Data_Sheet_1_Multicenter Analysis of Liver Injury Patterns and Mortality in COVID-19.docx

Background and Aim: Liver test abnormalities are common in COVID-19 patients. The aim of our study was to determine risk factors for different liver injury patterns and to evaluate the relationship between liver injury patterns and prognosis in patients with COVID-19.
Methods: We retrospectively analyzed patients admitted between January 1st to March 10th, with laboratory-confirmed COVID-19 and followed them up to April 20th, 2020. Information of clinical features of patients was collected for analysis.
Results: As a result, a total of 838 hospitalized patients with confirmed COVID-19, including 48.8% (409/838) patients with normal liver function and 51.2% (429/838) patients with liver injury were analyzed. Abnormal liver function tests are associated with organ injuries, hypoxia, inflammation, and the use of antiviral drugs. Hepatocellular injury pattern was associated with hypoxia. The mortality of the hepatocellular injury pattern, cholestatic pattern and mixed pattern were 25, 28.2, and 22.3%, respectively, while the death rate was only 6.1% in the patients without liver injury. Multivariate analyses showed that liver injury with cholestatic pattern and mixed pattern were associated with increased mortality risk.
Conclusions: Our study confirmed that hepatocellular injury pattern that may be induced by hypoxia was not risk factor for mortality in SARS-COV-2 infection, while liver injury with mixed pattern and cholestatic pattern that might be induced by SARS-CoV-2 directly might be potential risk factors for increased mortality in COVID-19 patients.

研究背景与目的：新型冠状病毒肺炎（COVID-19）患者中肝功能检测异常较为多见。本研究旨在明确不同肝损伤类型的危险因素，并评估COVID-19患者肝损伤类型与预后的相关性。
研究方法：本研究对2020年1月1日至3月10日期间收治的实验室确诊COVID-19患者进行回顾性分析，随访截至2020年4月20日，并收集患者的临床特征信息开展分析。
研究结果：最终共纳入838例确诊COVID-19住院患者，其中48.8%（409/838）患者肝功能正常，51.2%（429/838）患者合并肝损伤。肝功能检测异常与器官损伤、低氧血症、炎症反应及抗病毒药物使用相关。肝细胞损伤型肝损伤与低氧血症存在关联。肝细胞损伤型、胆汁淤积型及混合型肝损伤患者的病死率分别为25.0%、28.2%及22.3%，而无肝损伤患者的病死率仅为6.1%。多因素分析显示，合并胆汁淤积型与混合型肝损伤与病死率升高显著相关。
研究结论：本研究证实，由低氧血症诱导的肝细胞损伤型肝损伤并非严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者的死亡危险因素；而可能由SARS-CoV-2直接诱导的混合型及胆汁淤积型肝损伤，或为COVID-19患者病死率升高的潜在危险因素。