Clinical significance of hepatic derangement in severe acute respiratory syndrome.
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.
Chan
Henry-Lik-Yuen
HL
Department of Medicine and Therapeutics, Chinese University of Hong Kong, China.
Kwan
Ambrose-Chi-Pong
AC
To
Ka-Fai
KF
Lai
Sik-To
ST
Chan
Paul Kay-Sheung
PK
Leung
Wai-Keung
WK
Lee
Nelson
N
Wu
Alan
A
Sung
Joseph Jao-Yiu
JJ
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
D000410:Alanine Transaminase