<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452021000400253</article-id>
<article-id pub-id-type="doi">10.1159/000513593</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Impact of Liver Test Abnormalities and Chronic Liver Disease on the Clinical Outcomes of Patients Hospitalized with COVID-19]]></article-title>
<article-title xml:lang="pt"><![CDATA[Impacto das alterações da bioquímica hepática e da doença hepática crónica nos resultados clínicos dos doentes hospitalizados com COVID-19]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Garrido]]></surname>
<given-names><![CDATA[Mónica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Guedes]]></surname>
<given-names><![CDATA[Tiago Pereira]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Joana Alves]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Falcão]]></surname>
<given-names><![CDATA[Daniela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Novo]]></surname>
<given-names><![CDATA[Inês]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Archer]]></surname>
<given-names><![CDATA[Sara]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rocha]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Maia]]></surname>
<given-names><![CDATA[Luís]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sarmento-Castro]]></surname>
<given-names><![CDATA[Rui]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pedroto]]></surname>
<given-names><![CDATA[Isabel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar Universitário do Porto Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Hospitalar Universitário do Porto Department of Infectious Diseases ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,University of Porto Instituto de Ciências Biomédicas Abel Salazar ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>08</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>08</month>
<year>2021</year>
</pub-date>
<volume>28</volume>
<numero>4</numero>
<fpage>253</fpage>
<lpage>264</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452021000400253&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452021000400253&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452021000400253&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Background and Aims:  The impact of SARS-CoV-2 infection on the liver and the possibility of chronic liver disease (CLD) as a risk factor for COVID-19 severity is not fully understood. Our goal was to describe clinical outcomes of COVID-19 inpatients regarding the presence of abnormal liver tests and CLD.  Methods: A retrospective analysis of patients with SARS-CoV-2 infection, hospitalized in a tertiary center in Portugal, was performed. Studied outcomes were disease and hospitalization length, COVID-19 severity, admission to intensive care unit (ICU) and mortality, analyzed by the presence of abnormal liver tests and CLD.  Results: We included 317 inpatients with a mean age of 70.4 years, 50.5% males. COVID-19 severity was moderate to severe in 57.4% and critical in 12.9%. The mean disease length was 37.8 days, the median hospitalization duration 10.0 days and overall mortality 22.8%. At admission, 50.3% showed abnormal liver tests, and 41.5% showed elevated aminotransferase levels, from which 75.4% were mild. Elevated aminotransferase levels at admission were associated with COVID-19 severity (78.7 vs. 63.3%, p = 0.01), ICU admission (13.1 vs. 5.92%, p = 0.034) and increased mortality (25.8 vs. 13.3%, p = 0.007). However, in a subgroup analysis, only aspartate transaminase (AST) was associated with these worse outcomes. Alkaline phosphatase was elevated in 11.4% of the patients and was associated with critical COVID-19 (21.1 vs. 9.92%, p = 0.044) and mortality (20.4 vs. 9.52%, p = 0.025), while 24.6% of the patients showed elevated &#947;-glutamyl transferase, which was associated with ICU admission (42.3 vs. 22.8%, p = 0.028). Fourteen patients had baseline CLD (4.42%), 3 with liver cirrhosis. Alcohol (n = 6) and nonalcoholic fatty liver disease (n = 6) were the most frequent etiologies. CLD patients had critical COVID-19 in 21.4% (p = 0.237), mean disease length of 36.6 days (p = 0.291), median hospitalization duration of 11.5 days (p = 0.447) and a mortality rate of 28.6% (p = 0.595), which increased to 66.7% among cirrhotic patients (p = 0.176).  Conclusions: Liver test abnormalities in COVID-19 patients were frequent but most commonly mild. AST, but not alanine transaminase, was associated with worse clinical outcomes, such as COVID-19 severity and mortality, probably indicating these outcomes were independent of liver injury. A low prevalence of CLD was seen, and a clear impact on COVID-19 outcomes was not seen.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução e objetivos:  O impacto da infeção SARS-CoV-2 no fígado e da doença hepática crónica (DHC) na gravidade da COVID-19 não estão completamente esclarecidos. O objetivo deste trabalho foi descrever os resultados clínicos dos doentes internados com COVID-19 relativamente às alterações da bioquímica hepática (BH) e à presença de DHC.  Métodos: Foi efetuada uma análise retrospetiva de doentes internados com infeção SARS-CoV-2 num centro terciário de Portugal. Os resultados clínicos avaliados foram a duração da doença e do internamento, a gravidade da COVID-19, a admissão em Unidade de Cuidados Intensivos (UCI) e a mortalidade, analisados pela presença de alterações da BH e de DHC.  Resultados: Foram incluídos 317 doentes com uma média de idades de 70.4 anos, 50.5% do género masculino. A COVID-19 foi moderada a grave em 57.4% e crítica em 12.9% dos doentes. A duração média da doença foi de 37.8 dias e a mediana da duração do internamento 10.0 dias. A mortalidade global foi de 22.8%. À admissão, 50.3% dos doentes apresentavam alterações da BH e 41.5% aminotransferases elevadas, 75.4% dos quais elevações ligeiras. As aminotransferases elevadas na admissão associaram-se com a gravidade da COVID-19 (78.7 vs. 63.3%, p = 0.01), a admissão em UCI (13.1 vs. 5.92%, p = 0.034) e com o aumento da mortalidade (25.8 vs. 13.3%, p = 0.007). No entanto, numa análise de subgrupo, apenas a AST estava associada com estes resultados clínicos desfavoráveis. A fosfatase alcalina encontrava-se elevada em 11.4% dos doentes e foi associada com COVID-19 crítica (21.1 vs. 9.92%, p = 0.044) e com mortalidade aumentada (20.4 vs. 9.52%, p = 0.025), enquanto que 24.6% dos doentes apresentavam uma gamaglutamiltransferase elevada, e que foi associada com a admissão em UCI (42.3 vs. 22.8%, p = 0.028). Catorze doentes tinham antecedentes de DHC (4.42%), 3 deles com cirrose hepática. As etiologias mais frequentes foram o álcool (n = 6) e o fígado gordo não-alcoólico (n = 6). Os doentes com DHC apresentaram COVID-19 crítica em 21.4% (p = 0.237), duração média de doença de 36.6 dias (p = 0.291), duração de hospitalização mediana de 11.5 dias (p = 0.447) e mortalidade de 28.6% (p = 0.595), que aumentou para 66.7% nos doentes cirróticos (p = 0.176).  Conclusões: As alterações da BH nos doentes internados com COVID-19 foram frequentes mas ligeiras, na sua maioria. A AST, ao contrário da ALT, associou-se com piores resultados clínicos tais como a gravidade da COVID-19 e a mortalidade. Foi registada uma prevalência baixa de DHC na nossa coorte, não tendo sido observado um impacto claro nos outcomes da COVID-19.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[COVID-19]]></kwd>
<kwd lng="en"><![CDATA[SARS-CoV-2]]></kwd>
<kwd lng="en"><![CDATA[Chronic liver disease]]></kwd>
<kwd lng="en"><![CDATA[Cirrhosis]]></kwd>
<kwd lng="en"><![CDATA[Liver]]></kwd>
<kwd lng="pt"><![CDATA[COVID-19]]></kwd>
<kwd lng="pt"><![CDATA[SARS-CoV-2]]></kwd>
<kwd lng="pt"><![CDATA[Doença hepática crónica]]></kwd>
<kwd lng="pt"><![CDATA[Cirrose]]></kwd>
<kwd lng="pt"><![CDATA[Fígado]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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