Received: 24 June 2020 / Accepted: 31 July 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background COVID-19 has emerged as a threat to human health. Liver dysfunction has been reported to occur frequently in patients with COVID-19, although its significance has not yet been elucidated. Methods The subjects were 35 patients with COVID-19, and clinical characteristics were retrospectively analyzed. COVID-19 patients requiring ventilator were classified as having severe COVID-19. Results All 35 patients were diagnosed as having mild-tomoderate COVID-19 at admission, but the severity aggravated to severe in 8 patients (22.9%) in hospital. Hepatocellular-type liver injury, defined as elevation of the serum AST and/or ALT levels to C 3 times the ULN, was seen in 2 patients (5.7%), and cholestasis-type liver injury, defined as elevation of the serum ALP, c-GTP and/or total bilirubin levels to C twice the ULN, was seen in 4 patients (11.4%). A total of 9 patients (25.7%) fulfilled the criteria for liver injury. The percentage of patients with liver injury was higher in patients with severe COVID-19 than in the remaining patients (P = 0.001). Both the hepatic CT attenuation values and the liver-to-spleen attenuation (L/S) ratios at admission were lower in the former patients than in the latter patients (P \ 0.001). ROC curve revealed the optimal cut-off value of the L/S ratio of 1.03 for discriminating between patients with severe and non-severe
& Satoshi Mochida [email protected] 1
Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-Gun, Saitama 350-0495, Japan
2
Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan
diseases. The hepatic CT attenuation values increased at the remission phase of the disease as compared to the values at admission (P = 0.012). Conclusion Liver dysfunction associated with reduced hepatic CT attenuation values correlated with the disease severity in patients with COVID-19. Keywords COVID-19 CT values Liver injury SARSCoV-2
Introduction The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first isolated in December 2019 in Wuhan, China, as the causative virus of a severe form of pneumonia which was subsequently named coronavirus disease 2019 (COVID-19) [1, 2]. Since then, the virus has spread rapidly worldwide, and more than 8 million people with confirmed infection and 400,000 deaths from COVID-19 have been reported from around the world until June 2020 [3]. Although pneumonia is the main manifestation in patients with COVID-19 and is the main culprit in patients with unfavorable outcomes, C
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