title: Clinical significance of hepatic derangement in severe acute respiratory syndrome.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severe hepatitis had worse clinical outcome.
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, China.
authors.forename: Henry-Lik-Yuen
authors.initials: HL
authors.lastname: Chan
authors.forename: Ambrose-Chi-Pong
authors.initials: AC
authors.lastname: Kwan
authors.forename: Ka-Fai
authors.initials: KF
authors.lastname: To
authors.forename: Sik-To
authors.initials: ST
authors.lastname: Lai
authors.forename: Paul Kay-Sheung
authors.initials: PK
authors.lastname: Chan
authors.forename: Wai-Keung
authors.initials: WK
authors.lastname: Leung
authors.forename: Nelson
authors.initials: N
authors.lastname: Lee
authors.forename: Alan
authors.initials: A
authors.lastname: Wu
authors.forename: Joseph Jao-Yiu
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006505:Hepatitis / Q000401:mortality / Q000473:pathology* / Q000821:virology*; D006509:Hepatitis B / Q000150:complications / Q000401:mortality; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D045169:Severe Acute Respiratory Syndrome / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D012720:Severity of Illness Index
chemical_list: D000410:Alanine Transaminase