Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2005; 11(14): 2148-2153
Published online Apr 14, 2005. doi: 10.3748/wjg.v11.i14.2148
Clinical significance of hepatic derangement in severe acute respiratory syndrome
Henry Lik-Yuen Chan, Ambrose Chi-Pong Kwan, Ka-Fai To, Sik-To Lai, Paul Kay-Sheung Chan, Wai-Keung Leung, Nelson Lee, Alan Wu, Joseph Jao-Yiu Sung
Henry Lik-Yuen Chan, Wai-Keung Leung, Nelson Lee, Alan Wu, Joseph Jao-Yiu Sung, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
Ambrose Chi-Pong Kwan, Sik-To Lai, Department of Medicine, Princess Margaret Hospital, Hong Kong SAR, China
Ka-Fai To, Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong SAR, China
Paul Kay-Sheung Chan, Department of Microbiology, Chinese University of Hong Kong, Hong Kong SAR, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Joseph Jao-Yiu Sung, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, Shatin, Hong Kong SAR, China. joesung@cuhk.edu.hk
Telephone: +852-26323132 Fax: +852-26451699
Received: July 26, 2004
Revised: July 28, 2004
Accepted: September 19, 2004
Published online: April 14, 2005
Abstract

AIM: 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 > 5×ULN as a cut-off and after adjusting for potential confounding factors, the odds ratio of peak ALT > 5×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.

CONCLUSION: Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severe hepatitis had worse clinical outcome.

Keywords: SARS; Hepatitis; Hepatitis B virus; Coronavirus