In:
Annals of Intensive Care, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-12)
Abstract:
SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels ( 〉 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO 2 /FiO 2: 82 (58–114) vs. 117 (83–155); p 〈 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p 〈 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p 〈 0.05) and renal replacement therapy (86% vs. 30%; p 〈 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p 〈 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively ( p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p 〈 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p 〈 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p 〈 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p 〈 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.
Type of Medium:
Online Resource
ISSN:
2110-5820
DOI:
10.1186/s13613-021-00835-3
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2021
detail.hit.zdb_id:
2617094-2
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