PDF(Pubmed)
Abstract：
Beginning in October 2021 in the USA and elsewhere, cases of severe paediatric hepatitis of unknown aetiology were identified in young children. While the adenovirus and adenovirus-associated virus have emerged as leading aetiological suspects, we attempted to investigate a potential role for SARS-CoV-2 in the development of subsequent liver abnormalities.
We conducted a study using retrospective cohorts of deidentified, aggregated data from the electronic health records of over 100 million patients contributed by US healthcare organisations.
Compared with propensity score matched children with other respiratory infections, children aged 1-10 years with COVID-19 had a higher risk of elevated transaminases (HR (95% CI) 2.16 (1.74 to 2.69)) or total bilirubin (HR (95% CI) 3.02 (1.91 to 4.78)), or new diagnoses of liver diseases (HR (95% CI) 1.67 (1.21 to 2.30)) from 1 to 6 months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1-4 years) or illness requiring hospitalisation all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections.
These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver.
We conducted a study using retrospective cohorts of deidentified, aggregated data from the electronic health records of over 100 million patients contributed by US healthcare organisations.
Compared with propensity score matched children with other respiratory infections, children aged 1-10 years with COVID-19 had a higher risk of elevated transaminases (HR (95% CI) 2.16 (1.74 to 2.69)) or total bilirubin (HR (95% CI) 3.02 (1.91 to 4.78)), or new diagnoses of liver diseases (HR (95% CI) 1.67 (1.21 to 2.30)) from 1 to 6 months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1-4 years) or illness requiring hospitalisation all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections.
These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver.
摘要：
目标：从2021年10月在美国和其他地方开始，在幼儿中发现了病因不明的严重儿童肝炎病例。虽然腺病毒和腺病毒相关病毒已成为主要的病原学嫌疑人，我们试图研究SARS-CoV-2在随后的肝脏异常发展中的潜在作用.
方法：我们进行了一项研究，来自美国医疗机构提供的超过1亿患者的电子健康记录的汇总数据。
结果：与其他呼吸道感染患儿的倾向评分相匹配，1-10岁COVID-19患儿转氨酶(HR(95%CI)2.16(1.74至2.69))或总胆红素(HR(95%CI)3.02(1.91至4.78))升高的风险较高，或感染后1至6个月的肝脏疾病新诊断（HR（95％CI）1.67（1.21至2.30））。预先存在肝脏异常的患者，急性感染周围的肝脏异常，年龄较小(1-4岁)或需要住院治疗的疾病均有类似的风险升高.COVID-19后出现肝脏异常的儿童比其他感染后出现肝脏异常的儿童有更多的预先存在的疾病。
结论：这些结果表明SARS-CoV-2可能导致患者随后发生肝脏感染或非感染性肝脏疾病。虽然罕见(1000中~1)，SARS-CoV-2是随后肝功能异常或肝脏疾病诊断的风险。
方法：我们进行了一项研究，来自美国医疗机构提供的超过1亿患者的电子健康记录的汇总数据。
结果：与其他呼吸道感染患儿的倾向评分相匹配，1-10岁COVID-19患儿转氨酶(HR(95%CI)2.16(1.74至2.69))或总胆红素(HR(95%CI)3.02(1.91至4.78))升高的风险较高，或感染后1至6个月的肝脏疾病新诊断（HR（95％CI）1.67（1.21至2.30））。预先存在肝脏异常的患者，急性感染周围的肝脏异常，年龄较小(1-4岁)或需要住院治疗的疾病均有类似的风险升高.COVID-19后出现肝脏异常的儿童比其他感染后出现肝脏异常的儿童有更多的预先存在的疾病。
结论：这些结果表明SARS-CoV-2可能导致患者随后发生肝脏感染或非感染性肝脏疾病。虽然罕见(1000中~1)，SARS-CoV-2是随后肝功能异常或肝脏疾病诊断的风险。
