Preliminary study of liver injury in patients with severe acute respiratory syndrome

Objective To summarize the clinical features, changing trend and mechanism of liver injury in patients with severe acute respiratory syndrome (SARS).Methods We collected and analyzed the clinical and some laboratory data of 154 patients with SARS admitted to the isolation wards of Beijing Youan Hospital from March 11 to June 3, 2003. Serum IL-1β,IL-2,IL-4,IL-6,IL-8,IL-10,TNF-α were detected in 46 cases. Autopsy and pathological observations were performed in 3 deseased cases.Results Serum ALT level was elevated in 37.66% SARS patients during admission but turned to normal gradually within 3 weeks in most cases, serum albumin and bilirubin were elevated in 5.19% and 8.44% of SARS patients, respetively. The correlations between lactate dehydrogenase, creatine phosphate isoenzyme and ALT were 0.638 and 0.601, respectively. PaO 2 was lower than 10.64kPa in 84.48% of elevated ALT patients. but in 45.83% of patients with normal ALT. There was siginficant difference between these two groups (P0.01). The levels of IL-1β、IL-2、IL-6、IL-8、IL-10 in SARS patients were higher than those in the normal control group (P0.05～0.01). The levels of IL-1β,IL-6 and IL-10 in patients with elevated ALT were higher than those with normal ALT(P0.05).Conclusion Liver damage occurs frequently in SARS patients having elevated serum ALT and non-specific hepatic inflammatory changes. Systemic inflammatory response syndrome and anoxia are the major mechanisms involved in liver injury.