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. 2005 Apr 14;11(14):2148-53.
doi: 10.3748/wjg.v11.i14.2148.

Clinical significance of hepatic derangement in severe acute respiratory syndrome

Henry-Lik-Yuen Chan  1 , 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
Affiliations

Clinical significance of hepatic derangement in severe acute respiratory syndrome

Henry-Lik-Yuen Chan et al. World J Gastroenterol. .

Abstract

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.

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Figures

Figure 1
Figure 1
Clinical outcomes of patients included in the study. ALT, alanine aminotransferase. 1One patient did not have serial ALT results. 2Two patients did not have follow-up ALT results after discharge.
Figure 2
Figure 2
A: Proportion of patients with different ALT levels at initial visit (n = 294), at peak ALT (n = 293; 1 missing data) and on last follow-up (n = 264; 27 patients died, 3 missing data). B: Proportion of patients with different serum bilirubin levels at initial visit (n = 294) and at peak bilirubin (n = 293, 1 missing data). C: Proportion of patients with different prothrombin time at initial visit (n = 293, one missing data) and at peak prothrombin time (n = 283, 11 missing data).
Figure 3
Figure 3
Median ALT and serum bilirubin levels of patients admitted to Prince of Wales Hospital (n = 138) from the day of fever onset to day 21 at hospital discharge. Both ALT and bilirubin levels were expressed as folds of ULN. Only patients who had at least one elevated ALT level during admission were included (n=104). ULN, upper limit of laboratory normal; solid line, serum ALT; broken line, serum bilirubin.
See this image and copyright information in PMC

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