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Wang Z, Zhao L, Xie K. Development and validation of a nomogram to assess the occurrence of liver dysfunction in patients with COVID-19 pneumonia in the ICU. BMC Infect Dis 2025; 25:332. [PMID: 40065225 PMCID: PMC11892215 DOI: 10.1186/s12879-025-10684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 02/18/2025] [Indexed: 03/14/2025] Open
Abstract
The global pandemic of novel coronavirus pneumonia (COVID-19) has resulted in millions of deaths over the past three years. As one of the most commonly affected extra-pulmonary organs, numerous studies have reported varying degrees of liver injury in a significant proportion of patients with COVID-19, particularly in severe and critically ill patients. Early prediction of liver dysfunction in hospitalized patients would facilitate the clinical management of COVID-19 and improve clinical prognosis, but reliable and valid predictive models are still lacking.MethodsWe collected data from 286 patients with RT-PCR confirmed COVID-19 admitted to various ICUs from the case system. These patients were randomly divided into a training cohort (50%) and a validation cohort (50%). In the training cohort, we first used ROC curves to measure the predictive efficiency of each of the variables for the development of liver damage during hospitalization in patients with COVID-19, followed by LASSO regression analysis to screen the variables for predictive models and logistic regression analysis to identify relevant risk factors. A nomogram based on these variables was created following the above model. Finally, the efficiency of the prediction models in the training and validation cohorts was assessed using AUC, consistency index (C index), calibration curves and Decision Curve Analysis.ResultsOut of a total of 80 parameters for COVID-19 patients admitted to the ICUs, 10 were determined to be significantly associated with the occurrence of liver dysfunction during hospitalization. Based on these predictors, further prediction models were used to construct and develop a nomogram that was offered for practical clinical application. The C-index of the column line graphs for the training and validation cohorts was 0.956 and 0.844 respectively. in addition, the calibration curves for the model showed a high degree of agreement between the predicted and actual incidence of liver dysfunction in patients with COVID-19.ConclusionBy developing a predictive model and associated nomogram, we predicted the incidence of liver dysfunction during hospitalization in patients with COVID-19 in the ICU. The model's predictive performance was determined in both the training and validation cohorts, contributing to the clinical management of COVID-19.
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Affiliation(s)
- Zhiwei Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Lina Zhao
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.
- Laboratory of Anesthesia and Critical Care Medicine in Colleges and Universities of Shandong Province, School of Anesthesiology, Shandong Second Medical University, Weifangaq, Weifang, Shandong, 261053, China.
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Ghare S, Warner D, Warner J, Chilton PM, Lee J, Zhang J, Wang M, Hardesty J, Treves R, Gabbard J, Anderson C, Batra L, Sreenivasan C, Kraenzle J, McCulley M, McCoy S, Zhang L, Feng W, Gondim DD, Barve S, Zheng J, Palmer K, McClain C, Kirpich I. Impact of chronic ethanol consumption and SARS-COV-2 on the liver and intestine: A pilot dose-response study in mice. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2025; 49:587-598. [PMID: 39757351 PMCID: PMC11928281 DOI: 10.1111/acer.15528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 12/20/2024] [Indexed: 01/07/2025]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, there was a marked increase in alcohol consumption. COVID-19 superimposed on underlying liver disease notably worsens the outcome of many forms of liver injury. The goal of a current pilot study was to test the dual exposure of alcohol and COVID-19 infection in an experimental animal model of alcohol-associated liver disease (ALD). METHODS After 4 weeks of ethanol (EtOH) feeding, C57BL/6 male mice received SARS-CoV-2 (SARS2-N501YMA30) intranasally at 3 × 102, 1 × 103, 3 × 103, and 1 × 104 plaque-forming units (PFU). Mice were then weighed/monitored daily for morbidity/mortality for 10 days while continuing EtOH consumption. Markers of liver inflammation, injury, and intestinal barrier integrity were evaluated. RESULTS A similar gradual weight loss was observed in all inoculated mice (slightly less in the 3 × 102 group) up to post-infection day 4. Greater mortality was observed in mice receiving the highest viral dose at days 3 and 4 post-infection. The majority of the surviving mice subjected to EtOH and inoculated with 3 × 103 or 1 × 104 PFU rapidly lost 25% of their body weight and were euthanized on post-infection day 4. Analysis of liver health in animals that survived to the end of the experiment exhibited no significant changes in hepatic steatosis but had a limited increase in plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at all viral doses versus EtOH alone. However, the 1 × 104 PFU viral dose exacerbated EtOH-induced hepatic inflammation characterized by elevated levels of several pro-inflammatory cytokines, including Il-6 and Tnf-α. There was limited effect of viral infection on the intestine. CONCLUSIONS SARS-CoV-2 infection caused a dose-dependent negative impact on body weight and survival in mice fed EtOH. This pilot study suggests that early mortality observed after high-dose SARS-CoV-2 challenge could be due, in part, to hepatic dysfunction following chronic EtOH feeding.
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Affiliation(s)
- Smita Ghare
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Dennis Warner
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Jeffrey Warner
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Paula M. Chilton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Jiyeon Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - JingWen Zhang
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Min Wang
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Josiah Hardesty
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Rui Treves
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Jon Gabbard
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Charles Anderson
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Lalit Batra
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Chithra Sreenivasan
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Jennifer Kraenzle
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Matthew McCulley
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Stephanie McCoy
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Lihua Zhang
- Department of Structural & Cellular Biology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, United States
| | - Wenke Feng
- Department of Structural & Cellular Biology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, United States
| | - Dibson Dibe Gondim
- Department of Pathology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Shirish Barve
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Alcohol Research Center, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Hepatobiology and Toxicology Center, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Jian Zheng
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Kenneth Palmer
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
| | - Craig McClain
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Alcohol Research Center, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Hepatobiology and Toxicology Center, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Robley Rex Veterans Affairs Medical Center, 800 Zorn Avenue, Louisville, KY 40206, United States
| | - Irina Kirpich
- Alcohol Research Center, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Hepatobiology and Toxicology Center, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, 505 South Hancock Street, Louisville KY, 40202, United States
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Khan S, Hussain Timraz J, Al Ghamdi NA, Metwali NY, Yaseen FA, Alshaqha AM, Alamri SH, Turkistani H, Dwaima A, Ali Algarni I. COVID-19 and Its Effects on the Hepatobiliary System: A Literature Review. Cureus 2025; 17:e80231. [PMID: 40190856 PMCID: PMC11972666 DOI: 10.7759/cureus.80231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2025] [Indexed: 04/09/2025] Open
Abstract
COVID-19 encompasses a wide clinical spectrum, from mild influenza-like illness to severe pneumonia and systemic complications. There is emerging literature on hepatobiliary involvement in COVID-19, especially elevation in liver enzymes as surrogate markers of liver injury. Angiotensin-converting enzyme 2 receptors within the hepatobiliary system are a portal of entry for SARS-CoV-2, after which injury may be perpetuated through hypoxia and cytokine storms. This literature review covers studies published before 2024 from databases such as PubMed, Google Scholar, Springer, and BMC Library. The keywords used were "COVID-19", "liver", "SARS-CoV-2", "chronic liver disease", and other relevant terms to ensure a wide scope of investigation. The most common liver enzymes elevated among COVID-19 patients include aspartate transaminase, alanine transaminase, and alkaline phosphatase, all of which are associated with the severity of the disease. Chronic liver disease (CLD) and hepatocellular carcinoma (HCC) patients have worse outcomes with increased ICU admission rates and increased mortality. COVID-19 vaccination in CLD and liver transplant recipients is very often associated with suboptimal antibody responses, adding to the risks. SARS-CoV-2 causes liver involvement through direct viral cytopathic effects, immune-mediated injury, and systemic hypoxia. Individuals with CLD are particularly vulnerable to severe illness.
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Affiliation(s)
- Sariya Khan
- General Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | | | | | - Nada Y Metwali
- Obstetrics and Gynecology, Batterjee Medical College, Jeddah, SAU
| | - Faten A Yaseen
- Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | | | - Sarah H Alamri
- Internal Medicine, Batterjee Medical College, Jeddah, SAU
| | | | - Anas Dwaima
- Internal Medicine, International Medical Center Hospital, Jeddah, SAU
| | - Ibraheem Ali Algarni
- Family Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
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Florea CE, Bălaș-Maftei B, Obreja M, Rotaru A, Irimie-Băluță ER, Manciuc C. Hepatitis B virus associated with severe acute respiratory syndrome coronavirus 2 infection: a case report. J Med Case Rep 2025; 19:80. [PMID: 40016849 PMCID: PMC11869702 DOI: 10.1186/s13256-025-05085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 01/13/2025] [Indexed: 03/01/2025] Open
Abstract
BACKGROUND After secondary respiratory failure, liver failure is often reported in the literature on coronavirus disease 2019 infection. Angiotensin-converting enzyme 2 receptors in hepatocytes make the liver directly susceptible to the severe acute respiratory syndrome coronavirus 2 virus. An exacerbated immune response, drug-induced hepatotoxicity, and hypoxia secondary to respiratory failure are further possible causes of hepatocytolysis in coronavirus disease 2019 patients. Pre-existing infection with the hepatitis B virus can aggravate coronavirus disease 2019 or be aggravated/reactivated by it. This case report describes unusually severe liver damage in a coronavirus disease 2019 patient with well controlled hepatitis B, where the evidence points to coronavirus disease 2019-related factors as the main causes of hepatic cytolysis. CASE PRESENTATION A 70 year-old patient of Romanian ethnicity with a 5-year history of chronic hepatitis B presented to the emergency department complaining of fever, chills, and marked physical asthenia with an onset of 2 weeks. Blood tests revealed an inflammatory syndrome and incipient liver cytolysis. Low-intensity opacities were visible on chest X-ray, and the severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test was positive, so the patient was transferred to the infectious diseases hospital. His condition then aggravated atypically, with increasingly severe hepatic cytolysis that was not noted in other coronavirus disease 2019 patients with hepatitis B. CONCLUSION The patient's history of well-controlled hepatitis B suggests that, in this case, liver dysfunction was secondary to coronavirus disease 2019 manifestations such as the cytokine storm, respiratory failure, and drug-induced hepatotoxicity. The patient eventually recovered, and there was no demonstrable reactivation of hepatitis B after discharge. Coronavirus disease 2019 can thus affect liver function severely and primarily, yet without necessarily interacting with adequately managed hepatitis B.
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Affiliation(s)
- Carmen-Elena Florea
- Doctoral School, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universității Street, 700115, Iași, Romania
- Department of Infectious Diseases, "Sf. Parascheva" Clinical Hospital of Infectious Diseases, 2 Octav Botez Street, 700116, Iași, Romania
| | - Bianca Bălaș-Maftei
- Doctoral School, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universității Street, 700115, Iași, Romania.
- Department of Infectious Diseases, "Sf. Parascheva" Clinical Hospital of Infectious Diseases, 2 Octav Botez Street, 700116, Iași, Romania.
| | - Maria Obreja
- Department of Infectious Diseases, "Sf. Parascheva" Clinical Hospital of Infectious Diseases, 2 Octav Botez Street, 700116, Iași, Romania
- Department Medical Sciences II-Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universității Street, 700115, Iași, Romania
| | - Alexandra Rotaru
- Department of Infectious Diseases, "Sf. Parascheva" Clinical Hospital of Infectious Diseases, 2 Octav Botez Street, 700116, Iași, Romania
| | - Erika-Raluca Irimie-Băluță
- Doctoral School, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universității Street, 700115, Iași, Romania
- Department of Infectious Diseases, "Sf. Parascheva" Clinical Hospital of Infectious Diseases, 2 Octav Botez Street, 700116, Iași, Romania
| | - Carmen Manciuc
- Department of Infectious Diseases, "Sf. Parascheva" Clinical Hospital of Infectious Diseases, 2 Octav Botez Street, 700116, Iași, Romania
- Department Medical Sciences II-Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universității Street, 700115, Iași, Romania
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Liu Q, Miao H, Shi C, Hu P, An S. Association between the lowest level of serum albumin during hospitalization and adverse outcomes in older adults with COVID-19. Medicine (Baltimore) 2024; 103:e40734. [PMID: 39612427 PMCID: PMC11608705 DOI: 10.1097/md.0000000000040734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 11/11/2024] [Indexed: 12/01/2024] Open
Abstract
Serum albumin on admission has been investigated among inpatients with COVID-19. However, studies on the lowest level of serum albumin during hospitalization and adverse outcomes are limited. This research aimed to explore association between them in older adults with COVID-19. A retrospective study was conducted with 300 patients aged 60 or older with first confirmed COVID-19 from January to February 2023. An adverse outcome was defined as development of acute respiratory failure, shock, or death. Data on demographics, comorbidities, laboratory parameters, the initial phase of COVID-19, coinfection, sepsis, receipt of antiviral treatment and outcomes were gathered from the electronic medical records. The association between the lowest level of serum albumin and adverse outcomes was analyzed using univariate and multivariate regression models, along with generalized additive models. After adjusting potential confounders, nonlinear relationship with an inflection point of 29.1 g/L was detected between the lowest level of serum albumin and adverse outcomes in the elderly. The effect sizes and the confidence intervals on the left and right sides of the inflection point were 0.667 (0.520, 0.856) and 1.171 (0.875, 1.568), respectively. This demonstrated that the lowest level of serum albumin was negatively correlated with adverse outcomes when albumin was <29.1 g/L. A rise of 1 unit in the lowest level of albumin equated to a 33.3% decrease in the risk of adverse outcomes. The correlation between the lowest level of serum albumin and adverse outcomes of COVID-19 is a nonlinear. this study indicates that serum albumin levels should be sustained above the critical inflection point identified to reduce the risk of adverse outcomes.
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Affiliation(s)
- Qiaoli Liu
- Department of Infectious Diseases, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Haifeng Miao
- Department of Infectious Diseases, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Chunwei Shi
- Department of Infectious Diseases, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Piao Hu
- Department of Infectious Diseases, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Suhong An
- Department of Radiotherapy, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
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Agarwal R, Bhugra A, Gautam P, Suroliya V, Chhabra R, Pandey A, Garg P, Rao P, Babu R, Kumar G, Bihari C, Bhattacharyya D, Shasthry SM, Sarin SK, Gupta E. Clinical and Genomic Perspective of SARS CoV-2 Infection in Liver Disease Patients: A Single-Centre Retrospective Study. Curr Microbiol 2024; 81:301. [PMID: 39115704 DOI: 10.1007/s00284-024-03786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 06/22/2024] [Indexed: 08/15/2024]
Abstract
The limited literature on the clinical course of COVID-19 among patients with underlying liver disease (LD) is available from India. The present study aimed to evaluate the clinical and mutational profile of SARS-CoV-2 among LD cases. This was a retrospective study including admitted LD cases in whom SARS-CoV-2 RT-PCR testing was performed. Complete demographic and clinical details were retrieved from Hospital Information System. Detailed mutational analysis was performed by comparing LD COVID-19 positive study group, i.e. LD-CoV(+) with COVID-19 positive outpatients without any underlying LD as control, i.e. NLD-CoV(+). Out of 232 enrolled LD cases, 137 (59.1%) were LD-CoV(+). LD cases with existing co-morbidities were affected more (P = 0.002) and had 2.29 times (OR 2.29, CI 95%, 1.25-4.29) higher odds of succumbing to COVID-19 (P = 0.006). On multivariate regression analysis, ascites (P = 0.05), severe COVID-19 pneumonia (P = 0.046), and an increased levels of bilirubin (P = 0.005) and alkaline phosphatase (P = 0.003) were found to be associated with adverse outcome in LD-CoV(+).On mutational analysis, we found certain differences between LD- and NLD-CoV(+) infected with Delta [LD- and NLD-CoV (+ /D)] and Omicron [LD- and NLD-CoV(+/O)]. More mutations were shared between LD- and NLD-CoV(+/O) compared to LD- and NLD-CoV(+/D). There were differences in prevalence of indel mutations specific to LD-CoV ( +) for both Delta and Omicron. Moreover, we also reported an interesting genic bias between LD- and NLD-CoV( +) in harbouring deleterious/tolerated mutations. To conclude, LD cases with comorbidities were affected more and had higher odds of mortality due to COVID-19. The definite difference between LD- and NLD-CoV(+) groups with respect to frequency of harboured mutations and an inherent genic bias between them is of noteworthy importance.
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Affiliation(s)
- Reshu Agarwal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Arjun Bhugra
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Pramod Gautam
- Genome Sequencing Laboratory, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Varun Suroliya
- Genome Sequencing Laboratory, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ruchita Chhabra
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Amit Pandey
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India
| | - Prince Garg
- Genome Sequencing Laboratory, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Pooja Rao
- Genome Sequencing Laboratory, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rosmy Babu
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - S M Shasthry
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070, India.
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7
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Maimunah U, Kholili U, Vidyani A, Sugihartono T, Tanaya WM, Wessels FI, Alshawsh MA, Miftahussurur M. Association between COVID-19 severity with liver abnormalities: A retrospective study in a referral hospital in Indonesia. NARRA J 2024; 4:e816. [PMID: 39280282 PMCID: PMC11391993 DOI: 10.52225/narra.v4i2.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/18/2024] [Indexed: 09/18/2024]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by an acute respiratory infection with multisystem involvement and the association of its severity to liver function abnormalities is not well characterized. The aim of this study was to assess the association between the severity of COVID-19 patients and liver function abnormalities. This retrospective study included adult patients with confirmed COVID-19, which were classified as non-severe or severe according to World Health Organization guidelines. Liver function test results were compared between the severity groups. A total of 339 patients were included of which 150 (44.25%) were severe cases. The male-to-female ratio was 0.9:1 and 3:2 in the non-severe and severe groups, respectively (p=0.031). Aspartate aminotransferase (AST), alanine transaminase (ALT), and total bilirubin levels and acute liver injury (ALI) incidence were significantly higher in the severe group compared to non-severe group (p<0.001, p<0.001, p=0.025, p=0.014, respectively). In contrast, albumin levels were significantly lower (p=0.001). Multivariate analysis showed that ALI was significantly associated with human immunodeficiency virus (HIV) infection (odds ratio (OR): 5.275; 95% confidence interval (CI): 1.165-23.890, p=0.031), hemoglobin level (OR: 1.214; 95%CI: 1.083-1.361, p=0.001), and hypoalbuminemia (OR: 2.627; 95%CI: 1.283-5.379, p=0.008). Pre-existing liver diseases were present in 6.5% of patients. No significant differences were observed between the groups based on COVID-19 severity and ALI presence. Liver function test abnormalities, including ALI, are more prevalent in patients with severe COVID-19 infection. HIV infection, high hemoglobin levels, and hypoalbuminemia may be potential risk factors for ALI.
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Affiliation(s)
- Ummi Maimunah
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ulfa Kholili
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Amie Vidyani
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Titong Sugihartono
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Willa M Tanaya
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Firda I Wessels
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Mohammed A Alshawsh
- Department of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Miftahussurur
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- Helicobacter pylori and Microbiota Study Group, Institute Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
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8
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Nasir N, Khanum I, Habib K, Wagley A, Arshad A, Majeed A. Insight into COVID-19 associated liver injury: Mechanisms, evaluation, and clinical implications. HEPATOLOGY FORUM 2024; 5:139-149. [PMID: 39006140 PMCID: PMC11237249 DOI: 10.14744/hf.2023.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/25/2023] [Accepted: 11/02/2023] [Indexed: 07/16/2024]
Abstract
COVID-19 has affected millions worldwide, causing significant morbidity and mortality. While predominantly involving the respiratory tract, SARS-CoV-2 has also caused systemic illnesses involving other sites. Liver injury due to COVID-19 has been variably reported in observational studies. It has been postulated that liver damage may be due to direct damage by the SARS-CoV-2 virus or multifactorial secondary to hepatotoxic therapeutic options, as well as cytokine release syndrome and sepsis-induced multiorgan dysfunction. The approach to a COVID-19 patient with liver injury requires a thorough evaluation of the pattern of hepatocellular injury, along with the presence of underlying chronic liver disease and concurrent medications which may cause drug-induced liver injury. While studies have shown uneventful recovery in the majority of mildly affected patients, severe COVID-19 associated liver injury has been associated with higher mortality, prolonged hospitalization, and greater morbidity in survivors. Furthermore, its impact on long-term outcomes remains to be ascertained as recent studies report an association with metabolic-fatty liver disease. This present review provides insight into the subject by describing the postulated mechanism of liver injury, its impact in the presence of pre-existing liver disease, and its short- and long-term clinical implications.
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Affiliation(s)
- Nosheen Nasir
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Iffat Khanum
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Kiren Habib
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Abdullah Wagley
- Research Facilitation Office, Medical College, Aga Khan University, Karachi, Pakistan
| | - Aleena Arshad
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Atif Majeed
- Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Singh L, Kumar A, Rai M, Basnet B, Rai N, Khanal P, Lai KS, Cheng WH, Asaad AM, Ansari S. Spectrum of COVID-19 induced liver injury: A review report. World J Hepatol 2024; 16:517-536. [PMID: 38689748 PMCID: PMC11056898 DOI: 10.4254/wjh.v16.i4.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/20/2024] [Accepted: 02/28/2024] [Indexed: 04/24/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused changes in the global health system, causing significant setbacks in healthcare systems worldwide. This pandemic has also shown resilience, flexibility, and creativity in reacting to the tragedy. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection targets most of the respiratory tract, resulting in a severe sickness called acute respiratory distress syndrome that may be fatal in some individuals. Although the lung is the primary organ targeted by COVID-19 viruses, the clinical aspect of the disease is varied and ranges from asymptomatic to respiratory failure. However, due to an unorganized immune response and several affected mechanisms, the liver may also experience liver cell injury, ischemic liver dysfunction, and drug-induced liver injury, which can result in respiratory failure because of the immune system's disordered response and other compromised processes that can end in multisystem organ failure. Patients with liver cirrhosis or those who have impaired immune systems may be more likely than other groups to experience worse results from the SARS-CoV-2 infection. We thus intend to examine the pathogenesis, current therapy, and consequences of liver damage concerning COVID-19.
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Affiliation(s)
- Lokjan Singh
- Department of Microbiology, Karnali Academy of Health Science, Teaching Hospital, Jumla 21200, Karnali, Nepal
| | - Anil Kumar
- Department of Microbiology, Karnali Academy of Health Science, Teaching Hospital, Jumla 21200, Karnali, Nepal
| | - Maya Rai
- Department of Microbiology, Karnali Academy of Health Science, Teaching Hospital, Jumla 21200, Karnali, Nepal
| | - Bibek Basnet
- Health Sciences, Asian College of Advance Studies, Purbanchal University, Satdobato 24122, Lalitpur, Nepal
| | - Nishant Rai
- Department of Biotechnology, Graphic Era (Deemed to be University), Dehradun 248002, Uttarakhand, India
| | - Pukar Khanal
- Department of Pharmacology & Toxicology, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India
| | - Kok-Song Lai
- Division of Health Sciences, Abu Dhabi Women's College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates
| | - Wan-Hee Cheng
- Health and Life Sciences, INTI International University, Nilai 71800, Malaysia
| | - Ahmed Morad Asaad
- Department of Microbiology, College of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Shamshul Ansari
- Division of Health Sciences, Abu Dhabi Women's College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates.
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Allison R, Guraka A, Shawa IT, Tripathi G, Moritz W, Kermanizadeh A. Drug induced liver injury - a 2023 update. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2023; 26:442-467. [PMID: 37786264 DOI: 10.1080/10937404.2023.2261848] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Drug-Induced Liver Injury (DILI) constitutes hepatic damage attributed to drug exposure. DILI may be categorized as hepatocellular, cholestatic or mixed and might also involve immune responses. When DILI occurs in dose-dependent manner, it is referred to as intrinsic, while if the injury occurs spontaneously, it is termed as idiosyncratic. This review predominately focused on idiosyncratic liver injury. The established molecular mechanisms for DILI include (1) mitochondria dysfunction, (2) increased reactive oxygen species levels, (3) presence of elevated apoptosis and necrosis, (4) and bile duct injuries associated with immune mediated pathways. However, it should be emphasized that the underlying mechanisms responsible for DILI are still unknown. Prevention strategies are critical as incidences occur frequently, and treatment options are limited once the injury has developed. The aim of this review was to utilize retrospective cohort studies from across the globe to gain insight into epidemiological patterns. This review considers (1) what is currently known regarding the mechanisms underlying DILI, (2) discusses potential risk factors and (3) implications of the coronavirus pandemic on DILI presentation and research. Future perspectives are also considered and discussed and include potential new biomarkers, causality assessment and reporting methods.
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Affiliation(s)
- Rebecca Allison
- College of Science and Technology, University of Derby, Derby, UK
| | - Asha Guraka
- College of Science and Technology, University of Derby, Derby, UK
| | - Isaac Thom Shawa
- College of Science and Technology, University of Derby, Derby, UK
| | - Gyan Tripathi
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | | | - Ali Kermanizadeh
- College of Science and Technology, University of Derby, Derby, UK
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11
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Shoraka S, Mohebbi SR, Hosseini SM, Ghaemi A, Zali MR. SARS-CoV-2 and chronic hepatitis B: Focusing on the possible consequences of co-infection. JOURNAL OF CLINICAL VIROLOGY PLUS 2023; 3:100167. [DOI: 10.1016/j.jcvp.2023.100167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
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12
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Lu F, Chen R, Xu K, Huang J, Yang D, Bai T, Xie Y, Ling Y, Liu K, Du W, Yan J, Lin H, Li J, Feng Y, Zhou M, Guo Y. Liver dysfunction on admission worsens clinical manifestations and outcomes of coronavirus disease 2019. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2023; 1:181-187. [PMID: 39171123 PMCID: PMC11332890 DOI: 10.1016/j.pccm.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Indexed: 08/23/2024]
Abstract
Background Liver dysfunction was common in coronavirus disease 2019 (COVID-19), but its association with clinical features and poor prognosis has not been fully delineated. Our study aimed to determine the role of liver dysfunction in COVID-19 and understand the predictors for worse outcomes in patients with liver injury. Methods We conducted this multicenter, retrospective study in five designated hospitals for COVID-19 management. Laboratory-confirmed COVID-19 patients were enrolled and classified into the normal live function group and liver dysfunction group according to liver enzymes, bilirubin, and albumin on admission, respectively. Data of baseline, clinical manifestations, and outcomes were collected and compared in the paired groups. Results Of the 649 included COVID-19 patients, 200 (30.8%), 69 (10.6%), and 267 (41.1%) patients had elevated liver enzymes, increased bilirubin, and low-level albumin, respectively. Fever, cough, and dyspnea were the most common symptoms and showed an increased proportion in the liver dysfunction group. Compared with patients in the normal liver function group, patients with liver dysfunction manifested decreased lymphocytes, higher level of leukocytes, neutrophils, inflammatory indicators, and cytokines, as well as more severe impairment in kidney function and myocardium. They were more likely to show bilateral involvement and more pulmonary lobes involved according to chest images. With increased proportion of patients who developed severe/critical conditions and needed mechanical ventilation and systemic glucocorticoid therapy, patients with liver dysfunction on admission showed significantly higher in-hospital mortality. Moreover, cardiac troponin I ≥1.5 ng/mL was identified as an independent mortality predictor in the elevated liver enzymes group. Conclusion Patients with liver dysfunction on admission had worse clinical manifestation, and resulted in higher rate of severe/critical type, receiving mechanical ventilation and in-hospital mortality.
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Affiliation(s)
- Fangying Lu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Rong Chen
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Kandi Xu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jie Huang
- Department of Critical Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dexiang Yang
- Department of Respiratory Diseases, Tongling People's Hospital, Tongling, Anhui 244099, China
| | - Tao Bai
- Department of Infectious Disease, Wuhan Jinyintan Hospital, Wuhan, Hubei 430048, China
| | - Yusang Xie
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yun Ling
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 200025, China
| | - Kui Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Wei Du
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiayang Yan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Huihuang Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jian Li
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yun Feng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yi Guo
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Luxenburger H, Thimme R. SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease. Gut 2023; 72:1783-1794. [PMID: 37316169 PMCID: PMC10423489 DOI: 10.1136/gutjnl-2023-329623] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023]
Abstract
SARS-CoV-2 infection may affect the liver in healthy individuals but also influences the course of COVID-19 in patients with chronic liver disease (CLD). As described in healthy individuals, a strong SARS-CoV-2-specific adaptive immune response is important for the outcome of COVID-19, however, knowledge on the adaptive immune response in CLD is limited.Here, we review the clinical and immunological features of SARS-CoV-2 infection in individuals with CLD. Acute liver injury occurs in many cases of SARS-CoV-2 infection and may be induced by multiple factors, such as cytokines, direct viral infection or toxic effects of COVID-19 drugs. In individuals with CLD, SARS-CoV-2 infection may have a more severe course and promote decompensation and particularly in patients with cirrhosis. Compared with healthy individuals, the SARS-CoV-2-specific adaptive immune responses is impaired in patients with CLD after both, natural infection and vaccination but improves at least partially after booster vaccination.Following SARS-CoV-2 vaccination, rare cases of acute vaccine-induced liver injury and the development of autoimmune-like hepatitis have been reported. However, the concomitant elevation of liver enzymes is reversible under steroid treatment.
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Affiliation(s)
- Hendrik Luxenburger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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14
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Li X, Fan C, Tang J, Zhang N. Meta-analysis of liver injury in patients with COVID-19. Medicine (Baltimore) 2023; 102:e34320. [PMID: 37478243 PMCID: PMC10662882 DOI: 10.1097/md.0000000000034320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) is a major public health problem threatening human health. It can lead to multiple system complications, among which liver damage is also a common complication of COVID-19. The pathogenesis of liver injury is complex and involves the interaction of multiple factors. This study aims to investigate the incidence and risk factors of liver injury in COVID-19 patients and analyze the impact of liver injury on clinical prognosis of patients, so as to provide corresponding basis for clinical diagnosis and treatment. METHODS PubMed and Cochrane Library were searched in computer to collect original studies on liver injury cases, laboratory indicators and clinical outcomes in COVID-19 patients. Articles were screened according to inclusion and exclusion criteria, and data were meta-analyzed using Stata12.0 software. RESULTS A total of 49 studies, including 23,611 patients with COVID-19, had a prevalence of liver injury of 39.63%. Subgroup analysis found that patients in the Americas had the highest incidence of liver injury at 43.7% and lowest in Africa (25.99%). The vast majority of liver injury is manifested by aminotransferase or bilirubin levels greater than 1 times the upper limit of normal (49.16%). The older the age, the male, the associated chronic liver disease, and the higher the levels of white blood cells, neutrophils, and C-reactive protein, the higher the risk of liver injury. The use of hormones, hydroxychloroquine, and tocilizumab increases the risk of liver injury. Patients with concurrent liver injury have longer hospital stays, are more likely to progress to severe cases, and have a higher risk of death than patients without liver injury. CONCLUSION The incidence of liver injury in COVID-19 patients was high, affected by age, gender, chronic liver disease, inflammatory state and medication, and patients with liver injury were hospitalized longer and were more likely to have a poor prognosis. Therefore, clinical attention should be paid to early intervention.
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Affiliation(s)
- Xinghai Li
- Department of Minimally Invasive Intervention, Ganzhou People’s Hospital, Ganzhou, China
| | - Caiping Fan
- Department of Minimally Invasive Intervention, Ganzhou People’s Hospital, Ganzhou, China
| | - Jin Tang
- Department of Gastroenterology, Ganzhou People’s Hospital, Ganzhou, China
| | - Ning Zhang
- Department of Gastroenterology, Ganzhou People’s Hospital, Ganzhou, China
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15
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Fernandes S, Sosa-Napolskij M, Lobo G, Silva I. Relation of COVID-19 with liver diseases and their impact on healthcare systems: The Portuguese case. World J Gastroenterol 2023; 29:1109-1122. [PMID: 36844137 PMCID: PMC9950868 DOI: 10.3748/wjg.v29.i6.1109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/18/2022] [Accepted: 12/30/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The impact caused by the coronavirus disease 2019 (COVID-19) on the Portuguese population has been addressed in areas such as clinical manifestations, frequent comorbidities, and alterations in consumption habits. However, comorbidities like liver conditions and changes concerning the Portuguese population's access to healthcare-related services have received less attention. AIM To (1) Review the impact of COVID-19 on the healthcare system; (2) examine the relationship between liver diseases and COVID-19 in infected individuals; and (3) investigate the situation in the Portuguese population concerning these topics. METHODS For our purposes, we conducted a literature review using specific keywords. RESULTS COVID-19 is frequently associated with liver damage. However, liver injury in COVID-19 individuals is a multifactor-mediated effect. Therefore, it remains unclear whether changes in liver laboratory tests are associated with a worse prognosis in Portuguese individuals with COVID-19. CONCLUSION COVID-19 has impacted healthcare systems in Portugal and other countries; the combination of COVID-19 with liver injury is common. Previous liver damage may represent a risk factor that worsens the prognosis in individuals with COVID-19.
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Affiliation(s)
- Sara Fernandes
- Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
| | - Milaydis Sosa-Napolskij
- CINTESIS@RISE, Center for Health Technology and Services Research at The Associate Laboratory RISE–Health Research Network, Faculty of Medicine of The University of Porto, Porto 4200-219, Portugal
| | - Graça Lobo
- Laboratory of Pharmacology and Neurobiology–Department of Immuno-physiology and Pharmacology, Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
| | - Isabel Silva
- Laboratory of Pharmacology and Neurobiology–Department of Immuno-physiology and Pharmacology, Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
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Kowsar R, Rahimi AM, Sroka M, Mansouri A, Sadeghi K, Bonakdar E, Kateb SF, Mahdavi AH. Risk of mortality in COVID-19 patients: a meta- and network analysis. Sci Rep 2023; 13:2138. [PMID: 36747045 PMCID: PMC9901837 DOI: 10.1038/s41598-023-29364-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Understanding the most relevant hematological/biochemical characteristics, pre-existing health conditions and complications in survivors and non-survivor will aid in predicting COVID-19 patient mortality, as well as intensive care unit (ICU) referral and death. A literature review was conducted for COVID-19 mortality in PubMed, Scopus, and various preprint servers (bioRxiv, medRxiv and SSRN), with 97 observational studies and preprints, consisting of survivor and non-survivor sub-populations. This meta/network analysis comprised 19,014 COVID-19 patients, consisting of 14,359 survivors and 4655 non-survivors. Meta and network analyses were performed using META-MAR V2.7.0 and PAST software. The study revealed that non-survivors of COVID-19 had elevated levels of gamma-glutamyl transferase and creatinine, as well as a higher number of neutrophils. Non-survivors had fewer lymphocytes and platelets, as well as lower hemoglobin and albumin concentrations. Age, hypertension, and cerebrovascular disease were shown to be the most influential risk factors among non-survivors. The most common complication among non-survivors was heart failure, followed by septic shock and respiratory failure. Platelet counts, creatinine, aspartate aminotransferase, albumin, and blood urea nitrogen levels were all linked to ICU admission. Hemoglobin levels preferred non-ICU patients. Lower levels of hemoglobin, lymphocytes, and albumin were associated with increased mortality in ICU patients. This meta-analysis showed that inexpensive and fast biochemical and hematological tests, as well as pre-existing conditions and complications, can be used to estimate the risk of mortality in COVID-19 patients.
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Affiliation(s)
- Rasoul Kowsar
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Amir Mohammad Rahimi
- Department of Developmental Biology, Göttingen Center for Molecular Biosciences (GZMB), Georg-August-University, 37073, Göttingen, Germany
| | - Magdalena Sroka
- University Medical Center Göttingen, Georg-August-University, 37075, Göttingen, Germany
| | - Alireza Mansouri
- Global Agromedicine Research Center (GAMRC), Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
| | - Khaled Sadeghi
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Elham Bonakdar
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | | | - Amir Hossein Mahdavi
- Department of Animal Sciences, College of Agriculture, Isfahan University of Technology, Isfahan, 84156-83111, Iran
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Yang R, Feng J, Wan H, Zeng X, Ji P, Zhang J. Liver injury associated with the severity of COVID-19: A meta-analysis. Front Public Health 2023; 11:1003352. [PMID: 36817905 PMCID: PMC9932800 DOI: 10.3389/fpubh.2023.1003352] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Background The current 2019 novel coronavirus disease (COVID-19) pandemic is a major threat to global health. It is currently uncertain whether and how liver injury affects the severity of COVID-19. Therefore, we conducted a meta-analysis to determine the association between liver injury and the severity of COVID-19. Methods A systematic search of the PubMed, Embase, and Cochrane Library databases from inception to August 12, 2022, was performed to analyse the reported liver chemistry data for patients diagnosed with COVID-19. The pooled odds ratio (OR), weighted mean difference (WMD) and 95% confidence interval (95% CI) were assessed using a random-effects model. Furthermore, publication bias and sensitivity were analyzed. Results Forty-six studies with 28,663 patients were included. The pooled WMDs of alanine aminotransferase (WMD = 12.87 U/L, 95% CI: 10.52-15.23, I 2 = 99.2%), aspartate aminotransferase (WMD = 13.98 U/L, 95% CI: 12.13-15.83, I 2 = 98.2%), gamma-glutamyl transpeptidase (WMD = 20.67 U/L, 95% CI: 14.24-27.10, I 2 = 98.8%), total bilirubin (WMD = 2.98 μmol/L, 95% CI: 1.98-3.99, I 2 = 99.4%), and prothrombin time (WMD = 0.84 s, 95% CI: 0.46-1.23, I 2 = 99.4%) were significantly higher and that of albumin was lower (WMD = -4.52 g/L, 95% CI: -6.28 to -2.75, I 2 = 99.9%) in severe cases. Moreover, the pooled OR of mortality was higher in patients with liver injury (OR = 2.72, 95% CI: 1.18-6.27, I 2 = 71.6%). Conclusions Hepatocellular injury, liver metabolic, and synthetic function abnormality were observed in severe COVID-19. From a clinical perspective, liver injury has potential as a prognostic biomarker for screening severely affected patients at early disease stages. Systematic review registration https://www.crd.york.ac.uk/prospero/, Identifier: CRD42022325206.
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Affiliation(s)
- Ruiqi Yang
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jihua Feng
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huan Wan
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaona Zeng
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Pan Ji
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianfeng Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China,Department of General Practice, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China,*Correspondence: Jianfeng Zhang ✉
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Chela HK, Tallon EM, Baskett W, Gangu K, Tahan V, Shyu CR, Daglilar E. Liver injury on admission linked to worse outcomes in COVID-19: an analysis of 14,138 patients. Transl Gastroenterol Hepatol 2023; 8:4. [PMID: 36704655 PMCID: PMC9813654 DOI: 10.21037/tgh-21-94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/04/2021] [Indexed: 01/29/2023] Open
Abstract
Background Infection with the SARS-CoV-2 virus, which can result in hepatic inflammation and injury that varies from mild to severe and potentially acute fulminant liver injury, may be associated with poor outcomes. Our aims were to: (I) assess baseline clinical and demographic characteristics in patients with coronavirus disease 2019 (COVID-19) who did and did not have abnormalities in liver chemistries [alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (Tbili)] and (II) evaluate associations between abnormalities in liver chemistries and the primary outcomes of in-hospital death, intubation, and hospital length of stay (LOS). Methods In this nationwide retrospective cohort study of 14,138 patients, we analyzed associations between abnormalities in liver chemistries (ALT, AST, ALP, and Tbili) and mortality, intubation, and prolonged hospital LOS in patients with laboratory-confirmed COVID-19. We used Pearson's chi-squared tests to detect significant differences in categorical variables for patients with and without abnormal liver chemistries. Welch's two-sample t-tests were used to make comparisons of liver chemistry (ALT, AST, ALP, Tbili) and serum albumin results. All other continuous variables were analyzed using independent samples t-tests. A P value of <0.05 was considered significant. Results Propensity score matching demonstrated that abnormalities in liver chemistries at admission are significantly associated with increased risk for mortality (RR 1.70) and intubation (RR 1.44) in patients with COVID-19. Elevated AST is the liver chemistry abnormality associated with the highest risk for mortality (RR 2.27), intubation (RR 2.12), and prolonged hospitalization (RR 1.19). Male gender, pre-existing liver disease, and decreased serum albumin are also significantly associated with severe outcomes and death in COVID-19. Conclusions Routine liver chemistry testing should be implemented and used for risk stratification at the time of COVID-19 diagnosis.
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Affiliation(s)
- Harleen Kaur Chela
- Division of Gastroenterology, Department of Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Erin M. Tallon
- Institute for Data Science and Informatics, University of Missouri-Columbia, Columbia, MO, USA
| | - William Baskett
- Institute for Data Science and Informatics, University of Missouri-Columbia, Columbia, MO, USA
| | - Karthik Gangu
- Division of Hospital Medicine, Department of Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Veysel Tahan
- Division of Gastroenterology, Department of Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Chi-Ren Shyu
- Institute for Data Science and Informatics, University of Missouri-Columbia, Columbia, MO, USA;,Electrical Engineering and Computer Science Department, University of Missouri-Columbia, Columbia, MO, USA
| | - Ebubekir Daglilar
- Division of Gastroenterology, Department of Medicine, University of Missouri-Columbia, Columbia, MO, USA
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19
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Ali FEM, Abd El-Aziz MK, Ali MM, Ghogar OM, Bakr AG. COVID-19 and hepatic injury: cellular and molecular mechanisms in diverse liver cells. World J Gastroenterol 2023; 29:425-449. [PMID: 36688024 PMCID: PMC9850933 DOI: 10.3748/wjg.v29.i3.425] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) represents a global health and economic challenge. Hepatic injuries have been approved to be associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. The viral tropism pattern of SARS-CoV-2 can induce hepatic injuries either by itself or by worsening the conditions of patients with hepatic diseases. Besides, other factors have been reported to play a crucial role in the pathological forms of hepatic injuries induced by SARS-CoV-2, including cytokine storm, hypoxia, endothelial cells, and even some treatments for COVID-19. On the other hand, several groups of people could be at risk of hepatic COVID-19 complications, such as pregnant women and neonates. The present review outlines and discusses the interplay between SARS-CoV-2 infection and hepatic injury, hepatic illness comorbidity, and risk factors. Besides, it is focused on the vaccination process and the role of developed vaccines in preventing hepatic injuries due to SARS-CoV-2 infection.
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Affiliation(s)
- Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
| | | | - Mahmoud M Ali
- Department of Pharmacology, Al-Azhar University, Assiut 71524, Egypt
| | - Osama M Ghogar
- Department of Biochemistry Faculty of Pharmacy, Badr University in Assiut, Egypt
| | - Adel G Bakr
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
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20
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Papagiouvanni I, Kotoulas SC, Pataka A, Spyratos DG, Porpodis K, Boutou AK, Papagiouvannis G, Grigoriou I, Vettas C, Goulis I. COVID-19 and liver injury: An ongoing challenge. World J Gastroenterol 2023; 29:257-271. [PMID: 36687117 PMCID: PMC9846934 DOI: 10.3748/wjg.v29.i2.257] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
The new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in December 2019, in Wuhan, China. The virus was rapidly spread worldwide, causing coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is presented, usually, with typical respiratory symptoms (i.e., dyspnea, cough) and fever, extrapulmonary manifestations are also encountered. Liver injury is a common feature in patients with COVID-19 and ranges from mild and temporary elevation of liver enzymes to severe liver injury and, even, acute liver failure. The pathogenesis of liver damage is not clearly defined; multiple mechanisms contribute to liver disorder, including direct cytopathic viral effect, cytokine storm and immune-mediated hepatitis, hypoxic injury, and drug-induced liver toxicity. Patients with underlying chronic liver disease (i.e., cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID-19 and further liver deterioration, and, as a consequence, certain issues should be considered during disease management. The aim of this review is to present the prevalence, clinical manifestation and pathophysiological mechanisms of liver injury in patients with SARS-CoV-2 infection. Moreover, we overview the association between chronic liver disease and SARS-CoV-2 infection and we briefly discuss the management of liver injury during COVID-19.
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Affiliation(s)
- Ioanna Papagiouvanni
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Thessaloniki, Greece
| | | | - Athanasia Pataka
- Department of Respiratory Medicine, G Papanikolaou Hospital, Resp Failure Unit, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
| | - Dionisios G Spyratos
- Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
| | - Konstantinos Porpodis
- Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
| | - Afroditi K Boutou
- Pulmonary Department, G Papanikolaou Hospital, Resp Failure Unit, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Georgios Papagiouvannis
- Department of Pharmacy, School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
| | - Ioanna Grigoriou
- Respiratory Failure Clinic, Papanikolaou General Hospital, Thessloniki 57001, Greece
| | - Christos Vettas
- Fourth Department of Internal Medicine, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokration General Hospital, Thessaloniki 54642, Greece
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21
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Brandi N, Spinelli D, Granito A, Tovoli F, Piscaglia F, Golfieri R, Renzulli M. COVID-19: Has the Liver Been Spared? Int J Mol Sci 2023; 24:1091. [PMID: 36674607 PMCID: PMC9866733 DOI: 10.3390/ijms24021091] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
The liver is a secondary and often collateral target of COVID-19 disease but can lead to important consequences. COVID-19 might directly cause a high number of complications in patients with pre-existing chronic liver disease, increasing their risk of hepatic decompensation. Moreover, it also determines indirect consequences in the management of patients with liver disease, especially in those suffering from decompensated cirrhosis and HCC, as well as in the execution of their follow-up and the availability of all therapeutic possibilities. Liver imaging in COVID-19 patients proved to be highly nonspecific, but it can still be useful for identifying the complications that derive from the infection. Moreover, the recent implementation of telemedicine constitutes a possible solution to both the physical distancing and the re-organizational difficulties arising from the pandemic. The present review aims to encompass the currently hypothesized pathophysiological mechanisms of liver injury in patients with COVID-19 mediated by both the direct invasion of the virus and its indirect effects and analyze the consequence of the pandemic in patients with chronic liver disease and liver tumors, with particular regard to the management strategies that have been implemented to face this worldwide emergency and that can be further improved.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Daniele Spinelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alessandro Granito
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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22
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Polyzogopoulou E, Amoiridou P, Abraham TP, Ventoulis I. Acute liver injury in COVID-19 patients hospitalized in the intensive care unit: Narrative review. World J Gastroenterol 2022; 28:6662-6688. [PMID: 36620339 PMCID: PMC9813941 DOI: 10.3748/wjg.v28.i47.6662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 12/19/2022] Open
Abstract
In recent years, humanity has been confronted with a global pandemic due to coronavirus disease 2019 (COVID-19), which has caused an unprecedented health and economic crisis worldwide. Apart from the respiratory symptoms, which are considered the principal manifestations of COVID-19, it has been recognized that COVID-19 constitutes a systemic inflammatory process affecting multiple organ systems. Across the spectrum of organ involvement in COVID-19, acute liver injury (ALI) has been gradually gaining increasing attention by the international scientific community. COVID-19 associated liver impairment can affect a considerable proportion of COVID-19 patients and seems to correlate with the severity of the disease course. Indeed, COVID-19 patients hospitalized in the intensive care unit (ICU) run a greater risk of developing ALI due to the severity of their clinical condition and in the context of multi-organ failure. The putative pathophysiological mechanisms of COVID-19 induced ALI in ICU patients remain poorly understood and appear to be multifactorial in nature. Several theories have been proposed to explain the occurrence of ALI in the ICU setting, such as hypoperfusion and ischemia due to hemodynamic instability, passive liver congestion as a result of congestive heart failure, ischemia-reperfusion injury, hypoxia due to respiratory failure, mechanical ventilation itself, sepsis and septic shock, cytokine storm, endotheliitis with concomitant coagulopathy, drug-induced liver injury, parenteral nutrition and direct cytopathic viral effect. It should be noted that no specific therapy for COVID-19 induced ALI exists. Therefore, the therapeutic approach lies in preventive measures and is exclusively supportive once ALI ensues. The aim of the current review is to scrutinize the existing evidence on COVID-19 associated ALI in ICU patients, explore its clinical implications, shed light on the underlying pathophysiological mechanisms and propose potential therapeutic approaches. Ongoing research on the particular scientific field will further elucidate the pathophysiology behind ALI and address unresolved issues, in the hope of mitigating the tremendous health consequences imposed by COVID-19 on ICU patients.
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Affiliation(s)
- Effie Polyzogopoulou
- Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens 12462, Greece
| | - Pinelopi Amoiridou
- Department of Intensive Care, AHEPA University Hospital, Thessaloniki 54621, Greece
| | - Theodore P Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, United States
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Ptolemaida 50200, Greece
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23
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He YF, Jiang ZG, Wu N, Bian N, Ren JL. Correlation between COVID-19 and hepatitis B: A systematic review. World J Gastroenterol 2022; 28:6599-6618. [PMID: 36569273 PMCID: PMC9782843 DOI: 10.3748/wjg.v28.i46.6599] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/29/2022] [Accepted: 11/19/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND There is growing evidence that patients with coronavirus disease 2019 (COVID-19) frequently present with liver impairment. Hepatitis B virus (HBV) remains a major public health threat in current society. Both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HBV can cause liver damage, and current findings on whether HBV infection increases disease severity in COVID-19 patients are inconsistent, and whether SARS-CoV-2 infection accelerates hepatitis B progression or leads to a worse prognosis in hepatitis B patients has not been adequately elucidated. AIM To explore the complex relationship between COVID-19 and hepatitis B in order to inform the research and management of patients co-infected with SARS-CoV-2 and HBV. METHODS An experienced information specialist searched the literature in the following online databases: PubMed, China National Knowledge Infrastructure, Google Scholar, Scopus, Wiley, Web of Science, Cochrane, and ScienceDirect. The literature published from December 2019 to September 1, 2022 was included in the search. We also searched medRxiv and bioRxiv for gray literature and manually scanned references of included articles. Articles reporting studies conducted in humans discussing hepatitis B and COVID-19 were included. We excluded duplicate publications. News reports, reports, and other gray literature were included if they contained quantifiable evidence (case reports, findings, and qualitative analysis). Some topics that included HBV or COVID-19 samples but did not have quantitative evidence were excluded from the review. RESULTS A total of 57 studies were eligible and included in this review. They were from 11 countries, of which 33 (57.9%) were from China. Forty-two of the 57 studies reported abnormalities in liver enzymes, three mainly reported abnormalities in blood parameters, four indicated no significant liver function alterations, and another eight studies did not provide data on changes in liver function. Fifty-seven studies were retrospective and the total number of co-infections was 1932, the largest sample size was 7723, and the largest number of co-infections was 353. Most of the studies suggested an interaction between hepatitis B and COVID-19, while 12 studies clearly indicated no interaction between hepatitis B and COVID-19. Six of the 57 studies clearly reported HBV activation. Six studies were related to liver transplant patients. CONCLUSION There is some association between COVID-19 and hepatitis B. Future high-quality randomized trials are needed to further elucidate the interaction between COVID-19 and hepatitis B.
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Affiliation(s)
- Yan-Fei He
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Zhi-Gang Jiang
- Department of Statistics, Zunyi Medical University, Guizhou 563006, Guizhou Province, China
| | - Ni Wu
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Ning Bian
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Jun-Lin Ren
- Department of Infection Control, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
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24
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Saha L, Vij S, Rawat K. Liver injury induced by COVID 19 treatment - what do we know? World J Gastroenterol 2022; 28:6314-6327. [PMID: 36533104 PMCID: PMC9753058 DOI: 10.3748/wjg.v28.i45.6314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
The severity of coronavirus disease 2019 (COVID-19) may be correlated with the risk of liver injury development. An increasing number of studies indicate that degrees of hepatotoxicity have been associated with using some medications in the management of COVID-19 patients. However, limited studies have systematically investigated the evidence of drug-induced liver injury (DILI) in COVID-19 patients. An increasing number of studies indicate that degrees of hepatotoxicity have been associated with using some of these medications in the management of COVID-19 patients. Significantly, it was relieved after the cessation of these agents. However, to our knowledge, no studies have systematically investigated the evidence of DILI in COVID-19 patients. In this review, we discussed the association between hepatotoxicity in COVID-19 patients and the drugs used in these patients and possible mechanisms of hepatotoxicity. The currently available evidence on the association of different therapeutic agents with hepatotoxicity in COVID-19 patient was systematically reviewed.
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Affiliation(s)
- Lekha Saha
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Soumya Vij
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Kajal Rawat
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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25
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Elghannam MT, Hassanien MH, Ameen YA, ELattar GM, ELRay AA, Turky EA, ELTalkawy MD. COVID-19 and liver diseases. EGYPTIAN LIVER JOURNAL 2022; 12:43. [PMID: 35880136 PMCID: PMC9301896 DOI: 10.1186/s43066-022-00202-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus causes an outbreak of viral pneumonia that spread throughout the world. Liver injury is becoming more widely recognized as a component of the clinical picture of COVID-19 infection. Hepatitis with serum ALT elevation has been reported in up to half of patients. Patients with CLD were at a higher risk of decompensation with liver failure, hospitalization, and mortality. The percentage of acute liver injury (ALI) varied from 5 to 28%. COVID-19 hinders HCV elimination by 2030. It is recommended to continue treatment of chronic HCV and chronic HBV if already receiving treatment. Consider using antiviral therapy to prevent viral flare-ups in patients with occult or resolved HBV and COVID-19 who are receiving immunosuppressive agents. Patients with AIH do not have an increased risk of adverse outcomes even in high-risk areas. There is an association between MAFLD and disease progression. Patients with any type of cancer are at a higher risk of infection and are more likely to develop more severe clinical outcomes. Most societies advise against immunosuppressant modifications in patients with mild COVID-19, whereas in rare cases such as severe lymphopenia, worsening pneumonia, or bacterial or fungal superinfection, reduction or discontinuation of antiproliferative agents and lymphocyte-depleting therapies has been suggested.
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26
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Li X, Wang W, Yan S, Zhao W, Xiong H, Bao C, Chen J, Yue Y, Su Y, Zhang C. Drug-induced liver injury in COVID-19 treatment: Incidence, mechanisms and clinical management. Front Pharmacol 2022; 13:1019487. [PMID: 36518661 PMCID: PMC9742434 DOI: 10.3389/fphar.2022.1019487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/14/2022] [Indexed: 07/21/2023] Open
Abstract
The COVID-19 outbreak triggered a serious and potentially lethal pandemic, resulting in massive health and economic losses worldwide. The most common clinical manifestations of COVID-19 patients are pneumonia and acute respiratory distress syndrome, with a variety of complications. Multiple organ failure and damage, ultimately leading to patient death, are possible as a result of medication combinations, and this is exemplified by DILI. We hope to summarize DILI caused by the antiviral drugs favipiravir, remdesivir, lopinavir/ritonavir, and hydroxychloroquine in COVID-19 patients in this review. The incidence of liver injury in the treatment of COVID-19 patients was searched on PubMed to investigate DILI cases. The cumulative prevalence of acute liver injury was 23.7% (16.1%-33.1%). We discuss the frequency of these events, potential mechanisms, and new insights into surveillance strategies. Furthermore, we also describe medication recommendations aimed at preserving DILI caused by treatment in COVID-19 patients.
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Affiliation(s)
- Xichuan Li
- Tianjin Key Laboratory of Animal and Plant Resistance, College of Life Sciences, Tianjin Normal University, Tianjin, China
| | - Wanting Wang
- Department of Colorectal Surgery, Tianjin Institute of Coloproctology, The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Suying Yan
- Department of Colorectal Surgery, Tianjin Institute of Coloproctology, The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Weipeng Zhao
- Department of Breast Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Hui Xiong
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Cuiping Bao
- Departments of Radiology, Tianjin Union Medical Center, Tianjin, China
| | - Jinqian Chen
- Departments of Pharmacy, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China
| | - Yuan Yue
- Tianjin Key Laboratory of Animal and Plant Resistance, College of Life Sciences, Tianjin Normal University, Tianjin, China
| | - Yanjun Su
- Department of Lung Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Institute of Coloproctology, The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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27
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Payus AO, Mohd Noh M, Azizan N, Muthukaruppan Chettiar R. SARS-CoV-2-induced liver injury: A review article on the high-risk populations, manifestations, mechanisms, pathological changes, management, and outcomes. World J Gastroenterol 2022; 28:5723-5730. [PMID: 36338886 PMCID: PMC9627422 DOI: 10.3748/wjg.v28.i39.5723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/24/2022] [Accepted: 10/10/2022] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease 2019 is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was declared a global pandemic with more than 500 million reported cases and more than 6 million deaths worldwide to date. Although it has transitioned into the endemic phase in many countries, the mortality rate and overall prognosis of the disease are still abysmal and need further improvement. There has been evidence that shows the significance of SARS-CoV-2-related liver injury. Here, we review the literature on the various spectrum of SARS-CoV-2 infection-induced liver injury and the possible mechanisms of damage to the hepatobiliary system. This review aimed to illustrate the latest understanding regarding SARS-CoV-2-induced liver injury including the high-risk populations, the characteristic clinical manifestations, the possible pathogenic mechanism, the pathological changes, the current suggestions for clinical treatment for various spectrum of populations, and the prognosis of the condition. In conclusion, SARS-CoV-2 patients with a liver injury warrant close monitoring as it is associated with the more severe and poorer outcome of the infection.
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Affiliation(s)
- Alvin Oliver Payus
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Malehah Mohd Noh
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Nornazirah Azizan
- Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
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28
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Hepatocellular Damage and Severity of COVID-19 Infection in Iraqi Patients: A Biochemical Study. Rep Biochem Mol Biol 2022; 11:524-531. [PMID: 36718303 PMCID: PMC9883029 DOI: 10.52547/rbmb.11.3.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/24/2022] [Indexed: 01/17/2023]
Abstract
Background Infection with COVID-19 can cause hepatic damages. Here, we aimed to examine the effect of COVID-19 infection on the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, and procalcitonin (PCT) concentrations as markers to evaluate the liver function. Methods In this study, 56 patients infected with COVID- 19 and 28 healthy controls was recruited in Private Nursing Home Hospital of the Medical City, Baghdad. Patients were subdivided according to disease severity into severe and non-severe groups. Results The results showed that the mean±SD value of serum AST activity and serum PCT concentrations were elevated significantly in severe group in comparison to healthy control, (p< 0.01, p< 0.001) respectively. Also, the mean ±SD value of serum ALT activity was higher in severe group compared to the healthy subjects and non-severe ones, significantly (p< 0.0001, p< 0.003) respectively. While the mean value of serum albumin concentration of severe patients and non-severe group were significantly decreased compared to healthy subjects. The receiver operating characteristic curve (ROC) revealed that ROC value of albumin (0.992) differentiates between non-severe infected patients and healthy subjects, while the ROC value of serum ALT activity (0.735) differentiates between severe COVID-19 patients and non- severe ones. Conclusion Changes of liver function parameters in COVID-19 patients were mild to moderate and measurement of serum ALT activity is the best biomarker in differentiation between non-severe patients and severe ones and albumin concentration is excellent in discrimination between patients and controls.
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29
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Danna PS, Buoni GF, Bor S, Coda C, Abruzzese F, Bertoli M, Giaivia V, Airoldi C, Castello LM, Saba L, Carriero A. May an incidental finding on chest CT be a predictor of access in intensive care unit? Role of hepatic steatosis in patients affected by SARS-CoV-2. J Public Health Res 2022; 11:22799036221115779. [DOI: 10.1177/22799036221115779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Due to the high prevalence of hepatic steatosis (HS), the aim of the study is to verify the frequency of HS incidentally detected in chest computed tomography (CT) imaging in our population affected by SARS-CoV-2 and to investigate its association with the severity of the infection and outcome in terms of hospitalization. Design and methods: We retrospectively analyzed 500 patients with flu syndrome and clinically suspected of having Sars-CoV-2 infection who underwent unenhanced chest CT and have positive RT-PCR tests for Sars-CoV-2 RNA. Two radiologists both with >5 years of thoracic imaging experience, evaluated the images in consensus, without knowing the RT-PCR results. Liver density was measured by a region of interest (ROI), using a liver attenuation value ≤40 Hounsfield units (HU). Results: On 480 patients, 23.1% (111/480) had an incidental findings of HS on chest CT. The steatosis group, included 83 (74.7%) males and 28 (25.3%) females. Patients with HS were more likely to be hospitalized in the intensive care unit (ICU). On univariate analysis, there is a correlation between probability to be intubate (access in the ICU) and HS: patients with HS are twice as likely to be intubated (OR 2.04, CI 95% 1.11–3.73). Conclusion: Chest CT is an important diagnostic tool for COVID-19 and can provide information about the prognosis of the disease. HS can easily be detected on chest CT taken for the diagnosis of the COVID-19 disease, is an important sign for a poor prognosis and possible predictor of admission in ICU.
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Affiliation(s)
- Pietro S.C. Danna
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Giada Francesca Buoni
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Simone Bor
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Carolina Coda
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Flavia Abruzzese
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Matteo Bertoli
- Department of Translational Medicine, Universita del Piemonte Orientale, Novara, Italy
| | - Valentina Giaivia
- Department of Translational Medicine, Universita del Piemonte Orientale, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Universita del Piemonte Orientale, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Universita del Piemonte Orientale, Novara, Italy
| | - Luca Saba
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandro Carriero
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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30
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Wifi MN, Morad MA, El Sheemy R, Abdeen N, Afify S, Abdalgaber M, Abdellatef A, Zaghloul M, Alboraie M, El-Kassas M. Hemostatic system and COVID-19 crosstalk: A review of the available evidence. World J Methodol 2022; 12:331-349. [PMID: 36186748 PMCID: PMC9516549 DOI: 10.5662/wjm.v12.i5.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant coronavirus disease 2019 (COVID-19) pandemic, respiratory manifestations have been the mainstay of clinical diagnosis, laboratory evaluations, and radiological investigations. As time passed, other pathological aspects of SARS-CoV-2 have been revealed. Various hemostatic abnormalities have been reported since the rise of the pandemic, which was sometimes superficial, transient, or fatal. Mild thrombocytopenia, thrombocytosis, venous, arterial thromboembolism, and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19. Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19, especially in patients admitted to intensive care units. Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation. Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood, professional societies recommend prophylactic antithrombotic therapy in severe cases, especially in the presence of abnormal coagulation indices. The review article discusses the various available evidence on coagulation disorders, management strategies, outcomes, and prognosis associated with COVID-19 coagulopathy, which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.
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Affiliation(s)
- Mohamed-Naguib Wifi
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mohamed Abdelkader Morad
- Clinical Hematology Unit, Department of Internal Medicine, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Reem El Sheemy
- Department of Tropical Medicine, Minia Faculty of Medicine, Minia University, Minia 61511, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria 21523, Egypt
| | - Shimaa Afify
- Department of Gastroenterology, National Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo 11451, Egypt
| | - Mohammad Abdalgaber
- Department of Gastroenterology and Hepatology, Police Authority Hospital, Agoza, Giza 12511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh 33511, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan 11731, Egypt
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31
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Characteristics of COVID-19 Infection in a Hospitalized Autoimmune Hepatitis Patient. Pathogens 2022; 11:pathogens11091054. [PMID: 36145486 PMCID: PMC9501835 DOI: 10.3390/pathogens11091054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a major public health worldwide. Hepatic dysfunction has been seen in patients with COVID-19 and could be related to a viral cytopathic effect, an exacerbated immune reaction, or drug-induced liver damage. Currently, routine modification of immunosuppressive therapy in patients with autoimmune hepatitis (AIH) before and after SARS-CoV-2 infection remains an important topic to be discussed. However, there is little evidence about this thematic to support any recommendation. Here, we described a case report in which the use of an immunosuppressive drug by a patient with diagnosed AIH might have influenced the COVID-19 clinical course with altered laboratory hematological and biochemical parameters during infection.
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32
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Alnamshan MM. Potential histopathological and immunological effects of SARS-CoV-2 on the liver. BRAZ J BIOL 2022; 82:e262008. [PMID: 36074418 DOI: 10.1590/1519-6984.262008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease outbreak of 2019 (COVID-19) poses a serious threat to public health worldwide. Lung injury is the most common complication of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. However, other organs, including the liver, can also be affected. Currently, there is limited evidence that liver impairment is associated with severe SARS-CoV-2 infection. Clinicians will need to determine whether liver injury is caused by an underlying liver condition, COVID-19 therapy, the virus directly, or immune-mediated inflammation or represents a complicated disease course in the context of COVID-19. To address the scarcity of data on histopathological changes and immunological effects on the liver with COVID-19 positivity, we analyze and summarize recent findings. We searched PubMed, Medline, Google Scholar, Science Direct, Scopus, and Web of Science databases up to December 1, 2021, identifying published studies with the search terms "Histopathology in COVID-19," "COVID-19," "Pathological changes in liver in COVID-19," "Liver pathology in COVID-19," "immunological effects in liver in COVID-19," and "SARS-CoV-2." This concise review will aid clinicians and researchers in better understanding the tissue histopathology and immunological consequences of SARS-CoV-2 on the liver, enabling improved care planning and avoiding future dangers.
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Affiliation(s)
- M M Alnamshan
- Imam Abdulrahman Bin Faisal University, College of Science, Department of Biology, Dammam, Saudi Arabia
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33
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Chen H, Chen Q. COVID-19 Pandemic: Insights into Interactions between SARS-CoV-2 Infection and MAFLD. Int J Biol Sci 2022; 18:4756-4767. [PMID: 35874945 PMCID: PMC9305262 DOI: 10.7150/ijbs.72461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/23/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become an ongoing global health pandemic. Since 2019, the pandemic continues to cast a long shadow on all aspects of our lives, bringing huge health and economic burdens to all societies. With our in-depth understanding of COVID-19, from the initial respiratory tract to the later gastrointestinal tract and cardiovascular systems, the multiorgan involvement of this infectious disease has been discovered. Metabolic dysfunction-associated fatty liver disease (MAFLD), formerly named nonalcoholic fatty liver disease (NAFLD), is a major health issue closely related to metabolic dysfunctions, affecting a quarter of the world's adult population. The association of COVID-19 with MAFLD has received increasing attention, as MAFLD is a potential risk factor for SARS-CoV-2 infection and severe COVID-19 symptoms. In this review, we provide an update on the interactions between COVID-19 and MAFLD and its underlying mechanisms.
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Affiliation(s)
- Hanfei Chen
- Cancer Center, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China.,Centre for Precision Medicine Research and Training, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China
| | - Qiang Chen
- Cancer Center, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China.,Centre for Precision Medicine Research and Training, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China.,MOE Frontier Science Centre for Precision Oncology, University of Macau, Taipa, Macau SAR, China
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34
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Radonjić T, Milićević O, Jovanović I, Zdravković M, Dukić M, Mandić OM, Bjekić-Macut J, Marković OB, Todorović Z, Brajković M, Nikolić N, Klašnja S, Popadić V, Divac A, Marinković M, Alhayek N, Branković MS. Elevated Transaminases as Predictors of COVID-19 Pneumonia Severity. Medicina (B Aires) 2022; 58:medicina58070842. [PMID: 35888561 PMCID: PMC9319887 DOI: 10.3390/medicina58070842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background: This study aimed to calculate the frequency of elevated liver enzymes in hospitalized patients with coronavirus disease 2019 (COVID-19) infection and to test if liver enzyme biochemistry levels on admission could predict the computed tomography (CT) scan severity score of bilateral interstitial pneumonia. Methods: This single-center study comprised of 323 patients including their demographic data, laboratory analyses, and radiological findings. All the information was taken from electronic health records, followed by statistical analysis. Results: Out of 323 patients, 115 of them (35.60%) had aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) over 40 U/L on admission. AST was the best predictor of CT scan severity score of bilateral interstitial pneumonia (R2 = 0.313, Adjusted R2 = 0.299). CT scan severity score in the peak of the infection could be predicted with the value of AST, neutrophils, platelets, and monocytes count (R2 = 0.535, Adjusted R2 = 0.495). Conclusion: AST, neutrophils, platelets, and monocytes count on admission can account for almost half (49.5%) of the variability in CT scan severity score at peak of the disease, predicting the extensiveness of interstitial pneumonia related to COVID-19 infection. Liver enzymes should be closely monitored in order to stratify COVID-19 patients with a higher risk of developing severe forms of the disease and to plan the beforehand step-up treatment.
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Affiliation(s)
- Tijana Radonjić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
- Correspondence:
| | - Ognjen Milićević
- Faculty of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
| | - Igor Jovanović
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Marija Zdravković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
| | - Marija Dukić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Olga Milorad Mandić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Jelica Bjekić-Macut
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
| | - Olivera Borko Marković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
| | - Zoran Todorović
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
| | - Milica Brajković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Novica Nikolić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Slobodan Klašnja
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Višeslav Popadić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Anica Divac
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
| | - Milica Marinković
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
| | - Nabil Alhayek
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
| | - Marija Svetislav Branković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia; (I.J.); (M.Z.); (M.D.); (O.M.M.); (J.B.-M.); (O.B.M.); (Z.T.); (M.B.); (N.N.); (S.K.); (V.P.); (A.D.); (M.S.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.M.); (N.A.)
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Xu Z, Zhang Y, Zhang C, Xiong F, Zhang J, Xiong J. Clinical Features and Outcomes of COVID-19 Patients with Acute Kidney Injury and Acute Kidney Injury on Chronic Kidney Disease. Aging Dis 2022; 13:884-898. [PMID: 35656097 PMCID: PMC9116918 DOI: 10.14336/ad.2021.1125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/25/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 emerged in Wuhan in December 2019 and soon became a worldwide pandemic. We collected and analyzed the data from 1077 patients with COVID-19 who were admitted to the west campus of Wuhan Union Hospital from January 16 to April 16, 2020. Sixty (5.6%) of the 1077 COVID-19 patients were diagnosed with acute kidney injury (AKI) during hospitalization, and 18 of them (30%) had AKI on chronic kidney disease (AKI/CKD). COVID-19 patients with AKI had a worse prognosis, with higher intensive care unit (ICU) admission (28.3%) and fatality (65%) rates than patients without AKI (3.4% and 10.7%, respectively). Among the COVID-19 patients, AKI was more likely to occur in male patients, the elderly, patients with more severe disease states and those with comorbidities (such as hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD) and CKD). COVID-19 patients with AKI were more likely to develop respiratory failure, gastrointestinal bleeding, acute liver injury, acute myocardial injury, heart failure, acute respiratory distress syndrome (ARDS), cerebrovascular accident, and disseminated intravascular coagulation (DIC) than those without AKI. Compared with patients without AKI, COVID-19 patients with AKI had lower platelet counts, lymphocyte counts, albumin levels and serum calcium levels but had elevated leukocyte counts, neutrophil counts and serum potassium levels. Inflammatory indicators, such as C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT), were significantly higher in patients with AKI than in those without AKI. COVID-19 patients with AKI also exhibited a longer prothrombin time (PT), a longer activated partial thromboplastin time (APTT), and a higher D-dimer level than those without AKI. Survival analysis revealed that COVID-19 patients with AKI had a reduced survival rate compared with those without AKI. Furthermore, COVID-19 patients with AKI/CKD had a lower survival rate than those with AKI or CKD only. Multiple logistic regression indicated that the predictors of AKI in COVID-19 patients included complications, such as respiratory failure and acute myocardial injury, and higher creatinine and PCT levels during hospitalization.
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Affiliation(s)
- Zhifeng Xu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yuanyuan Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Fei Xiong
- Department of Nephrology, Wuhan No. 1 Hospital, Wuhan, China
| | - Jianduan Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jing Xiong
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Ombajo LA, Mutono N, Sudi P, Mutua M, Sood M, Loo AM, Juma P, Odhiambo J, Shah R, Wangai F, Maritim M, Anzala O, Amoth P, Kamuri E, Munyu W, Thumbi SM. Epidemiological and clinical characteristics of patients hospitalised with COVID-19 in Kenya: a multicentre cohort study. BMJ Open 2022; 12:e049949. [PMID: 35589368 PMCID: PMC9121111 DOI: 10.1136/bmjopen-2021-049949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess outcomes of patients admitted to hospital with COVID-19 and to determine the predictors of mortality. SETTING This study was conducted in six facilities, which included both government and privately run secondary and tertiary level facilities in the central and coastal regions of Kenya. PARTICIPANTS We enrolled 787 reverse transcriptase-PCR-confirmed SARS-CoV2-infected persons. Patients whose records could not be accessed were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was COVID-19-related death. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality. RESULTS Data from patients with 787 COVID-19 were available. The median age was 43 years (IQR 30-53), with 505 (64%) being men. At admission, 455 (58%) were symptomatic with an additional 63 (9%) developing clinical symptoms during hospitalisation. The most common symptoms were cough (337, 43%), loss of taste or smell (279, 35%) and fever (126, 16%). Comorbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%), respectively. 90 (11%) were admitted to the Intensive Care Unit (ICU) for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age (HR 1.57 (95% CI 1.13 to 2.19)) for persons >60 years compared with those <60 years old; having comorbidities (HR 2.34 (1.68 to 3.25)) and among men (HR 1.76 (1.27 to 2.44)) compared with women. Elevated white cell count and aspartate aminotransferase were associated with higher risk of death. CONCLUSIONS The risk of death from COVID-19 is high among older patients, those with comorbidities and among men. Clinical parameters including patient clinical signs, haematology and liver function tests were associated with risk of death and may guide stratification of high-risk patients.
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Affiliation(s)
- Loice Achieng Ombajo
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Nyamai Mutono
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Paul Sudi
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mbuvi Mutua
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mohammed Sood
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Alliyy Muhammad Loo
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Phoebe Juma
- Department of Medicine, Nairobi Hospital, Nairobi, Kenya
| | | | - Reena Shah
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Frederick Wangai
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Marybeth Maritim
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Patrick Amoth
- Office of The Director General, Kenya Ministry of Health, Nairobi, Kenya
| | - Evans Kamuri
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Waweru Munyu
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
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37
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Wang LG, Wang L. Current Strategies in Treating Cytokine Release Syndrome Triggered by Coronavirus SARS-CoV-2. Immunotargets Ther 2022; 11:23-35. [PMID: 35611161 PMCID: PMC9124488 DOI: 10.2147/itt.s360151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/07/2022] [Indexed: 12/15/2022] Open
Abstract
Since the beginning of the SARS-CoV-2 pandemic, the treatments and management of the deadly COVID-19 disease have made great progress. The strategies for developing novel treatments against COVID-19 include antiviral small molecule drugs, cell and gene therapies, immunomodulators, neutralizing antibodies, and combination therapies. Among them, immunomodulators are the most studied treatments. The small molecule antiviral drugs and immunoregulators are expected to be effective against viral variants of SARS-CoV-2 as these drugs target either conservative parts of the virus or common pathways of inflammation. Although the immunoregulators have shown benefits in reducing mortality of cytokine release syndrome (CRS) triggered by SARS-CoV-2 infections, extensive investigations on this class of treatment to launch novel therapies that substantially improve efficacy and reduce side effects are still warranted. Moreover, great challenges have emerged as the SARS-CoV-2 virus quickly, frequently, and continuously evolved. This review provides an update and summarizes the recent advances in the treatment of COVID-19 and in particular emphasized the strategies in managing CRS triggered by SARS-CoV-2. A brief perspective in the battle against the deadly disease was also provided.
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Affiliation(s)
- Long G Wang
- Department of Research and Development, Natrogen Therapeutics International, Inc., Valhalla, NY, USA
| | - Luxi Wang
- Department of Clinical Research, Clinipace Clinical Research, Morrisville, NC, USA
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Kumar D, Srivastava S, Rajnikant T, Dawra S, Tevatia M, Mukherjee R. Liver function tests in COVID 19: A retrospective record-based study from a tertiary care centre in urban Maharashtra, India. Med J Armed Forces India 2022; 79:S0377-1237(22)00026-0. [PMID: 35582519 PMCID: PMC9098942 DOI: 10.1016/j.mjafi.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background COVID-19 is a multi system disorder and causes various abnormalities in liver function tests. The aim of this study was to estimate the prevalence of abnormal liver function tests in patients of COVID-19 and to describe the association of liver function tests with clinical features and disease severity in these patients. Methods We retrospectively evaluated and analyzed the liver function tests of all real-time polymerase chain reaction (RT-PCR) positive COVID-19 patients admitted to a tertiary care hospital in Western Maharashtra. The Institutional Ethics Committee of our hospital approved the study. Results Of the 533 patients included in our study, 50% had abnormal albumin levels while 40.1%, 43.5%, 9.3%, and 6.3% patients had deranged alanine transaminase (ALT) aspartate transaminase (AST), total protein and bilirubin levels, respectively. Hepatocellular injury was observed in 21 (3.9%) patients, and cholestatic liver injury was observed in seven (1.3%) patients. Abnormal liver function test (LFT) was significantly associated with disease severity but not with mortality. Conclusion Abnormal LFT in patients of COVID-19 is associated with severe disease but not mortality. Liver injury is common in patients of COVID-19.
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Affiliation(s)
- Dharmendra Kumar
- Senior Adviser (Medicine) & Gastroenterologist, Command Hospital (Northern Command), Udhampur, India
| | - Sharad Srivastava
- Senior Adviser (Medicine) & Gastroenterologist, Command Hospital (Southern Command), Pune, India
| | - T. Rajnikant
- Classified Specialist (Medicine) & Gastroenterologist, Command Hospital (Southern Command), Pune, India
| | - Saurabh Dawra
- Classified Specialist (Medicine) & Gastroenterologist, Command Hospital (Southern Command), Pune, India
| | - M.S. Tevatia
- Commandant, Command Hospital (Southern Command), Pune, India
| | - Reema Mukherjee
- Scientist E, Indian Council of Medical Research, New Delhi, India
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Harapan H, Fajar JK, Supriono S, Soegiarto G, Wulandari L, Seratin F, Prayudi NG, Dewi DP, Monica Elsina MT, Atamou L, Wiranata S, Aprianto DP, Friska E, Sari Firdaus DF, Alaidin M, Wardhani FA, Husnah M, Hidayati NW, Hendriyanti Y, Wardani K, Evatta A, Manugan RA, Pradipto W, Rahmawati A, Tamara F, Mahendra AI, Nainu F, Santoso B, Irawan Primasatya CA, Tjionganata N, Budiman HA. The prevalence, predictors and outcomes of acute liver injury among patients with COVID-19: A systematic review and meta-analysis. Rev Med Virol 2022; 32:e2304. [PMID: 34643006 PMCID: PMC8646502 DOI: 10.1002/rmv.2304] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 01/09/2023]
Abstract
The data on the predictors and prognosis of acute liver injury (ALI) among patients in coronavirus disease 2019 (COVID-19) patients are limited. The aim of this study was to determine the prevalence, predictors and outcomes of ALI among patients with COVID-19. A systematic review was conducted up to 10 June 2021. The relevant papers were searched from PubMed, Embase, Cochrane and Web of Science, and the data were analysed using a Z test. A total of 1331 papers were identified and 16 papers consisting of 1254 COVID-19 with ALI and 4999 COVID-19 without ALI were analysed. The cumulative prevalence of ALI among patients with COVID-19 was 22.8%. Male and having low lymphocyte levels were more likely to be associated with ALI compared with female and having higher lymphocyte level, odds ratio (OR): 2.70; 95% confidence interval (CI): 2.03, 3.60 and mean difference (MD) -125; 95% CI: -207, -43, respectively. COVID-19 patients with ALI had higher risk of developing severe COVID-19 compared with those without ALI (OR: 3.61; 95% CI: 2.60, 5.02). Our findings may serve as the additional evaluation for the management of ALI in COVID-19 patients.
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Affiliation(s)
- Harapan Harapan
- Medical Research UnitSchool of MedicineUniversitas Syiah KualaBanda AcehIndonesia
- Tropical Disease CentreSchool of MedicineUniversitas Syiah KualaBanda AcehIndonesia
- Department of MicrobiologySchool of MedicineUniversitas Syiah KualaBanda AcehIndonesia
| | - Jonny Karunia Fajar
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Supriono Supriono
- Department of Internal MedicineDivision of Gastro‐Entero‐HepatologyFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Gatot Soegiarto
- Department of Internal MedicineDivision of Allergy & ImmunologyUniversitas AirlanggaSurabayaIndonesia
| | - Laksmi Wulandari
- Department of Pulmonology and Respiratory MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Fiha Seratin
- Department of PaediatricFaculty of MedicineUniversitas PadjajaranBandungIndonesia
| | - Nyoman Gede Prayudi
- Department of UrologyFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | | | | | | | | | | | - Erlin Friska
- Faculty of MedicineUniversitas IndonesiaDepokIndonesia
| | | | - Makdum Alaidin
- Department of NursingFaculty of MedicineUniversitas DiponegoroSemarangIndonesia
| | | | - Milda Husnah
- Master Program of BiologyFaculty of Mathematics and Natural SciencesUniversitas Syiah KualaBanda AcehIndonesia
| | | | | | - Kristia Wardani
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Arde Evatta
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Reizal Audi Manugan
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Wiryawan Pradipto
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Ade Rahmawati
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Fredo Tamara
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Aditya Indra Mahendra
- Brawijaya Internal Medicine Research CentreDepartment of Internal MedicineFaculty of MedicineUniversitas BrawijayaMalangIndonesia
| | - Firzan Nainu
- Faculty of PharmacyHasanuddin UniversityMakassarIndonesia
| | - Budi Santoso
- Department of Internal MedicineRSUD BangilPasuruanIndonesia
| | | | - Nindy Tjionganata
- Department of Internal MedicineFaculty of MedicineUniversitas AirlanggaSurabayaIndonesia
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Liver Injury in COVID-19 Patients with Drugs as Causatives: A Systematic Review of 996 DILI Cases Published 2020/2021 Based on RUCAM as Causality Assessment Method. Int J Mol Sci 2022; 23:ijms23094828. [PMID: 35563242 PMCID: PMC9100611 DOI: 10.3390/ijms23094828] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023] Open
Abstract
Patients with coronavirus disease 19 (COVID-19) commonly show abnormalities of liver tests (LTs) of undetermined cause. Considering drugs as tentative culprits, the current systematic review searched for published COVID-19 cases with suspected drug-induced liver injury (DILI) and established diagnosis using the diagnostic algorithm of RUCAM (Roussel Uclaf Causality Assessment Method). Data worldwide on DILI cases assessed by RUCAM in COVID-19 patients were sparse. A total of 6/200 reports with initially suspected 996 DILI cases in COVID-19 patients and using all RUCAM-based DILI cases allowed for a clear description of clinical features of RUCAM-based DILI cases among COVID-19 patients: (1) The updated RUCAM published in 2016 was equally often used as the original RUCAM of 1993, with both identifying DILI and other liver diseases as confounders; (2) RUCAM also worked well in patients treated with up to 18 drugs and provided for most DILI cases a probable or highly probable causality level for drugs; (3) DILI was preferentially caused by antiviral drugs given empirically due to their known therapeutic efficacy in other virus infections; (4) hepatocellular injury was more often reported than cholestatic or mixed injury; (5) maximum LT values were found for alanine aminotransferase (ALT) 1.541 U/L and aspartate aminotransferase (AST) 1.076 U/L; (6) the ALT/AST ratio was variable and ranged from 0.4 to 1.4; (7) the mean or median age of the COVID-19 patients with DILI ranged from 54.3 to 56 years; (8) the ratio of males to females was 1.8–3.4:1; (9) outcome was favorable for most patients, likely due to careful selection of the drugs and quick cessation of drug treatment with emerging DILI, but it was fatal in 19 patients; (10) countries reporting RUCAM-based DILI cases in COVID-19 patients included China, India, Japan, Montenegro, and Spain; (11) robust estimation of the percentage contribution of RUCAM-based DILI for the increased LTs in COVID-19 patients is outside of the current scope. In conclusion, RUCAM-based DILI with its clinical characteristics in COVID-19 patients and its classification as a confounding variable is now well defined, requiring a new correct description of COVID-19 features by removing DILI characteristics as confounders.
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Kariyawasam JC, Jayarajah U, Abeysuriya V, Riza R, Seneviratne SL. Involvement of the Liver in COVID-19: A Systematic Review. Am J Trop Med Hyg 2022; 106:1026-1041. [PMID: 35203056 PMCID: PMC8991364 DOI: 10.4269/ajtmh.21-1240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/16/2022] [Indexed: 01/11/2023] Open
Abstract
COVID-19, a respiratory viral infection, has affected 388 million individuals worldwide as of the February 4, 2022. In this review, we have outlined the important liver manifestations of COVID-19 and discussed the possible underlying pathophysiological mechanisms and their diagnosis and management. Factors that may contribute to hepatic involvement in COVID-19 include direct viral cytopathic effects, exaggerated immune responses/systemic inflammatory response syndrome, hypoxia-induced changes, vascular changes due to coagulopathy, endothelitis, cardiac congestion from right heart failure, and drug-induced liver injury. The majority of COVID-19-associated liver symptoms are mild and self-limiting. Thus management is generally supportive. Liver function tests and abdominal imaging are the primary investigations done in relation to liver involvement in COVID-19 patients. However, imaging findings are nonspecific. Severe acute respiratory syndrome coronavirus 2 RNA has been found in liver biopsies. However, there is limited place for liver biopsy in the clinical context, as it does not influence management. Although, the management is supportive in the majority of patients without previous liver disease, special emphasis is needed in those with nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, hepatitis B and C infections, and alcoholic liver disease, and in liver transplant recipients.
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Affiliation(s)
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
| | - Rishdha Riza
- Colombo South Teaching Hospital, Colombo, Sri Lanka
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Pandey R, Rai D, Tahir MW, Wahab A, Bandyopadhyay D, Lesho E, Laguio-Vila M, Fentanes E, Tariq R, Naidu SS, Aronow WS. Prevalence of comorbidities and symptoms stratified by severity of illness amongst adult patients with COVID-19: a systematic review. Arch Med Sci Atheroscler Dis 2022; 7:e5-e23. [PMID: 35582712 PMCID: PMC9081912 DOI: 10.5114/amsad.2022.115008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction We performed a systematic review of comorbidities and symptoms of adult patients with coronavirus disease 2019 (COVID-19) to evaluate comorbidities, symptoms, and severity. Material and methods We searched databases and extracted comorbidities and symptoms from the included studies. We stratified the similar signs and symptoms in groups and on the basis of severity and compared them with stratified analysis. Individual case reports and case series with < 5 patients were excluded. Results A total of 163 studies with 43,187 patients were included. Mean age was 54.6 years. There were significantly fewer women in the study (43.9% vs. 56.1%, p < 0.0001). Prevalent cardiovascular comorbidities were hypertension (31.9%), obesity (27.9%), hyperlipidemia (26.4%), smoking (18.9%), diabetes mellitus (17.2%), atherosclerotic disease (9.2%) and arrhythmia (5.0%). The most frequently reported constitutional symptoms of COVID-19 were fever (73.9%), fatigue (33.4%), malaise (29.9%), myalgia and/or arthralgia (19.2%), generalized weakness (19.0%), and chills (11.3%). For the cardiovascular system, chest pain and/or tightness were most often reported (19.6%), followed by palpitations (5.2%). Hypertension and diabetes were common in severe disease. Obesity and congestive heart failure were not observed in any non-severe cases. Severe cases compared to non-severe cases more frequently had fever (87.8% vs. 58.5%, p < 0.001), shortness of breath (47.4% vs. 20.6%, p < 0.001), cough (66.8% vs. 62.9%, p < 0.001), sputum production (35.4% vs. 26.5%, p < 0.001) and rhinorrhea (32.2% vs. 7.3%, p < 0.001). Conclusions Hypertension, diabetes, and atherosclerotic diseases are common comorbidities across the world, with obesity as the second most common in the US and more common in men.
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Affiliation(s)
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, USA
| | | | - Abdul Wahab
- Department of Internal Medicine, University of Iowa, IA, USA
| | | | - Emil Lesho
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Maryrose Laguio-Vila
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Emilio Fentanes
- Department of Cardiology, Brigham and Women’s Hospital, MA, USA
| | - Raseen Tariq
- Department of Internal Medicine, Rochester General Hospital, USA
| | - Srihari S. Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
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D’Ardes D, Boccatonda A, Cocco G, Fabiani S, Rossi I, Bucci M, Guagnano MT, Schiavone C, Cipollone F. Impaired coagulation, liver dysfunction and COVID-19: Discovering an intriguing relationship. World J Gastroenterol 2022; 28:1102-1112. [PMID: 35431501 PMCID: PMC8985482 DOI: 10.3748/wjg.v28.i11.1102] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/09/2021] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is, at present, one of the most relevant global health problems. In the literature hepatic alterations have been described in COVID-19 patients, and they are mainly represented by worsening of underlying chronic liver disease leading to hepatic decompensation and liver failure with higher mortality. Several potential mechanisms used by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to cause liver damage have been hypothesized. COVID-19 primary liver injury is less common than secondary liver injury. Most of the available data demonstrate how liver damage in SARS-CoV-2 infection is likely due to systemic inflammation, and it is less likely mediated by a cytopathic effect directed on liver cells. Moreover, liver alterations could be caused by hypoxic injury and drugs (antibiotics and non-steroidal anti-inflammatory drugs, remdesivir, tocilizumab, tofacitinib and dexamethasone). SARS-CoV-2 infection can induce multiple vascular district atherothrombosis by affecting simultaneously cerebral, coronary and peripheral vascular beds. Data in the literature highlight how the virus triggers an exaggerated immune response, which added to the cytopathic effect of the virus can induce endothelial damage and a prothrombotic dysregulation of hemostasis. This leads to a higher incidence of symptomatic and confirmed venous thrombosis and of pulmonary embolisms, especially in central, lobar or segmental pulmonary arteries, in COVID-19. There are currently fewer data for arterial thrombosis, while myocardial injury was identified in 7%-17% of patients hospitalized with SARS-CoV-2 infection and 22%-31% in the intensive care unit setting. Available data also revealed a higher occurrence of stroke and more serious forms of peripheral arterial disease in COVID-19 patients. Hemostasis dysregulation is observed during the COVID-19 course. Lower platelet count, mildly increased prothrombin time and increased D-dimer are typical laboratory features of patients with severe SARS-CoV-2 infection, described as "COVID-19 associated coagulopathy." These alterations are correlated to poor outcomes. Moreover, patients with severe SARS-CoV-2 infection are characterized by high levels of von Willebrand factor with subsequent ADAMTS13 deficiency and impaired fibrinolysis. Platelet hyperreactivity, hypercoagulability and hypofibrinolysis during SARS-CoV-2 infection induce a pathological state named as "immuno-thromboinflammation." Finally, liver dysfunction and coagulopathy are often observed at the same time in patients with COVID-19. The hypothesis that liver dysfunction could be mediated by microvascular thrombosis has been supported by post-mortem findings and extensive vascular portal and sinusoidal thrombosis observation. Other evidence has shown a correlation between coagulation and liver damage in COVID-19, underlined by the transaminase association with coagulopathy, identified through laboratory markers such as prothrombin time, international normalized ratio, fibrinogen, D-dimer, fibrin/fibrinogen degradation products and platelet count. Other possible mechanisms like immunogenesis of COVID-19 damage or massive pericyte activation with consequent vessel wall fibrosis have been suggested.
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Affiliation(s)
- Damiano D’Ardes
- “Clinica Medica” Institute, Department of Medicine and Aging Sciences, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Andrea Boccatonda
- Unit of Ultrasound, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Giulio Cocco
- Unit of Ultrasound, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Stefano Fabiani
- Unit of Ultrasound, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Ilaria Rossi
- “Clinica Medica” Institute, Department of Medicine and Aging Sciences, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Marco Bucci
- “Clinica Medica” Institute, Department of Medicine and Aging Sciences, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Maria Teresa Guagnano
- “Clinica Medica” Institute, Department of Medicine and Aging Sciences, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Cosima Schiavone
- Unit of Ultrasound, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
| | - Francesco Cipollone
- “Clinica Medica” Institute, Department of Medicine and Aging Sciences, “G. D’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
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KAR F, YILMAZ S, MUSMUL A, ŞENTÜRK H. COVID-19 İlişkili Biyokimyasal ve Hematolojik Parametreler: Tek merkezli Popülasyon İndeks Çalışması. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.982963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Alroomi M, Rajan R, Alsaber A, Pan J, Abdullah M, Abdelnaby H, Aboelhassan W, AlNasrallah N, Al-Bader B, Malhas H, Ramadhan M, Hussein S, Alotaibi N, Al Saleh M, Zhanna KD, Almutairi F. In-hospital mortality in SARS-CoV-2 stratified by gamma-glutamyl transferase levels. J Clin Lab Anal 2022; 36:e24291. [PMID: 35261080 PMCID: PMC8993645 DOI: 10.1002/jcla.24291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study investigates in-hospital mortality amongst patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relation to serum levels of gamma-glutamyl transferase (GGT). METHODS Patients were stratified according to serum levels of gamma-glutamyl transferase (GGT) (GGT<50 IU/L or GGT≥50 IU/L). RESULTS A total of 802 participants were considered, amongst whom 486 had GGT<50 IU/L and a mean age of 48.1 (16.5) years, whilst 316 had GGT≥50 IU/L and a mean age of 53.8 (14.7) years. The chief sources of SARS-CoV-2 transmission were contact (366, 45.7%) and community (320, 40%). Most patients with GGT≥50 IU/L had either pneumonia (247, 78.2%) or acute respiratory distress syndrome (ARDS) (85, 26.9%), whilst those with GGT<50 IU/L had hypertension (141, 29%) or diabetes mellitus (DM) (147, 30.2%). Mortality was higher amongst patients with GGT≥50 IU/L (54, 17.1%) than amongst those with GGT<50 IU/L (29, 5.9%). More patients with GGT≥50 required high (83, 27.6%) or low (104, 34.6%) levels of oxygen, whereas most of those with GGT<50 had no requirement of oxygen (306, 71.2%). Multivariable logistic regression analysis indicated that GGT≥50 IU/L (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.20-3.45, p=0.009), age (OR: 1.05, 95% CI: 1.03-1.07, p<0.001), hypertension (OR: 2.06, 95% CI: 1.19-3.63, p=0.011), methylprednisolone (OR: 2.96, 95% CI: 1.74-5.01, p<0.001) and fever (OR: 2.03, 95% CI: 1.15-3.68, p=0.016) were significant predictors of all-cause cumulative mortality. A Cox proportional hazards regression model (B = -0.68, SE =0.24, HR =0.51, p = 0.004) showed that patients with GGT<50 IU/L had a 0.51-times lower risk of all-cause cumulative mortality than patients with GGT≥50 IU/L. CONCLUSION Higher levels of serum GGT were found to be an independent predictor of in-hospital mortality.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Ahmad Alsaber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Jiazhu Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Division of Gastroenterology, Department of Medicine, Al Sabah Hospital, Shuwaikh Medical Area, Kuwait
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of Medicine, Jaber Al Ahmed Hospital, South Surra, Kuwait
| | | | - Bader Al-Bader
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
| | - Haya Malhas
- Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Maryam Ramadhan
- Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait
| | - Soumoud Hussein
- Department of Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Naser Alotaibi
- Department of Medicine, Al Adan Hospital, Hadiya, Kuwait
| | | | - Kobalava D Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Farah Almutairi
- Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait
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Wang Y, Gao D, Li X, Xu P, Zhou Q, Yin J, Xu J. Early changes in laboratory tests predict liver function damage in patients with moderate coronavirus disease 2019: a retrospective multicenter study. BMC Gastroenterol 2022; 22:113. [PMID: 35264110 PMCID: PMC8905025 DOI: 10.1186/s12876-022-02188-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/25/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Most patients with coronavirus disease 2019 demonstrate liver function damage. In this study, the laboratory test data of patients with moderate coronavirus disease 2019 were used to establish and evaluate an early prediction model to assess the risk of liver function damage. METHODS Clinical data and the first laboratory examination results of 101 patients with moderate coronavirus disease 2019 were collected from four hospitals' electronic medical record systems in Jilin Province, China. Data were randomly divided into training and validation sets. A logistic regression analysis was used to determine the independent factors related to liver function damage in patients in the training set to establish a prediction model. Model discrimination, calibration, and clinical usefulness were evaluated in the training and validation sets. RESULTS The logistic regression analysis showed that plateletcrit, retinol-binding protein, and carbon dioxide combining power could predict liver function damage (P < 0.05 for all). The receiver operating characteristic curve showed high model discrimination (training set area under the curve: 0.899, validation set area under the curve: 0.800; P < 0.05). The calibration curve showed a good fit (training set: P = 0.59, validation set: P = 0.19; P > 0.05). A decision curve analysis confirmed the clinical usefulness of this model. CONCLUSIONS In this study, the combined model assesses liver function damage in patients with moderate coronavirus disease 2019 performed well. Thus, it may be helpful as a reference for clinical differentiation of liver function damage. Trial registration retrospectively registered.
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Affiliation(s)
- Yiting Wang
- Department of Laboratory Medicine, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021 China
| | - Dandan Gao
- Department of Laboratory Medicine, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021 China
| | - Xuewen Li
- Department of Laboratory Medicine, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021 China
| | - Panyang Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021 China
| | - Qi Zhou
- Department of Pediatrics, First Hospital of Jilin University, Changchun, 130021 China
| | - Junguo Yin
- Department of Laboratory Medicine, Changchun Hospital of Traditional Chinese Medicine, Changchun, 130021 China
| | - Jiancheng Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021 China
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Boglione L, Corcione S, Shbaklo N, Rosso T, Lupia T, Pinna SM, Scabini S, Ciccone G, De Benedetto I, Borrè S, De Rosa FG. Liver involvement and mortality in COVID-19: A retrospective analysis from the CORACLE study group. LE INFEZIONI IN MEDICINA 2022; 30:80-85. [PMID: 35350260 PMCID: PMC8929727 DOI: 10.53854/liim-3001-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION liver abnormalities are common in COVID-19 patients and associated with higher morbidity and mortality. We aimed to investigate clinical significance and effect on the mortality of abnormal liver function tests (ALFTs) in COVID-19 patients. METHODS we retrospectively evaluated in a multicentre study all patients admitted with confirmed diagnosis of COVID-19. RESULTS 434 patients were included in this analysis. Among overall patients, 311 (71.6%) had normal baseline ALT levels. 123 patients showed overall abnormal liver function tests (ALFTs) at baseline [101 ALFTs <2x UNL and 22 ≥2 UNL]. Overall in-hospital mortality was 14% and mean duration of hospitalization was 10.5 days. Hypertension (50.5%), cardiovascular diseases (39.6%), diabetes (23%) were frequent comorbidities and 53.7% of patients had ARDS. At multivariate analysis, the presence of ARDS at baseline (OR=6.11; 95% CI: 3.03-12.32; p<0.000); cardiovascular diseases (OR=4; 95% CI: 2.05-7.81; p<0.000); dementia (OR=3.93; 95%CI:1.87-8.26; p<0.000) and no smoking (OR=4.6; 95% CI: 1.45-14.61; p=0.010) resulted significantly predictive of in-hospital mortality. The presence of ALFTs at baseline was not significantly associated with mortality (OR=3.44; 95% CI=0.81-14.58; p=0.094). CONCLUSION ALFTs was frequently observed in COVID-19 patients, but the overall in-hospital mortality was mainly determined by the severity of illness, comorbidities and presence of ARDS.
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Affiliation(s)
- Lucio Boglione
- University of Eastern Piedmont, Department of Translational Medicine, Novara, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
- Tufts University School of Medicine, Boston, MA, USA
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Tiziana Rosso
- Clinical Epidemiology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia Hospital, Asti, Italy
| | | | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Silvio Borrè
- Saint Andrea Hospital, Unit of Infectious Diseases, Vercelli, Italy
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48
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Xiao Y, Ren C, Chen G, Shang P, Song X, You G, Yan S, Yao Y, Zhou H. Neutrophil membrane-mimicking nanodecoys with intrinsic anti-inflammatory properties alleviate sepsis-induced acute liver injury and lethality in a mouse endotoxemia model. Mater Today Bio 2022; 14:100244. [PMID: 35345558 PMCID: PMC8956822 DOI: 10.1016/j.mtbio.2022.100244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022] Open
Abstract
Sepsis-induced acute liver injury often develops in the early stages of sepsis and can exacerbate the pathology by contributing to multiple organ dysfunction and increasing lethality. No specific therapies for sepsis-induced liver injury are currently available; therefore, effective countermeasures are urgently needed. Considering the crucial role of neutrophils in sepsis-induced liver injury, herein, neutrophil membrane-mimicking nanodecoys (NM) were explored as a biomimetic nanomedicine for the treatment of sepsis-associated liver injury. NM administration exhibited excellent biocompatibility and dramatically decreased the plasma levels of inflammatory cytokines and liver injury biomarkers, including aspartate aminotransferase, alanine aminotransferase, and direct bilirubin, in a sepsis mouse model. NM treatment also reduced hepatic malondialdehyde content, myeloperoxidase activity, and histological injury, and ultimately improved survival in the septic mice. Further in vitro studies showed that NM treatment neutralized the neutrophil chemokines and inflammatory mediators and directly mitigated neutrophil chemotaxis and adhesion. Additionally, NM also markedly weakened lipopolysaccharide-induced reactive oxygen species generation, cyclooxygenase-2 expression, nitric oxide secretion, and subsequent hepatocyte injury. Thus, this study provides a promising therapeutic strategy for the management of sepsis-induced acute liver injury.
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Affiliation(s)
- Yao Xiao
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Chao Ren
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Gan Chen
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Pan Shang
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Xiang Song
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Guoxing You
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Shaoduo Yan
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Yongming Yao
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, China
| | - Hong Zhou
- Institute of Health Service and Transfusion Medicine, Beijing, China
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49
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Pang W, Yang F, Zhao Y, Dai E, Feng J, Huang Y, Guo Y, Zhou S, Huang M, Zheng W, Ma J, Li H, Li Q, Hou L, Zhang S, Wang H, Liu Q, Zhang B, Zhang J. Qingjin Yiqi granules for post-COVID-19 condition: A randomized clinical trial. J Evid Based Med 2022; 15:30-38. [PMID: 35416437 PMCID: PMC9114922 DOI: 10.1111/jebm.12465] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of Qingjin Yiqi granules (QJYQ) on post-COVID-19 condition (PCC). METHOD Patients who met the inclusion criteria were randomly assigned to two groups, the QJYQ group received QJYQ combined with standard rehabilitation treatments (SRTs) and the control group only received SRTs. The treatment course was 14 days. The primary outcomes were modified Medical Research Council (mMRC) scale and Borg scale, while the secondary outcomes included symptoms score and 6-minute walking distance (6MWD). The safety outcome was the incidence of adverse events. RESULTS A total of 388 patients with PCC were enrolled and randomly assigned to the QJYQ group (n = 194) and the control group (n = 194). Compared to the controls, the mMRC scale was improved in the QJYQ group, which was better than that of the control group [β (95%CI): -0.626 (-1.101, -0.151), p = 0.010]. A significant improvement in Borg scale was also observed in the QJYQ group compared to the control group [β (95%CI): -0.395(-0.744, -0.046), p = 0.026]. There was no statistically significant difference in symptoms score and 6MWD between the two groups (p = 0.293, p = 0.724). No treatment-related adverse events were observed in either group. CONCLUSIONS QJYQ can bring benefits to patients with PCC, mainly in the improvement of breathlessness and fatigue.
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Affiliation(s)
- Wentai Pang
- State Key Laboratory of Component‐Based Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina
- Evidence‐Based Medicine CenterTianjin University of Traditional Chinese MedicineTianjinChina
| | - Fengwen Yang
- State Key Laboratory of Component‐Based Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina
- Evidence‐Based Medicine CenterTianjin University of Traditional Chinese MedicineTianjinChina
| | - Yubin Zhao
- Shijiazhuang People's HospitalShijiazhuangChina
| | - Erhei Dai
- Shijiazhuang Fifth HospitalShijiazhuangChina
| | - Jihong Feng
- Second Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Yuhong Huang
- Second Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Yongming Guo
- College of Acupuncture‐moxibustion and TuinaTianjin University of Traditional Chinese MedicineTianjinChina
| | - Shengyuan Zhou
- Second Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Ming Huang
- State Key Laboratory of Component‐Based Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina
| | - Wenke Zheng
- State Key Laboratory of Component‐Based Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina
- Evidence‐Based Medicine CenterTianjin University of Traditional Chinese MedicineTianjinChina
| | - Jiang Ma
- Shijiazhuang People's HospitalShijiazhuangChina
| | - Hong Li
- Shijiazhuang People's HospitalShijiazhuangChina
| | - Qing Li
- Shijiazhuang People's HospitalShijiazhuangChina
| | - Lijuan Hou
- Shijiazhuang People's HospitalShijiazhuangChina
| | - Shuo Zhang
- Second Teaching Hospital of Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Hui Wang
- State Key Laboratory of Component‐Based Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina
- Evidence‐Based Medicine CenterTianjin University of Traditional Chinese MedicineTianjinChina
| | - Qingquan Liu
- Beijing Hospital of Traditional Chinese MedicineBeijingChina
| | - Boli Zhang
- State Key Laboratory of Component‐Based Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina
- Evidence‐Based Medicine CenterTianjin University of Traditional Chinese MedicineTianjinChina
| | - Junhua Zhang
- State Key Laboratory of Component‐Based Chinese MedicineTianjin University of Traditional Chinese MedicineTianjinChina
- Evidence‐Based Medicine CenterTianjin University of Traditional Chinese MedicineTianjinChina
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50
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Ozkurt Z, Çınar Tanrıverdi E. COVID-19: Gastrointestinal manifestations, liver injury and recommendations. World J Clin Cases 2022; 10:1140-1163. [PMID: 35211548 PMCID: PMC8855202 DOI: 10.12998/wjcc.v10.i4.1140] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/28/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused a pandemic that affected all countries with nearly 270 million patients and 5 million deaths, as of as of December, 2021. The severe acute respiratory syndrome coronavirus 2 virus targets the receptor, angiotensin-converting enzyme 2, which is frequently found in human intestinal epithelial cells, bile duct epithelial cells, and liver cells, and all gastrointestinal system organs are affected by COVID-19 infection. The aim of this study is to review the gastrointestinal manifestations and liver damage of COVID-19 infection and investigate the severe COVID-19 infection risk in patients that have chronic gastrointestinal disease, along with current treatment guidelines. A literature search was conducted on electronic databases of PubMed, Scopus, and Cochran Library, consisting of COVID-19, liver injury, gastrointestinal system findings, and treatment. Liver and intestinal involvements are the most common manifestations. Diarrhea, anorexia, nausea/vomiting, abdominal pain are the most frequent symptoms seen in intestinal involvement. Mild hepatitis occurs with elevated levels of transaminases. Gastrointestinal involvement is associated with long hospital stay, severity of the disease, and intensive care unit necessity. Treatments and follow-up of patients with inflammatory bowel diseases, cirrhosis, hepatocellular carcinoma, or liver transplant have been negatively affected during the pandemic. Patients with cirrhosis, hepatocellular carcinoma, auto-immune diseases, or liver transplantation may have a greater risk for severe COVID-19. Diagnostic or therapeutic procedures should be restricted with specific conditions. Telemedicine should be used in non-urgent periodic patient follow up. COVID-19 treatment should not be delayed in patients at the risk group. COVID-19 vaccination should be prioritized in this group.
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Affiliation(s)
- Zulal Ozkurt
- Department of Infectious Disease, Atatürk University, School of Medicine, Erzurum 25100, Turkey
| | - Esra Çınar Tanrıverdi
- Department of Medical Education, Atatürk University, School of Medicine, Erzurum 25100, Turkey
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