Abstract
BackgroundInfection with SARS-CoV-2 has been associated with liver dysfunction, aggravation of liver burden, and liver injury. This study aimed to assess the effects of liver injuries on the clinical outcomes of patients with COVID-19.MethodsA total of 1520 patients with severe or critical COVID-19 from Huoshenshan Hospital, Wuhan, were enrolled. Chronic liver disease (CLD) was confirmed by consensus diagnostic criteria. Laboratory test results were compared between different groups. scRNA-seq data and bulk gene expression profiles were used to identify cell types associated with liver injury.ResultsA total of 10.98% of patients with severe or critical COVID-19 developed liver injury after admission that was associated with significantly higher rates of mortality (21.74%, p < 0.001) and intensive care unit admission (26.71%, p < 0.001). Pre-existing CLDs were not associated with a higher risk. However, fatty liver disease and cirrhosis were associated with higher risks, supported by evidences from single cell and bulk transcriptome analysis that showed more TMPRSS2+ cells in these tissues. By generating a model, we were able to predict the risk and severity of liver injury during hospitalization.ConclusionWe demonstrate that liver injury occurring during therapy as well as pre-existing CLDs like fatty liver disease and cirrhosis in patients with COVID-19 is significantly associated with the severity of disease and mortality, but the presence of other CLD is not associated. We provide a risk-score model that can predict whether patients with COVID-19 will develop liver injury or proceed to higher-risk stages during subsequent hospitalizations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12072-020-10123-0.
Highlights
A novel coronavirus named SARS-CoV-2 began to rapidly spread across the world in December 2019 and was declared a global pandemic by the World Health Organization
Among the 161 COVID-19 patients with liver injury during hospitalization, 59 were hepatocellular type, 61 cholestatic type, and 41 mixed type (Fig. S2A), but there was no significant difference in prognosis (Fig. S2B, Fig. S2C) and treatments (Fig. S2D)
We found that patients who developed liver injuries during hospitalization had higher mortality and ICU admission rates than those without liver injury and with liver injury upon admission
Summary
A novel coronavirus named SARS-CoV-2 began to rapidly spread across the world in December 2019 and was declared a global pandemic by the World Health Organization. SARS-CoV-2 S protein is cleaved by a plasma membrane-associated type II transmembrane serine protease (TMPRSS2), leading to membrane fusion which is essential to release the viral contents into the infected cell cytosol. Both ACE2 and TMPRSS2 are essential for viral spreading to the host cell [1]. Results A total of 10.98% of patients with severe or critical COVID-19 developed liver injury after admission that was associated with significantly higher rates of mortality (21.74%, p < 0.001) and intensive care unit admission (26.71%, p < 0.001). We provide a risk-score model that can predict whether patients with COVID-19 will develop liver injury or proceed to higher-risk stages during subsequent hospitalizations
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