Volume 71, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Severe acute respiratory syndrome (SARS) is a newly emerging infectious disease. To describe the hepatic injury caused by this disease, we report the sequential changes of serum transaminase in probable SARS patients during a hospital outbreak in southern Taiwan. From April to June, 2003, 52 probable SARS patients were hospitalized. Serial serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were retrospectively analyzed and hepatitis B surface antigen (HBsAg) was also evaluated to correlate with the progression of this disease. Fifty-three percent of the patients had abnormal liver function during hospitalization. More than 70% of abnormal transaminase levels were mildly elevated. Most elevated levels were noted during the second week after onset of fever. Neither transaminase elevation nor HBsAg was related to the prognosis of SARS, and only advanced age was an independent predictor of poor outcome. Our study suggested that coronavirus causing SARS might induce liver damage.


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  1. World Health Organization, Cumulative number of reported probable cases of severe acute respiration syndrome. (http://www.who.int/csr/sars/country/en).
  2. Peiris JS, Lai ST, Poon LL, Guan Y, Yam LY, Lim W, Nicholls J, Yee WK, Yan WW, Cheung MT, Cheng VC, Chan KH, Tsang DN, Yung RW, Ng TK, Yuen KY; SARS study group, 2003. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 361 : 1319–1325. [Google Scholar]
  3. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Comer JA, Lim W, Rollin PE, Dowell SF, Ling AE, Humphrey CD, Shieh WJ, Guarner J, Paddock CD, Rota P, Fields B, DeRisi J, Yang JY, Cox N, Hughes JM, LeDuc JW, Bellini WJ, Anderson LJ; SARS study group, 2003. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 348 : 1953–1966. [Google Scholar]
  4. Drosten C, Gunther S, Preiser W, van der Werf S, Brodt HR, Becker S, Rabenau H, Panning M, Kolesnikova L, Fouchier RA, Berger A, Burguiere AM, Cinatl J, Eickmann M, Escriou N, Grywna K, Kramme S, Manuguerra JC, Muller S, Rickerts V, Sturmer M, Vieth S, Klenk HD, Osterhaus AD, Schmitz H, Doerr HW, 2003. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 348 : 1967–1976. [Google Scholar]
  5. Rota PA, Oberste MS, Monroe SS, Nix WA, Campagnoli R, Icenogle JP, Penaranda S, Bankamp B, Maher K, Chen MH, Tong S, Tamin A, Lowe L, Frace M, DeRisi JL, Chen Q, Wang D, Erdman DD, Peret TC, Burns C, Ksiazek TG, Rollin PE, Sanchez A, Liffick S, Holloway B, Limor J, McCaustland K, Olsen-Rasmussen M, Fouchier R, Gunther S, Osterhaus AD, Drosten C, Pallansch MA, Anderson LJ, Bellini WJ, 2003. Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science 300 : 1394–1399. [Google Scholar]
  6. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, Ahuja A, Yung MY, Leung CB, To KF, Lui SF, Szeto CC, Chung S, Sung JJ, 2003. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 348 : 1986–1994. [Google Scholar]
  7. Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, Walmsley SL, Mazzulli T, Avendano M, Derkach P, Ephtimios IE, Kitai I, Mederski BD, Shadowitz SB, Gold WL, Hawryluck LA, Rea E, Chenkin JS, Cescon DW, Poutanen SM, Detsky AS, 2003. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA 289 : 2801–2809. [Google Scholar]
  8. Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, Tellier R, Draker R, Adachi D, Ayers M, Chan AK, Skowronski DM, Salit I, Simor AE, Slutsky AS, Doyle PW, Krajden M, Petric M, Brunham RC, McGeer AJ; National Microbiology Laboratory, Canada; Canadian Severe Acute Respiratory Syndrome Study Team, 2003. Identification of severe acute respiratory syndrome in Canada. N Engl J Med 348 : 1995–2005. [Google Scholar]
  9. Vu TH, Cabau JF, Nguyen NT, Lenoir M, 2003. SARS in northern Vietnam (letter). N Engl J Med 348 : 2035. [Google Scholar]
  10. Hon KL, Leung CW, Cheng WT, Chan PK, Chu WC, Kwan YW, Li AM, Fong NC, Ng PC, Chiu MC, Li CK, Tam JS, Fok TF, 2003. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet 361 : 1701–1703. [Google Scholar]
  11. Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL, Law KI, Tang BS, Hon TY, Chan CS, Chan KH, Ng JS, Zheng BJ, Ng WL, Lai RW, Guan Y, Yuen KY; HKU/UCH SARS Study Group, 2003. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 361 : 1767–1772. [Google Scholar]
  12. Centers for Disease Control and Prevention, Severe acute respiratory syndrome (SARS) updated interim case definition (Accessed April 22, 2003.at http://www.cdc.gov/ncidod/sars/casedefinition.htm.).
  13. So LK, Lau AC, Yam LY, Cheung TM, Poon E, Yung RW, Yuen KY, 2003. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet 361 : 1615–1617. [Google Scholar]
  14. Davern TJ, Scharschmidt BF, 2002. Biochemical liver tests. Feldman M, ed. Gastrointestinal and Liver Disease. Volume 2. Seventh edition. Philadelphia: W. B. Saunders, 1227–1239.
  15. Roberts RB, Laskin OL, Laurence J, Scavuzzo D, Murray HW, Kim YT, Connor JD, 1987. Ribavirin pharmacodynamics in high-risk patients for acquired immunodeficiency syndrome. Clin Pharmacol Ther 42 : 365–373. [Google Scholar]
  16. Zhang JZ, 2003. Severe acute respiratory syndrome and its lesions in digestive system. World J Gastroenterol 9 : 1135–1138. [Google Scholar]
  17. Hui AY, Chan HL, Liew CT, Chan PK, To KF, Chan CP, Sung JJ, 2003. Fatal outcome of SARS in a patient with reactivation of chronic hepatitis B. Am J Med 115 : 334–336. [Google Scholar]
  18. Wang CE, Qin ED, Gan YH, Li YC, Wu XH, Cao JT, Yu M, Si BY, Yan G, Li JF, Zhu QY, 2003. Pathological observation on suckling mice and Vero E6 cells inoculated with SARS samples. Jifangjun Yixue Zuzhi 28 : 383–384. [Google Scholar]
  19. Duan ZP, Chen Y, Zhang J, Zhao J, Lang ZW, Meng FK, Bao XL, 2003. Clinical characteristics and mechanism of liver injury in patients with severe acute respiratory syndrome. Zhonghua Gan Zang Bing Za Zhi 11 : 493–495. [Google Scholar]

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  • Received : 24 Nov 2003
  • Accepted : 05 Feb 2004

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