Sars-Cov-2 Enfeksiyonunun Hepatobiliyer Sisteme Etkileri ve Klinik Özellikleri; Vaka-Kontrollü Çalışma

Year 2022, Volume: 3 Issue: 2, 157 - 166, 01.08.2022

Berrin Yalınbaş Kaya , Yonca Yılmaz Ürün , İsmail Yenilmez , Yeliz Mert Kantar , Ali Türeyen , Hatice Hamarat , Zeynep Irmak Kaya , Serdar Efe , Cansu Demiral Pamir Çerçi , Muslih Ürün

Abstract

Giriş: SARS-CoV-2 enfeksiyonuyla gelişen pandemi son 3 yıldır dünya çapında önemli bir sağlık sorunudur. COVID-19 hastalığında gelişen karaciğer hasarının patogenezi ve sonuçları hala belirsizdir. Biz de bu çalışmamızda, COVID-19 hastalarında karaciğer fonksiyon testi (KCFT) anormalliklerinin prevalansını, ilaçlarla ilişkisini, şiddetli ve şiddetli olmayan COVID-19 hastaları arasındaki farkı, yoğun bakımda ve serviste yatan hastalarda KCFT seyrinin sonuçlarını araştırdık. Yöntemler: Çalışmaya Eskişehir Şehir Hastanesine Mart 2020 ve Ekim 2020 tarihleri arasında başvuran 389 hasta çalışmaya dahil edildi. RT-PCR (+) hasta ve RT-PCR(-) kontrol grubunun demografik verileri (yaş, cinsiyet, komorbiditeler, semptomları), laboratuvar parametreleri, radyolojik tetkikleri, servis ve yoğun bakım takipleri ve kullanılan ilaçlar retrospektif olarak kaydedildi. COVID-19’lu tüm hastalar şiddetli veya hafif ve orta şiddetli vakalar olarak sınıflandırıldı. Bulgular: RT-PCR (+) 321 hastanın 115’inde (%35,2), PCR (-) kontrol grubunda 68 hastanın 10’unda (%14,7) anormal KCFT saptandı. Hastaneye yatış anında karaciğer testleri (Alanin aminotransferaz, Aspartat aminotransferaz, total bilirubin, Gama-glutamil transferaz, Alkalen fosfataz) hasta grubunda sırasıyla %10,3, %22,7, %4,9, %11,4 ve %1,2; kontrol grubunda ise %1,9, %2,9, %2, %3,3, %0,8 oranında yüksekti (p=0,610, p=0,00, p=0,269, p=0,198, P=0,158). Antibiyotik (Levofloksasin, Seftriakson, Klaritromisin, Tazobaktam, Karbapenem), düşük molekül ağırlıklı heparin (DMAH) ve antiviral (favipravir) tedavi alan hastalarda KCFT’de anlamlı yükseklik saptandı (p=0,001, p=0,001, p=0,001). KCFT’de yükselme hafif şiddetli vaka grubunda (%40,2; %8,2) ve şiddetli vaka grubunda (%41,2; %5,2) belirgin iken, kontrol grubunda ise düşüktü (%0,5). Sonuç: SARS-CoV-2 enfeksiyonda, karaciğer hasarı sık görülür ancak oldukça hafiftir. Şiddetli COVID-19 hastalarında anormal karaciğer testlerinin sıklığı, hafif hastalığı olanlara göre daha yüksektir. Hastalık şiddeti, önceden var olan karaciğer hastalığı ve ileri yaş, karaciğer hasarı için risktir. İlaç kaynaklı karaciğer hasarı, sistemik inflamatuvar yanıt sendromu ve hipoksi tarafından tetiklenen karaciğer hasarı, COVID-19'da karaciğer hasarı için esas etiyolojik faktörler olabilir.

Keywords

COVID-19, Karaciğer hasarı, SARS-CoV-2

Supporting Institution

Çalışmamızda, ticari firma ya da firmaların katkısı bulunmamaktadır.

Thanks

Eskişehir Şehir Hastanesinde COVID-19 hastalarının tanı ve tedavisinde yer alan tüm hekim ve sağlık çalışanlarına teşekkür ediyoruz

Hepatobiliary System Effects And Clinical Features of Sars-Cov-2 Infection; Case-Control Study

Abstract

Introduction: Pandemic caused by SARS-CoV-2 infection has been an important health problem worldwide for the last 3 years. The pathogenesis and consequences of liver injury developed in COVID-19 disease are still unclear. We investigated the prevalence of liver function tests (LFTs) abnormalities in COVID-19 patients, their relationship with drugs, the difference between severe and non-severe COVID-19 patients, and the results of the course of LFTs among patients hospitalized in intensive care units and clinics. Methods: 389 patients who applied to Eskişehir City Hospital between March 2020 and October 2020 were included in the study. Demographic data of RT-PCR (+) patients and RT-PCR (-) control groups (age, gender, comorbidities, symptoms), laboratory parameters, radiological examinations, follow-ups in the clinics and intensive care units, drugs used for the infection were collected retrospectively. All patients with COVID-19 were classified as severe cases or mild to moderate cases groups. Results: Abnormal LFTs were found in 115 (35.2%) of 321 patients with RT-PCR(+), and in 10 (14.7%) of 68 patients in the PCR(-) control group. LFTs at the time of hospitalization were 10.3%, 22.7%, 4.9%, 11.4% and 1.2% in the patient group, respectively; in the control group, it was 1.9%, 2.9%, 2%, 3.3%, 0.8% (p=0.610, p=0.00, p=0.269, p=0.198, p=0.158). There was a significant increase in LFTs in patients who received antibiotics (Levofloxacin, Ceftriaxone, Clarithromycin, Tazobactam, Carbapenem), low molecular weight heparins and antiviral (favipravir) treatments (p=0.001, p=0.001, p=0.001). While the increase in LFTs were significant in the mild (40.2%; 8.2%) and severe groups (41.2%; 5.2%), the number of patients with elevated LFTs in the control group was low (0.5%). Conclusion: Liver damage is common in SARS-CoV-2 infection, but it is quite mild. Patients with severe COVID-19 have a higher frequency of abnormal LFTs than those with mild disease. Disease severity, pre-existing liver disease, and advanced age are risk factors for liver damage. Drug-induced liver injury, systemic inflammatory response syndrome, and hypoxia-induced liver injury may be the main etiological factors for liver injury in COVID-19.

Keywords

COVID-19, Liver damage, SARS-CoV-2

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