To the Editor,
We would like to thank Dr Ye and Dr Song for their interest and comments on our study. 1
As coronavirus disease 2019 (COVID‐19) is a new, emerging infectious disease, guidance or consensus on liver injury is lacking. 2 The definition of COVID‐19‐associated liver injury in our manuscript was as alanine transaminase (ALT), aspartate aminotransferase (AST) or bilirubin above the upper limit of normal (ULN), which were 50 U/L, 40 U/L and 26 μmol/L respectively. The abnormal test results of ALT, AST and total bilirubin at baseline data were defined as liver injury in our manuscript. Baseline data referred to the clinical data on the time of admission and laboratory data within the first 24 hours after admission, as biochemical indexes of some cases were tested and reported at the second day during hospitalization. The levels of ALT and AST after treatment were collected at the 10th day after hospitalization. For those who were discharged within 10 days, the last liver function prior to discharge was collected. As a retrospective study, bias is inevitable. In the process of research design and data collection, we made efforts to reduce the bias.
Computed tomographic (CT) post‐processing software or artificial intelligence (AI) algorithms may be more accurate and reproducible in obtaining CT scores. But in terms of the special situation during pandemic, those techniques were not available. The semi‐quantitative CT scoring method has the advantages of simplicity, rapidity and relative accuracy, so it is suitable to be used in this study. 3
In univariate analysis, gender, C‐reactive protein (CRP), D‐dimer and CT scores were different between cases with liver injury and those without, thus were included in the logistic regression. Stepwise logistic regression suggested that CT scores were an independent predictors for liver injury independent of gender, CRP and D‐dimer.
In conclusion, this preliminary study is not perfect but provides some interesting information on COVID‐19 with liver injury. The relationship among viral load of COVID‐19, liver injury and chest CT is worth further study.
CONFLICTS OF INTEREST
Ningfang Lian prepared and revised the manuscript, Su Lin made critical comments on the manuscript and Hansheng Xie prepared the manuscript. The authors disclose no conflicts of interest.
REFERENCES
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