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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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Salahshour F, Karimpour Reyhan S, Zendedel K, Seifouri K, Seyyedsalehi MS, Naghavi P, Abbaszadeh M, Esteghamati A, Nakhjavani M, Rabizadeh S. FIB-4 Index Can Predict Mortality in Hospitalized Patients with COVID-19 Infection, Independent of CT Severity Score. ARCHIVES OF IRANIAN MEDICINE 2025; 28:88-94. [PMID: 40062496 PMCID: PMC11892101 DOI: 10.34172/aim.33514] [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: 11/19/2024] [Revised: 12/25/2024] [Accepted: 01/01/2025] [Indexed: 05/13/2025]
Abstract
BACKGROUND The fibrosis 4 (FIB-4) index is typically used in assessing liver fibrosis, and has shown potential in predicting the outcome in various diseases. This study aims to evaluate the predictive power of the FIB-4 index for mortality in COVID-19 patients admitted to a reference hospital in Tehran, Iran. METHODS In this prospective cohort study, 387 patients with COVID-19 without diabetes, were categorized into deceased and surviving groups. We compared anthropometric and demographic data, liver function tests, CT scores, and FIB-4 indices between the groups. Multivariate logistic regression assessed the independent association of FIB-4 with mortality. RESULTS Among the 387 patients, (all non-diabetics), 58 (15%) died, with a higher mortality rate observed in patients with a FIB-4 index≥2.6 (63.4%) compared to those with FIB-4<2.6 (29.7%). Deceased patients were considerably older and more likely to be hypertensive (P values<0.001). After adjustment of confounding factors, a FIB-4 index≥2.6 was found to be independently associated with increased mortality (OR: 13.511, 95% CI: 1.356-134.580, P=0.026). CONCLUSION The FIB-4 index, calculable by routine laboratory tests, may be a valuable prognostic factor for COVID-19 mortality. This easily obtainable marker could help identify high-risk patients early, potentially allowing for more rapid intervention and treatment prioritization.
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Affiliation(s)
- Faeze Salahshour
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Karimpour Reyhan
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendedel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiana Seifouri
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Monireh Sadat Seyyedsalehi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Parnian Naghavi
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Mahsa Abbaszadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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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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Mijac D, Vucelj S, Todorovic K, Vojnovic M, Milicic B, Lukic S, Filipovic B, Marjanovic Haljilji M, Popovic D, Adzic Vukicevic T. Gastrointestinal and Hepatological Manifestations in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results from the Major COVID Hospital in Serbia. Microorganisms 2023; 12:27. [PMID: 38257854 PMCID: PMC10819747 DOI: 10.3390/microorganisms12010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
The coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), includes a clinical spectrum of diseases from mild to severe progressive pneumonia, which has affected and still affects the human population worldwide. Most commonly, it is presented by respiratory symptoms, but studies have shown that about 50% of patients with SARS-CoV-2 infection have at least one gastrointestinal symptom (GI), predominantly nausea, diarrhea, vomiting, or loss of appetite. In addition, abnormal liver functional tests are commonly present in the SARS-CoV-2 virus. The aim of our study was to examine the GI and hepatic manifestations of COVID-19 in patients hospitalized due to COVID-19 pneumonia in "COVID hospital Batajnica", University Clinical Center of Serbia in Belgrade. The study included 498 consecutive patients, and the data was obtained from the patient's electronic medical history. GI symptoms included nausea, vomiting, diarrhea, and anorexia. Collected laboratory values included baseline and peak values of blood count, inflammatory parameters, liver function tests, renal function tests, and cardiac enzyme tests. The results have shown that GI symptoms occurred in 26% of cases at diagnosis, which indicates the great susceptibility of the GI system to SARS-CoV-2. There was a high risk of liver injury in patients with COVID-19 pneumonia (>60%). The level of AST is more often increased compared to ALT, which is different from other virus-induced liver lesions and may be a useful indicator of SARS-CoV-2 infection. Further research should focus on the causes of liver damage in SARS-CoV-2 virus and the impact on treatment and outcome of COVID-19 disease.
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Affiliation(s)
- Dragana Mijac
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Samir Vucelj
- Department of Internal Medicine, General Hospital Novi Pazar, Generala Zivkovica 1, 36300 Novi Pazar, Serbia;
| | - Kristina Todorovic
- Department of Internal Medicine, General Hospital Jagodina, Karadjordjeva 4, 35000 Jagodina, Serbia;
| | - Marko Vojnovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Biljana Milicic
- Faculty of Dental Medicine, University of Belgrade, Rankeova 4, 11000 Belgrade, Serbia;
| | - Snezana Lukic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Koste Todorovica No 2, 11000 Belgrade, Serbia;
| | - Branka Filipovic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Marija Marjanovic Haljilji
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Dusan Popovic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Department of Gastroenterology, Clinical and Hospital Center “Dr Dragisa Misovic–Dedinje”, Heroja Milana Tepica 1, 11020 Belgrade, Serbia;
| | - Tatjana Adzic Vukicevic
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia; (S.L.); (B.F.); (D.P.); (T.A.V.)
- Clinic for Pulmology, University Clinical Center of Serbia, Dr Koste Todorovica No 6, 11000 Belgrade, Serbia
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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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Sgamato C, Rocco A, Compare D, Minieri S, Marchitto SA, Maurea S, Nardone G. Autoimmune liver diseases and SARS-CoV-2. World J Gastroenterol 2023; 29:1838-1851. [PMID: 37032727 PMCID: PMC10080695 DOI: 10.3748/wjg.v29.i12.1838] [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: 11/20/2022] [Revised: 01/12/2023] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), can trigger autoimmunity in genetically predisposed individuals through hyperstimulation of immune response and molecular mimicry. Here we summarise the current knowledge about auto-immune liver diseases (AILDs) and SARS-CoV-2, focusing on: (1) The risk of SARS-CoV-2 infection and the course of COVID-19 in patients affected by AILDs; (2) the role of SARS-CoV-2 in inducing liver damage and triggering AILDs; and (3) the ability of vaccines against SARS-CoV-2 to induce autoimmune responses in the liver. Data derived from the literature suggest that patients with AILDs do not carry an increased risk of SARS-Cov-2 infection but may develop a more severe course of COVID-19 if on treatment with steroids or thiopurine. Although SARS-CoV-2 infection can lead to the development of several autoimmune diseases, few reports correlate it to the appearance of de novo manifestation of immune-mediated liver diseases such as autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) or AIH/PBC overlap syndrome. Different case series of an AIH-like syndrome with a good prognosis after SARS-CoV-2 vaccination have been described. Although the causal link between SARS-CoV-2 vaccines and AIH cannot be definitively established, these reports suggest that this association could be more than coincidental.
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Affiliation(s)
- Costantino Sgamato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Alba Rocco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Debora Compare
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Stefano Minieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Stefano Andrea Marchitto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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Farias JP, Codes L, Vinhaes D, Amorim AP, D’Oliveira RC, Farias AQ, Bittencourt PL. Impact of baseline abnormal liver enzymes in the outcome of COVID-19 infection. Transl Gastroenterol Hepatol 2023; 8:5. [PMID: 36704646 PMCID: PMC9813650 DOI: 10.21037/tgh-22-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background Little is known about the significance of liver function tests (LFT) abnormalities in COVID-19 and their impact on disease outcomes. The aims of the study were to evaluate abnormalities of LFT in patients with COVID-19 and their impact on disease severity, mortality, and correlation with leukocyte markers of inflammation. Methods All patients with COVID-19 admitted to the emergency department (ED) of a single reference center were retrospectively evaluated. Data were collected using an electronic medical database covering the following variables: demographics, baseline complete blood count (CBC) and ratios, neutrophil-lymphocyte (NLR) and monocyte-lymphocyte ratios (MLR), systemic immune-inflammation index (SII), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Disease severity was defined by the presence of organ failure (OF) or requirement for intensive care unit (ICU) support. Mortality was considered as patient death during hospitalization. Results A total of 1,539 subjects (799 women, mean age 57±18 years) with COVID-19 were evaluated. Abnormal AST and/or ALT were seen in 50% of them, with a frequency and magnitude that significantly correlated with leukocyte count and ratios. Both LFT were significantly associated with requirement for hospital and ICU admission and mortality. High AST levels were significantly associated with the presence, number, and types of OFs and in-hospital length of stay (LOS). Elevated ALT was also significantly associated with the aforementioned variables, with the exception of OFs presence, circulatory failure and LOS. Conclusions LFT abnormalities are frequently seen in COVID-19 patients, reflect SARS-CoV-2 associated inflammation and may predict adverse outcomes. LFT may be useful to aid decision-making in the ED for hospital admission or scheduled outpatient reevaluation.
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Affiliation(s)
| | - Liana Codes
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil;,Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Diana Vinhaes
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil
| | | | - Ricardo Cruz D’Oliveira
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil;,Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | | | - Paulo Lisboa Bittencourt
- Portuguese Hospital of Bahia, Salvador, Bahia, Brazil;,Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
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Mihai N, Lazar M, Tiliscan C, Barbu EC, Chitu CE, Stratan L, Ganea OA, Arama SS, Ion DA, Arama V. Predictors of Liver Injury in Hospitalized Patients with SARS-CoV-2 Infection. Medicina (B Aires) 2022; 58:medicina58121714. [PMID: 36556915 PMCID: PMC9786677 DOI: 10.3390/medicina58121714] [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: 10/12/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: SARS-CoV-2 infection is frequently associated with pneumonia but has a broad tissue tropism also leading to systemic complications (hematologic, gastro-intestinal, cardiac, neurologic, etc.). In this study, we aim to evaluate the impact of COVID-19 infection on the liver and to identify the risk factors/predictors for liver injury at admission to the hospital. Materials and Methods: We performed a retrospective cohort study on 249 patients, divided into two Group A (157 patients with liver involvement) and Group B (92 patients without liver involvement). We recorded demographic and lifestyle parameters, anthropometric parameters, comorbidities, clinical parameters, inflammation markers, complete blood count, coagulation, and biochemical parameters. Lung parenchyma, liver dimensions, and morphology were evaluated by computer tomography (CT) scans. Results: Patients with liver involvement had higher heart and respiratory rates, lower oxygen saturation (SO2), and necessitated higher oxygen flow at admittance. We found higher serum levels of C-reactive protein, fibrinogen, ferritin, creatine kinase, lactate dehydrogenase (LDH), serum triglycerides, and lower values for serum albumin in Group A patients. The patients with liver involvement presented more extensive lung injury with higher percentages of alveolar, mixed, and interstitial lesions, an increase in liver dimensions, and lower density ranges for the liver parenchyma. The patients presented hepatocytolytic involvement in 26 cases (10.4% from the entire study population), cholestatic involvement in 63 cases (37.7% from the entire study population), and mixed liver involvement in 68 cases (37.7% from the entire study population). Conclusions: Liver involvement in COVID-19 patients is frequent, usually mild, and occurs mostly in male patients over 50 years old. Cholestatic and mixed liver injuries are more frequent than hepatocytolytic injuries. The severity of lung injury evaluated by CT scan, increased values of inflammatory markers, LDH, and low values of SO2 can be considered risk factors/predictors for liver injury at admission to the hospital.
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Affiliation(s)
- Nicoleta Mihai
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, 1 Dr. Grozovici Street, 021105 Bucharest, Romania
| | - Mihai Lazar
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, 1 Dr. Grozovici Street, 021105 Bucharest, Romania
- Correspondence: (M.L.); (C.T.)
| | - Catalin Tiliscan
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, 1 Dr. Grozovici Street, 021105 Bucharest, Romania
- Correspondence: (M.L.); (C.T.)
| | - Ecaterina Constanta Barbu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Cristina Emilia Chitu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Laurentiu Stratan
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Oana Alexandra Ganea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, 1 Dr. Grozovici Street, 021105 Bucharest, Romania
| | - Sorin Stefan Arama
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Daniela Adriana Ion
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Victoria Arama
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, 1 Dr. Grozovici Street, 021105 Bucharest, Romania
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Li P, Liu Y, Cheng Z, Yu X, Li Y. COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management. Biomed Pharmacother 2022; 154:113568. [PMID: 36029543 PMCID: PMC9381432 DOI: 10.1016/j.biopha.2022.113568] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global epidemic and poses a major threat to public health. In addition to COVID-19 manifesting as a respiratory disease, patients with severe disease also have complications in extrapulmonary organs, including liver damage. Abnormal liver function is relatively common in COVID-19 patients; its clinical manifestations can range from an asymptomatic elevation of liver enzymes to decompensated hepatic function, and liver injury is more prevalent in severe and critical patients. Liver injury in COVID-19 patients is a comprehensive effect mediated by multiple factors, including liver damage directly caused by SARS-CoV-2, drug-induced liver damage, hypoxia reperfusion dysfunction, immune stress and inflammatory factor storms. Patients with chronic liver disease (especially alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma) are at increased risk of severe disease and death after infection with SARS-CoV-2, and COVID-19 aggravates liver damage in patients with chronic liver disease. This article reviews the latest SARS-CoV-2 reports, focusing on the liver damage caused by COVID-19 and the underlying mechanism, and expounds on the risk, treatment and vaccine safety of SARS-CoV-2 in patients with chronic liver disease and liver transplantation.
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Affiliation(s)
- Penghui Li
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Ying Liu
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Ziqi Cheng
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Xiaorui Yu
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yinxiong Li
- Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; China-New Zealand Joint Laboratory on Biomedicine and Health, Guangzhou, China.
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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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11
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Roman A, Moldovan S, Stoian M, Ţilea B, Dobru D. SARS-CoV-2 associated liver injury: a six-month follow-up analysis of liver function recovery. Med Pharm Rep 2022; 95:393-399. [PMID: 36506606 PMCID: PMC9694743 DOI: 10.15386/mpr-2347] [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: 08/09/2021] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background and aims SARS-CoV-2 infection has raised the interest in clinical and paraclinical research worldwide, representing a public health issue since the beginning of 2020. Studies have established the variable, unpredictable character of COVID-19. Our main objective was to assess the liver function of patients without pre-existing liver disease, diagnosed with SARS-CoV-2 associated liver injury in a 6-month follow-up study after discharge from hospital. Methods We conducted a prospective paraclinical and imagingstic follow-up study between 1st September 2020 and 30th April 2021 on patients without pre-existing liver disease previously diagnosed with SARS-CoV-2 associated liver injury who had been admitted in Mures County Clinical Hospital, Targu Mures, Romania. We followed up the patients 'clinical and paraclinical datacharacteristics at index COVID-19 hospitalization and at T1 (6-month follow-up visit). Results We performed abdominal ultrasonography and laboratory examinations in 78 patients (mean age 45±10 years) hospitalized 6 months earlier for symptomatic COVID-19, with a male:female ratio of 1.3:1.Thirty patients (38.46%) were discharged at index COVID-19 hospitalization with abnormal liver function tests, while the rest presented paraclinical normalization at discharge and mean duration of liver injury of approximately 7 days. Follow-up examination revealed abnormal liver function tests in twenty-four patients, most of which presented with mild liver injury. All patients with severe COVID-19 at index hospitalization presented with abnormal liver function tests at follow-up examination. Conclusions By performing a complete clinical and paraclinical 6-month follow-up study, with a specific focus on 34.6% of patients in which we noted a persistence of liver function tests abnormality, we could analyzse a possible long-term effect of SARS-CoV-2 infection over liver function and also raise awareness of liver function tests monitoring and therapeutic management in post COVID-19 patients. Long-term follow-up studies of COVID-19 multi-organ sequelae are therefore mandatory in order to improve the practice of consultant gastroenterologists.
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Affiliation(s)
- Adina Roman
- Gastroenterology Department, Mureş County Clinical Hospital, Târgu Mureş, Romania,“George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Doctoral School, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Septimiu Moldovan
- “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Intensive Care Unit, Mures County Clinical Hospital, Târgu Mureş, Romania
| | - Mircea Stoian
- “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Intensive Care Unit, Mures County Clinical Hospital, Târgu Mureş, Romania
| | - Brînduşa Ţilea
- “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Infectious Diseases Department, Mures County Clinical Hospital, Târgu Mureş, Romania
| | - Daniela Dobru
- Gastroenterology Department, Mureş County Clinical Hospital, Târgu Mureş, Romania,“George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
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THE RELATIONS BETWEEN FEAR OF COVID-19, ANXIETY OF DEATH, AND MEANING OF LIFE AMONG NURSING STUDENTS. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2022. [DOI: 10.33457/ijhsrp.1112061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Aim of the study was to determine the effects of socio-demographic factors on fear of COVID-19, death anxiety, and meaning of life among nursing students, and to explain the relations between fear of COVID-19, death anxiety, and meaning of life. The study was conducted with 262 students on 7-27 October 2020 in a descriptive-correlational and cross-sectional design. According to the correlation analysis, a moderate and positive relationship was detected between Fear of COVID-19 Scale (CFS) and Turkish Death Anxiety Scale (TDAS) total score and subscale scores. The mean age of the students who participated in the study was found to be 20.63±2.31, 64.1% were female. It was found that 29% of the students had sleep problems in this period, and 7.6% were diagnosed with COVID-19, and 85.9% of themhad their close friends and relatives diagnosed with COVID-19. The majority of the students (n=16) who were diagnosed with COVID-19 passed this process under quarantine at home without treatment, 59.2% of them stated that someone in their close circle had a positive COVID-19 test, and 31.7% lost a relative due to COVID-19. The model that was created in the multiple linear regression analysis which was made to determine the effects of TDAS and Meaning of Life Questionnaire (MLQ) on CFS was found to be statistically significant (F:54.91, p
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Sagnelli C, Macera M, Camaioni C, Salvati A, Coppola N, Sagnelli E. SARS-CoV-2 infection: a hurricane that does not ignore chronic hepatitis. Infection 2022; 50:849-858. [PMID: 35316530 PMCID: PMC8938965 DOI: 10.1007/s15010-022-01804-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic significantly compromised screening, laboratory controls, clinical surveillance and treatment of chronic hepatitis patients and worsened their outcome, as evidenced by its significant correlation with advanced cirrhosis, liver decompensation and mortality. RESULTS This pandemic significantly impaired also the sector of liver transplantation, whose wards, operating rooms, outpatients' facilities, and healthcare personnel have been dedicated to patients with COVID-19. In addition, screening and treatment for HBV infection have been delayed or suspended in in most countries, with an increased risk of viral reactivation. Similar delay or suspension have also occurred for universal hepatitis B vaccination programs in many countries. Likewise, COVID-19 pandemic has made unreachable the goal of elimination of HCV infection as a worldwide public-health issue predicted for 2030 by the WHO. CONCLUSION This review article demonstrates how COVID-19 pandemic is causing serious damage to the sector of liver disease, which has quickly lost the beneficial effects of years of study, research, and clinical and technological application, as well as considerable financial investments.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Margherita Macera
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Clarissa Camaioni
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Annabella Salvati
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80101, Naples, Italy.
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Chin YF, Tang WF, Chang YH, Chang TY, Lin WC, Lin CY, Yang CM, Wu HL, Liu PC, Sun JR, Hsu SC, Lee CY, Lu HY, Chang JY, Jheng JR, Chen CC, Kau JH, Huang CH, Chiu CH, Hung YJ, Tsai HP, Horng JT. Orally delivered perilla (Perilla frutescens) leaf extract effectively inhibits SARS-CoV-2 infection in a Syrian hamster model. J Food Drug Anal 2022; 30:252-270. [PMID: 39666306 PMCID: PMC9635900 DOI: 10.38212/2224-6614.3412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/10/2022] [Accepted: 04/28/2022] [Indexed: 05/28/2024] Open
Abstract
On analyzing the results of cell-based assays, we have previously shown that perilla (Perilla frutescens) leaf extract (PLE), a food supplement and orally deliverable traditional Chinese medicine approved by the Taiwan Food and Drug Administration, effectively inhibits SARS-CoV-2 by directly targeting virions. PLE was also found to modulate virus-induced cytokine expression levels. In this study, we explored the anti-SARS-CoV-2 activity of PLE in a hamster model by examining viral loads and virus-induced immunopathology in lung tissues. Experimental animals were intranasally challenged with different SARS-CoV-2 doses. Jugular blood samples and lung tissue specimens were obtained in the acute disease stage (3-4 post-infection days). As expected, SARS-CoV-2 induced lung inflammation and hemorrhagic effusions in the alveoli and perivascular areas; additionally, it increased the expression of several immune markers of lung injury - including lung Ki67-positive cells, Iba-1-positive macrophages, and myeloperoxidase-positive neutrophils. Virus-induced lung alterations were significantly attenuated by orally administered PLE. In addition, pretreatment of hamsters with PLE significantly reduced viral loads and immune marker expression. A purified active fraction of PLE was found to confer higher antiviral protection. Notably, PLE prevented SARS-CoV-2-induced increase in serum markers of liver and kidney function as well as the decrease in serum high-density lipoprotein and total cholesterol levels in a dose-dependent fashion. Differently from lung pathology, monitoring of serum biomarkers in Syrian hamsters may allow a more humane assessment of the novel drugs with potential anti-SARS-CoV-2 activity. Our results expand prior research by confirming that PLE may exert an in vivo therapeutic activity against SARS-CoV-2 by attenuating viral loads and lung tissue inflammation, which may pave the way for future clinical applications.
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Affiliation(s)
- Yuan-Fan Chin
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Wen-Fan Tang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Kweishan, Taoyuan,
Taiwan
| | - Yu-Hsiu Chang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Tein-Yao Chang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114,
Taiwan
| | - Wen-Chin Lin
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114,
Taiwan
| | - Chia-Yi Lin
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Kweishan, Taoyuan,
Taiwan
| | - Chuen-Mi Yang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Hsueh-Ling Wu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Ping-Cheng Liu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Jun-Ren Sun
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114,
Taiwan
- Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei,
Taiwan
| | - Shu-Chen Hsu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Chia-Ying Lee
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Hsuan-Ying Lu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Jia-Yu Chang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Jia-Rong Jheng
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN,
USA
| | - Cheng Cheung Chen
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei,
Taiwan
| | - Jyh-Hwa Kau
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei,
Taiwan
- Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei,
Taiwan
| | - Chih-Heng Huang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei,
Taiwan
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei,
Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan,
Taiwan
| | - Yi-Jen Hung
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Hui-Ping Tsai
- Institute of Preventive Medicine, National Defense Medical Center, Taipei,
Taiwan
| | - Jim-Tong Horng
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Kweishan, Taoyuan,
Taiwan
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan,
Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, Chang Gung University, Kweishan, Taoyuan,
Taiwan
- Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan,
Taiwan
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15
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Choudhary A, Singh V, Bharadwaj M. Maternal and Neonatal Outcomes in Pregnant Women With SARS-CoV-2 Infection Complicated by Hepatic Dysfunction. Cureus 2022; 14:e25347. [PMID: 35761912 PMCID: PMC9233295 DOI: 10.7759/cureus.25347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 01/09/2023] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) pandemic has caused one of the most devastating healthcare crises in recent times and presented many diagnostic challenges and uncertainties. COVID-19 complicated by acute hepatic dysfunction is a well-described phenomenon, but its impact on maternal and perinatal outcomes is not well documented. In this study, we aimed to evaluate the maternal and neonatal outcomes in pregnant women with COVID-19 complicated by liver dysfunction and compare those with pregnant women with COVID-19 and normal liver function. Methodology This was a retrospective observational cohort study conducted at the Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. All COVID-19-positive pregnant women (n=249) admitted to the hospital from May 15, 2020, to August 15, 2021, were included in this study. Retrospective data collection was done using the medical records of these COVID-19-positive pregnant women and included the baseline characteristics, past medical history, obstetric history, clinical presentation, laboratory results, management modalities, and maternal and neonatal outcomes. Of note, 107 women were found to have acute liver function abnormality on admission and 142 women had normal liver function tests (LFTs). Pregnant women with normal LFTs were classified as group one and those with deranged LFTs as group two. Characteristics such as age, period of gestation, symptoms, associated comorbidities, laboratory results, management, and outcomes were compared across both groups. Results Out of the total 249 pregnant women with COVID-19 admitted during the study period, 42.97% (n=107) women had laboratory findings consistent with liver dysfunction and 142 women (57.03%) had a normal liver function. Significantly higher levels of lactate dehydrogenase (LDH), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), alanine transaminase (ALT), aspartate aminotransferase (AST), and total bilirubin levels were seen in pregnant women with hepatic dysfunction when compared to those with normal liver function. Among the 249 patients, the majority were asymptomatic or had mild disease, 12 women had moderate disease, and six women had severe COVID-19. All women with severe COVID-19 had deranged LFTs. There was no statistical difference in terms of obstetric management between pregnant patients with and without liver dysfunction. Out of the 107 women with deranged liver function, 18 women had a preterm birth, four had intrauterine fetal death, and one had neonatal death. Complications such as postpartum hemorrhage, the need for blood transfusions, sepsis and multiorgan failure, and mortality were more commonly seen in the group of pregnant women with hepatic dysfunction associated with COVID-19. Conclusion COVID-19 in pregnancy may cause deranged LFTs in these women. Pregnant women with COVID-19 complicated by liver dysfunction have been reported to have worse inflammation, higher disease severity, and more morbidity and mortality when compared to those without liver dysfunction. They are also at a higher risk of complications such as postpartum hemorrhage, the need for blood transfusion, sepsis, and multiorgan dysfunction.
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16
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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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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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18
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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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19
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Krishnan A, Prichett L, Tao X, Alqahtani SA, Hamilton JP, Mezey E, Strauss AT, Kim A, Potter JJ, Chen PH, Woreta TA. Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients. World J Gastroenterol 2022; 28:570-587. [PMID: 35316959 PMCID: PMC8905016 DOI: 10.3748/wjg.v28.i5.570] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/21/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019 (COVID-19). However, the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood. AIM We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality. METHODS This retrospective, observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System (Baltimore, MD, United States). Demographic data, clinical characteristics, laboratory findings, treatment measures, and outcome data were collected. Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis. RESULTS A total of 2698 (70.4%) had abnormal alanine aminotransferase (ALT) at the time of admission. Other more prevalent abnormal liver chemistries were aspartate aminotransferase (AST) (44.4%), alkaline phosphatase (ALP) (16.1%), and total bilirubin (T-Bil) (5.9%). Factors associated with liver injury were older age, Asian ethnicity, other race, being overweight, and obesity. Higher ALT, AST, T-Bil, and ALP levels were more commonly associated with disease severity. Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization. Abnormal AST, T-Bil, and ALP were associated with a need for vasopressor drugs, whereas higher levels of AST, T-Bil, and a decreased albumin levels were associated with mechanical ventilation. CONCLUSION Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient's severity and prognosis. Elevated liver chemistries, specifically ALT, AST, ALP, and T-Bil levels, can be used to stratify risk and predict the need for advanced therapies in these patients.
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Affiliation(s)
- Arunkumar Krishnan
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Laura Prichett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Xueting Tao
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh 12713, Saudi Arabia
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Esteban Mezey
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Alexandra T Strauss
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ahyoung Kim
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - James J Potter
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Po-Hung Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Tinsay A Woreta
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
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20
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Alternative SARS-CoV-2 detection protocol from self-collected saliva for mass diagnosis and epidemiological studies in low-incoming regions. J Virol Methods 2022; 300:114382. [PMID: 34843823 PMCID: PMC8626149 DOI: 10.1016/j.jviromet.2021.114382] [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: 04/20/2021] [Revised: 09/12/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022]
Abstract
Until mass vaccination befalls, control of the new betacoronavirus-associated severe acute respiratory syndrome pandemic (SARS-CoV-2) is based on decreasing virus circulation by social distancing and blocking transmission foci after diagnosis. Globally adopted SARS-CoV-2 diagnostic criteria embrace viral RNA detection by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) on nasopharynx secretions, which requires healthcare facilities and specialized personnel for sample collection. To develop an alternative protocol, hydrophilic cotton as the material and saliva as the source for biological sample collection in qRT-PCR/RT-endpoint-PCR SARS-CoV-2 diagnostic methods prepared with local consumables were evaluated using 99 archived nasopharynx samples previously diagnosed as positive for SARS-CoV-2 and 111 prospective saliva samples pared with nasopharynx samples from patients attending the local reference ABC Medical School diagnostic laboratory. The kappa agreement coefficient between the SARS-CoV-2 qRT-PCR and RT-endpoint-PCR was k = 0.97 (95 % CI 0.92-1.00) and k = 0.90 (95 % CI 0.81-0.99), respectively, on SARS-CoV-2-positive archived samples, with the initial qRT-PCR CT under 25. The agreement coefficient of the SARS-CoV-2 alternative saliva diagnostic protocol, when used to test the paired nasopharynx samples, was k = 0.79 (95 % CI 0.56-1,00). These data support that the SARS-CoV-2 diagnostic assay based on self-collected saliva on cotton represents an alternative protocol for mass diagnosis and epidemiological studies in low-income regions.
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21
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Ekpanyapong S, Bunchorntavakul C, Reddy KR. COVID-19 and the Liver: Lessons Learnt from the EAST and the WEST, A Year Later. J Viral Hepat 2022; 29:4-20. [PMID: 34352133 PMCID: PMC8446947 DOI: 10.1111/jvh.13590] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023]
Abstract
Globally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) has been a major cause for significant morbidity and mortality. Since the start of the pandemic, several hepato-biliary manifestations in coronavirus disease 2019 (COVID-19) have been described and unique considerations raised. The review aims to summarize the pathogenesis and hepato-biliary manifestations in COVID-19 and discuss the similarities, contrasting features and disease-specific management across a range of hepato-biliary diseases from the EAST and the WEST. Published studies and regional society guidelines from the EAST and the WEST were comprehensively reviewed and summarized. A wide range of hepato-biliary manifestations, including the infrequent and chronic manifestation of cholangiopathy, has been observed in COVID-19. The pathogenesis of liver injury is multifactorial and with scant evidence for a direct SARS-CoV-2 infection of the liver. Patients with non-alcoholic fatty liver disease, cirrhosis, and liver cancer are potentially at increased risk for severe COVID-19, and there are unique considerations in chronic hepatitis B or C, hepatocellular carcinoma, and in those immunosuppressed such as autoimmune hepatitis or liver transplant recipients. With the surges in SARS-CoV-2 infection, liver transplant activity has variably been impacted. Preliminarily, SARS-CoV-2 vaccines appear to be safe in those with chronic liver disease and in transplant recipients, while emerging data suggest the need for a third dose in immunosuppressed patients. In conclusion, patients with chronic liver disease, particularly cirrhosis, and liver transplant recipients, are vulnerable to severe COVID-19. Over the past year, several unique considerations have been highlighted across a spectrum of hepato-biliary diseases. Vaccination is strongly recommended for those with chronic liver disease and liver transplant recipients.
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Affiliation(s)
- Sirina Ekpanyapong
- Division of Gastroenterology and HepatologyDepartment of MedicineRajavithi HospitalBangkokThailand
| | | | - K. Rajender Reddy
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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22
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Zhao W, Zhang X, Zhu F, Jiang X. Dynamic Changes of Liver Function Indexes in Patients with Different Clinical Types of COVID-19. Int J Gen Med 2022; 15:877-884. [PMID: 35115814 PMCID: PMC8801727 DOI: 10.2147/ijgm.s347291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wei Zhao
- Department of Respiratory and Critical Care Medicine, Wuxi Fifth People’s Hospital, Wuxi, 214000, People’s Republic of China
| | - Xiaoqing Zhang
- Department of Respiratory and Critical Care Medicine, Wuxi Fifth People’s Hospital, Wuxi, 214000, People’s Republic of China
| | - Feng Zhu
- Department of Respiratory and Critical Care Medicine, Wuxi Fifth People’s Hospital, Wuxi, 214000, People’s Republic of China
- Correspondence: Feng Zhu; Xiufeng Jiang, Department of Respiratory and Critical Care Medicine, Wuxi Fifth People’s Hospital, Wuxi, 214000, People’s Republic of China, Tel +86-13914135026; +86-13013630369, Email ;
| | - Xiufeng Jiang
- Department of Respiratory and Critical Care Medicine, Wuxi Fifth People’s Hospital, Wuxi, 214000, People’s Republic of China
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23
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Kumar N, Satyapriya S, Tahaseen S, Singh K, Kumar A. Severe progression of autoimmune hepatitis in a young COVID-19 adult patient: A case report. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.355327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Assessment of background levels of autoantibodies as a prognostic marker for severe SARS-CoV-2 infection. J Circ Biomark 2022; 11:24-27. [PMID: 35517714 PMCID: PMC9069225 DOI: 10.33393/jcb.2022.2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Patients with more severe forms of SARS-CoV-2 exhibit activation of immunological cascades. Participants (current or ex-smokers with at least 20 years pack history) in a trial (Early Diagnosis of Lung Cancer, Scotland [ECLS]) of autoantibody detection to predict lung cancer risk had seven autoantibodies measured 5 years before the pandemic. This study compared the response to Covid infection in study participants who tested positive and negative to antibodies to tumour-associated antigens: p53, NY-ESO-1, CAGE, GBU4-5, HuD, MAGE A4 and SOX2. Methods: Autoantibody data from the ECLS study was deterministically linked to the EAVE II database, a national, real-time prospective cohort using Scotland’s health data infrastructure, to describe the epidemiology of SARS-CoV-2 infection, patterns of healthcare use and outcomes. The strength of associations was explored using a network algorithm for exact contingency table significance testing by permutation. Results: There were no significant differences discerned between SARS-CoV-2 test results and EarlyCDT-Lung test results (p = 0.734). An additional analysis of intensive care unit (ICU) admissions detected no significant differences between those who tested positive and negative. Subgroup analyses showed no difference in COVID-19 positivity or death rates amongst those diagnosed with chronic obstructive pulmonary disease (COPD) with positive and negative EarlyCDT results. Conclusions: This hypothesis-generating study demonstrated no clinically valuable or statistically significant associations between EarlyCDT positivity in 2013-15 and the likelihood of SARS-CoV-2 positivity in 2020, ICU admission or death in all participants (current or ex-smokers with at least 20 years pack history) or in those with COPD or lung cancer.
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25
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Abstract
Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.
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Affiliation(s)
- Richard Taylor
- Pediatric Residency Program, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229, USA
| | - Daniel Mallon
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2010, Cincinnati, OH 45229, USA.
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26
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Salık F, Uzundere O, Bıçak M, Akelma H, Akgündüz M, Korhan Z, Kandemir D, Kaçar CK. Liver function as a predictor of mortality in COVID-19: A retrospective study. Ann Hepatol 2021; 26:100553. [PMID: 34624543 PMCID: PMC8492360 DOI: 10.1016/j.aohep.2021.100553] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES In many studies, varying degrees of liver damage have been reported in more than half of the COVID-19 patients. The aim of this study is to determine the effect of liver biochemical parameters abnormality on mortality in critical COVID-19 patients who have been followed in the ICU since the beginning of the pandemic process. MATERIALS AND METHODS In this study 533 critical patients who admitted to the ICU due to COVID-19 were included. The patients were divided into three groups according to their ALT, AST, and total bilirubin levels at their admission to the ICU. Group 1 was formed of patients with normal liver biochemical parameters values; Group 2 was formed of patients with liver biochemical parameters abnormality; Group 3 was formed of patients with liver injury. RESULTS 353 (66.2%) of all patients died. Neutrophil, aPTT, CRP, LDH, CK, ALT, AST, bilirubin, procalcitonin and ferritin values in Group 2 and Group 3 were found to be statistically significantly higher than Group 1. It was detected that the days of stay in ICU of the patients in Group 1 was statistically significantly longer than others group. It was found that the patients in Groups 2 and 3 had higher total, 7-day, and 28-day mortality rates than expected. CONCLUSIONS The study showed that liver disfunction was associated with higher mortality and shorter ICU occupation time.
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Affiliation(s)
- Fikret Salık
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
| | - Osman Uzundere
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
| | - Mustafa Bıçak
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
| | - Hakan Akelma
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
| | - Mesut Akgündüz
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
| | - Zeki Korhan
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
| | - Deniz Kandemir
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
| | - Cem Kıvılcım Kaçar
- Gazi Yaşargil Training and Research Hospital, Anesthesiology and Reanimation Clinic, Diyarbakir 21010, Turkey.
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27
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Impact of the Severity of Liver Injury in COVID-19 Patients Admitted to an Intensive Care Unit During the SARS-CoV2 Pandemic Outbreak. J Crit Care Med (Targu Mures) 2021; 7:211-216. [PMID: 34722924 PMCID: PMC8519387 DOI: 10.2478/jccm-2021-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/27/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction The World Health Organization (WHO) identified a novel coronavirus, originating in Wuhan, China, in December 2019, as a pneumonia causing pathogen. Epidemiological data in Romania show more than 450.000 confirmed patients, with a constant number of approximately 10% admission in intensive care unit. Method A retrospective, observational study was conducted from 1st March to 30th October 2020, comprising 657 patients, confirmed as having COVID-19, and who had been admitted to the intensive care unit of the Mures County Clinical Hospital, Tîrgu Mures, Romania, which had been designated as a support hospital during the pandemic. Patients who presented at admission or developed abnormal liver function tests in the first seven days of admission, were included in the study; patients with pre-existing liver disease, were excluded. Results The mean (SD) age of patients included in the study was 59.41 (14.66) years with a male: female ratio of 1.51:1. Survivor status, defined as patients discharged from the intensive care unit, was significantly associated with parameters such as age, leukocyte count, albumin level, glycaemia level (p<0.05 for all parameters.) Conclusions Liver injury expressed through liver function tests cannot solely constitute a prognostic factor for COVID-19 patients, but its presence in critically ill patients should be further investigated and included in future guideline protocols.
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28
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Tcaciuc E, Olaru-Stavila C, Alexa Z, Tcaciuc A, Ardeleanu D. Gastrointestinal manifestations in hospitalized patients with chronic liver disease and COVID-19. Med Pharm Rep 2021; 94:S6-S11. [PMID: 38912406 PMCID: PMC11188023 DOI: 10.15386/mpr-2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background and aim Gastrointestinal manifestations in COVID-19 have been frequently acknowledged by clinicians and scientists. However, their clinical significance and potential influence on the disease outcome is not entirely elucidated. In this study we aim to evaluate gastrointestinal involvement, both digestive symptoms and liver-related changes in hospitalized COVID-19 patients in correlation to the presence or absence of underlying liver disease and rate of mortality. Methods We performed a retrospective cohort study of COVID-19 patients, consecutively admitted in a hospital from Chisinau, between September 3, 2020 and May 31, 2021. Data on clinical symptoms and laboratory findings were collected from electronic clinical records. The cohort was divided into two groups, with and without pre-existing liver disease. The Fisher exact, Pearson Chi-square tests were used to compare groups. Results A total of 1835 patients were included, 108 (5.9%) with pre-existing liver disease and 1727 (94.1%) without this comorbidity. Digestive symptoms were reported by 331(18%) of the patients, diarrhea being the most common symptom 11.8% (217) and being encountered more in patients with underlying chronic liver disease. No statistical difference was identified between the groups in regard to other symptoms, comorbidities and rate of mortality. But patients with chronic liver disease had significant (P < 0.001) lower ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in comparison with the other group. At admission, 341 (19.2%) had increased aspartate aminotransferase level (AST) and 317 (17.8%) alanine aminotransferase. The enzyme abnormalities were predominantly mild and transitory. Abnormal AST level at admission and during follow up, higher ESR, CRP, ferritin, lactate dehydrogenase (LDH) was found to correlate with higher rates of mortality. Conclusion Digestive implications, especially diarrhea in COVID-19 patients is frequent, but do not appear to be associated with mortality. Elevated liver enzymes during hospitalization, age, high ferritin, CRP, LDH might be interpreted as risk factors for mortality in COVID-19 but further studies are needed to address this topic.
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Affiliation(s)
- Eugen Tcaciuc
- Department of Gastroenterology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Catalina Olaru-Stavila
- Department of Internal Medicine, Timofei Mosneaga State Republican Hospital, Chisinau, Republic of Moldova
| | - Zinaida Alexa
- Department of Internal Medicine, Timofei Mosneaga State Republican Hospital, Chisinau, Republic of Moldova
| | - Angela Tcaciuc
- Department of Internal Medicine, Timofei Mosneaga State Republican Hospital, Chisinau, Republic of Moldova
| | - Denis Ardeleanu
- Department of Gastroenterology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
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Yang Q, Wen Y, Qi F, Gao X, Chen W, Xu G, Wei C, Wang H, Tang X, Lin J, Zhao J, Zhang M, Zhang S, Zhang Z. Suppressive Monocytes Impair MAIT Cells Response via IL-10 in Patients with Severe COVID-19. THE JOURNAL OF IMMUNOLOGY 2021; 207:1848-1856. [PMID: 34452933 DOI: 10.4049/jimmunol.2100228] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022]
Abstract
Immune cell responses are strikingly altered in patients with severe coronavirus disease 2019 (COVID-19), but the immunoregulatory process in these individuals is not fully understood. In this study, 23 patients with mild and 22 patients with severe COVID-19 and 6 asymptomatic carriers of COVID-19 were enrolled, along with 44 healthy controls (HC). Peripheral immune cells in HC and patients with COVID-19 were comprehensively profiled using mass cytometry. We found that in patients with severe COVID-19, the number of HLA-DRlow/- monocytes was significantly increased, but that of mucosal-associated invariant T (MAIT) cells was greatly reduced. MAIT cells were highly activated but functionally impaired in response to Escherichia coli and IL-12/IL-18 stimulation in patients with severe COVID-19, especially those with microbial coinfection. Single-cell transcriptome analysis revealed that IFN-stimulated genes were significantly upregulated in peripheral MAIT cells and monocytes from patients with severe COVID-19. IFN-α pretreatment suppressed MAIT cells' response to E. coli by triggering high levels of IL-10 production by HLA-DRlow/--suppressive monocytes. Blocking IFN-α or IL-10 receptors rescued MAIT cell function in patients with severe COVID-19. Moreover, plasma from patients with severe COVID-19 inhibited HLA-DR expression by monocytes through IL-10. These data indicate a unique pattern of immune dysregulation in severe COVID-19, which is characterized by enrichment of suppressive HLA-DRlow/- monocytes associated with functional impairment of MAIT cells through the IFN/IL-10 pathway.
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Affiliation(s)
- Qianting Yang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Yanling Wen
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Furong Qi
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Xiang Gao
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Weixin Chen
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Gang Xu
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Cailing Wei
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Haiyan Wang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Xian Tang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Jingyan Lin
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Juanjuan Zhao
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China.,Shenzhen Bay Laboratory, Shenzhen, China
| | - Mingxia Zhang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Shuye Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China; and
| | - Zheng Zhang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, China; .,The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China.,Shenzhen Bay Laboratory, Shenzhen, China.,Shenzhen Research Center for Communicable Disease Diagnosis and Treatment of Chinese Academy of Medical Science, Shenzhen, China
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30
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Kong X, Qi Y, Huang J, Zhao Y, Zhan Y, Qin X, Qi Z, Atanda AJ, Zhang L, Wang J, Fang Y, Jia P, Golozar A, Zhang L, Jiang Y. Epidemiological and clinical characteristics of cancer patients with COVID-19: A systematic review and meta-analysis of global data. Cancer Lett 2021; 508:30-46. [PMID: 33757803 PMCID: PMC7980494 DOI: 10.1016/j.canlet.2021.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/12/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022]
Abstract
There are minimal data regarding the prevalence of cancer in patients with coronavirus disease 2019 (COVID-19), as well as the incidence of severe illness and rate of mortality in COVID-19 patients with cancer. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched, from database inception to July 15, 2020, for studies of patients with COVID-19 that included information regarding comorbid cancer. In total, 109 eligible global studies were included in this systematic review. Ninety studies with 94,845 COVID-19 patients, among which 4106 exhibited comorbid cancer, were included in the meta-analysis regarding prevalence of comorbid cancer. Twenty-three studies with 71,969 COVID-19 patients, among which 4351 with comorbid cancer had severe illness or death, were included in the meta-analysis. The overall prevalence of cancer among COVID-19 patients was 0.07 (95% CI 0.05-0.09). The cancer prevalence in COVID-19 patients was higher in Europe (0.22, 95% CI 0.17-0.28) than in the Asia-Pacific region (0.04, 95% CI 0.03-0.06) or North America (0.05, 95% CI 0.04-0.06). The cancer prevalence in COVID-19 patients aged >60 years was 0.10 (95% CI 0.07-0.14), while the prevalence among patients aged ≤60 years was 0.05 (95% CI 0.03-0.06). The pooled prevalence of severe illness among COVID-19 patients with cancer was 0.34 (95% CI 0.26-0.42) and the pooled mortality rate of COVID-19 patients with cancer was 0.20 (95% CI 0.16-0.25). Pooled incidences of severe illness among COVID-19 patients with cancer from Asia Pacific, Europe, and North America were 0.38 (95% CI 0.24-0.52), 0.39 (95% CI 0.25-0.53), and 0.26 (95% CI 0.20-0.31), respectively; pooled mortality rates from the Asia-Pacific region, Europe, and North America were 0.17 (95% CI 0.10-0.24), 0.26 (95% CI 0.18-0.35), and 0.19 (95% CI 0.13-0.25), respectively.
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Affiliation(s)
- Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yihang Qi
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yang Zhao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, The University of Melbourne, Victoria, 3010, Australia
| | - Yongle Zhan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuzhen Qin
- Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Zhihong Qi
- Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Adejare Jay Atanda
- School of Community Health and Policy, Morgan State University, Baltimore, MD, USA
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shanxi, 710061, PR China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
| | - Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Regeneron Pharmaceuticals, New York, NY, USA.
| | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia; Centre of Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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31
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Karuppan MKM, Devadoss D, Nair M, Chand HS, Lakshmana MK. SARS-CoV-2 Infection in the Central and Peripheral Nervous System-Associated Morbidities and Their Potential Mechanism. Mol Neurobiol 2021; 58:2465-2480. [PMID: 33439437 PMCID: PMC7805264 DOI: 10.1007/s12035-020-02245-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
The recent outbreak of SARS-CoV-2 infections that causes coronavirus-induced disease of 2019 (COVID-19) is the defining and unprecedented global health crisis of our time in both the scale and magnitude. Although the respiratory tract is the primary target of SARS-CoV-2, accumulating evidence suggests that the virus may also invade both the central nervous system (CNS) and the peripheral nervous system (PNS) leading to numerous neurological issues including some serious complications such as seizures, encephalitis, and loss of consciousness. Here, we present a comprehensive review of the currently known role of SARS-CoV-2 and identify all the neurological problems reported among the COVID-19 case reports throughout the world. The virus might gain entry into the CNS either through the trans-synaptic route via the olfactory neurons or through the damaged endothelium in the brain microvasculature using the ACE2 receptor potentiated by neuropilin-1 (NRP-1). The most critical of all symptoms appear to be the spontaneous loss of breathing in some COVID-19 patients. This might be indicative of a dysfunction within the cardiopulmonary regulatory centers in the brainstem. These pioneering studies, thus, lay a strong foundation for more in-depth basic and clinical research required to confirm the role of SARS-CoV-2 infection in neurodegeneration of critical brain regulatory centers.
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Affiliation(s)
- Mohan Kumar Muthu Karuppan
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Dinesh Devadoss
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Madhavan Nair
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Hitendra S Chand
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Madepalli K Lakshmana
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
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32
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Campos-Varela I, Villagrasa A, Simon-Talero M, Riveiro-Barciela M, Ventura-Cots M, Aguilera-Castro L, Alvarez-Lopez P, Nordahl EA, Anton A, Bañares J, Barber C, Barreira-Diaz A, Biagetti B, Camps-Relats L, Ciudin A, Cocera R, Dopazo C, Fernandez A, Jimenez C, Jimenez MM, Jofra M, Gil C, Gomez-Gavara C, Guanozzi D, Guevara JA, Lobo B, Malagelada C, Martinez-Camprecios J, Mayorga L, Miret E, Pando E, Pérez-Lopez A, Pigrau M, Prio A, Rivera-Esteban JM, Romero A, Tasayco S, Vidal-Gonzalez J, Vidal L, Minguez B, Augustin S, Genesca J. The role of liver steatosis as measured with transient elastography and transaminases on hard clinical outcomes in patients with COVID-19. Therap Adv Gastroenterol 2021; 14:17562848211016567. [PMID: 34104210 PMCID: PMC8170328 DOI: 10.1177/17562848211016567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/12/2021] [Indexed: 02/04/2023] Open
Abstract
Liver injury has been widely described in patients with Coronavirus disease 2019 (COVID-19). We aimed to study the effect of liver biochemistry alterations, previous liver disease, and the value of liver elastography on hard clinical outcomes in COVID-19 patients. We conducted a single-center prospective observational study in 370 consecutive patients admitted for polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia. Clinical and laboratory data were collected at baseline and liver parameters and clinical events recorded during follow-up. Transient elastography [with Controlled Attenuation Parameter (CAP) measurements] was performed at admission in 98 patients. All patients were followed up until day 28 or death. The two main outcomes of the study were 28-day mortality and the occurrence of the composite endpoint intensive care unit (ICU) admission and/or death. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated at admission in 130 patients (35%) and 167 (45%) patients, respectively. Overall, 14.6% of patients presented the composite endpoint ICU and/or death. Neither ALT elevations, prior liver disease, liver stiffness nor liver steatosis (assessed with CAP) had any effect on outcomes. However, patients with abnormal baseline AST had a higher occurrence of the composite ICU/death (21% versus 9.5%, p = 0.002). Patients ⩾65 years and with an AST level > 50 U/ml at admission had a significantly higher risk of ICU and/or death than those with AST ⩽ 50 U/ml (50% versus 13.3%, p < 0.001). In conclusion, mild liver damage is prevalent in COVID-19 patients, but neither ALT elevation nor liver steatosis influenced hard clinical outcomes. Elevated baseline AST is a strong predictor of hard outcomes, especially in patients ⩾65 years.
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Affiliation(s)
- Isabel Campos-Varela
- Liver Unit, Department of Internal Medicine,
Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron, 119-129, Barcelona,
08035, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Ares Villagrasa
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Macarena Simon-Talero
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Meritxell Ventura-Cots
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Lara Aguilera-Castro
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Patricia Alvarez-Lopez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilie A Nordahl
- Department of Clinical Pharmacology, Vall
d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Adrian Anton
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Bañares
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Barber
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Ana Barreira-Diaz
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Betina Biagetti
- Department of Endocrinology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Camps-Relats
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- Department of Endocrinology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Raul Cocera
- Department of Urology, Vall d’Hebron Barcelona
Hospital Campus, Barcelona, Spain
| | - Cristina Dopazo
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Andrea Fernandez
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cesar Jimenez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria M Jimenez
- Department of Hematology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Mariona Jofra
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Gil
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Gomez-Gavara
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Danila Guanozzi
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Jorge A Guevara
- Department of Endoscopy, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Lobo
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Carolina Malagelada
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Joan Martinez-Camprecios
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Mayorga
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Enric Miret
- Department of Urology, Vall d’Hebron Barcelona
Hospital Campus, Barcelona, Spain
| | - Elizabeth Pando
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Pérez-Lopez
- Department of Hematology, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Marc Pigrau
- Department of Endoscopy, Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Prio
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus M Rivera-Esteban
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Romero
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stephanie Tasayco
- Department of Gastroenterology, Vall d’Hebron
Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona,
Spain
| | - Judit Vidal-Gonzalez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Vidal
- Department of Hepatobiliar Surgery and Liver
Transplant, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Minguez
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
| | - Salvador Augustin
- Liver Unit, Department of Internal Medicine,
Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron, 119-129, Barcelona,
08035, Spain
| | - Joan Genesca
- Liver Unit, Hospital Universitari Vall
d’Hebron, Vall d’Hebron Institut of Reseach (VHIR), Vall d’Hebron Barcelona
Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos
III, Madrid, Spain
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33
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Bzeizi K, Abdulla M, Mohammed N, Alqamish J, Jamshidi N, Broering D. Effect of COVID-19 on liver abnormalities: a systematic review and meta-analysis. Sci Rep 2021; 11:10599. [PMID: 34012016 PMCID: PMC8134580 DOI: 10.1038/s41598-021-89513-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Emerging evidence suggest association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the development of many liver abnormalities. The overarching aim of this study was therefore to assess the available evidence on the clinical effects of SARS-CoV-2 on the profiles of liver chemistries and coagulation in COVID-19 diagnosed patients. We considered all study designs including epidemiological and observational that reported liver function test abnormalities in patients confirmed with SARS-CoV-2 infection. Medline, Embase databases and Google Scholar as well as relevant reviews were searched to identify appropriate studies from inception to 31st of August 2020. We calculated the pooled mean with 95% confidence intervals (95% CI) through a random-effect model meta-analysis. A total of 35 studies with 10,692 participants were considered for the review from which 23 studies with sufficient quantitative data were included in the meta-analysis. The pooled mean for liver enzymes and coagulation parameters did not significantly change in patients diagnosed with COVID-19 and remained within normal range. Notwithstanding potential bias from confounding factors in interpretation of data in this review, findings from the observational studies and case reports suggest that COVID-19 does not appear to have a significant impact on the transaminases or total bilirubin levels of patients with confirmed SARS-CoV-2 infection. Further controlled studies and larger sample size observational studies are needed with adequate reporting of other liver function parameters are warranted.
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Affiliation(s)
- Khalid Bzeizi
- Department of Liver & Small Bowel Transplantation & Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, Riyadh, 11211, Saudi Arabia.
| | - Maheeba Abdulla
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Nafeesa Mohammed
- Internal Medicine Department, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Negar Jamshidi
- School of Science, RMIT University, Melbourne, VIC, 3000, Australia
| | - Dieter Broering
- Organ Transplant Center & Department of Surgery, King Faisal Specialist Hospital & Research Centre (Gen. Org) MBC 96, AlFaisal University, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
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34
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Wu H, Liu S, Luo H, Chen M. Progress in the Clinical Features and Pathogenesis of Abnormal Liver Enzymes in Coronavirus Disease 2019. J Clin Transl Hepatol 2021; 9:239-246. [PMID: 34007806 PMCID: PMC8111107 DOI: 10.14218/jcth.2020.00126] [Citation(s) in RCA: 2] [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: 11/24/2020] [Revised: 02/15/2021] [Accepted: 03/28/2021] [Indexed: 02/06/2023] Open
Abstract
With the rapid development of research on coronavirus disease 2019 (COVID-19), more and more attention has been drawn to its damage to extrapulmonary organs. There are increasing lines of evidence showing that liver injury is closely related to the severity of COVID-19, which may have an adverse impact on the progression and prognosis of the patients. What is more, severe acute respiratory syndrome coronavirus-2 infection, cytokine storm, ischemia/hypoxia reperfusion injury, aggravation of the primary liver disease and drug-induced liver injury may all contribute to the hepatic damage in COVID-19 patients; although, the drug-induced liver injury, especially idiosyncratic drug-induced liver injury, requires further causality confirmation by the updated Roussel Uclaf Causality Assessment Method published in 2016. Up to now, there is no specific regimen for COVID-19, and COVID-19-related liver injury is mainly controlled by symptomatic and supportive treatment. Here, we review the clinical features of abnormal liver enzymes in COVID-19 and pathogenesis of COVID-19-related liver injury based on the current evidence, which may provide help for clinicians and researchers in exploring the pathogenesis and developing treatment strategies.
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Affiliation(s)
| | | | - Hesheng Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Mingkai Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Frater JL, Wang T, Lee YS. Laboratory hematologic features of COVID-19 associated liver injury: A systematic review. World J Meta-Anal 2021; 9:193-207. [DOI: 10.13105/wjma.v9.i2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/31/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
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Frater JL, Wang T, Lee YS. Laboratory hematologic features of COVID-19 associated liver injury: A systematic review. World J Meta-Anal 2021; 9:192-206. [DOI: 10.13105/wjma.v9.i2.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Ahmad A, Ishtiaq SM, Khan JA, Aslam R, Ali S, Arshad MI. COVID-19 and comorbidities of hepatic diseases in a global perspective. World J Gastroenterol 2021; 27:1296-1310. [PMID: 33833483 PMCID: PMC8015303 DOI: 10.3748/wjg.v27.i13.1296] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/17/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
The worldwide outbreak of coronavirus disease 2019 (COVID-19) has challenged the priorities of healthcare system in terms of different clinical management and infection transmission, particularly those related to hepatic-disease comorbidities. Epidemiological data evidenced that COVID-19 patients with altered liver function because of hepatitis infection and cholestasis have an adverse prognosis and experience worse health outcomes. COVID-19-associated liver injury is correlated with various liver diseases following a severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2) infection that can progress during the treatment of COVID-19 patients with or without pre-existing liver disease. SARS-CoV-2 can induce liver injury in a number of ways including direct cytopathic effect of the virus on cholangiocytes/hepatocytes, immune-mediated damage, hypoxia, and sepsis. Indeed, immediate cytopathogenic effects of SARS-CoV-2 via its potential target, the angiotensin-converting enzyme-2 receptor, which is highly expressed in hepatocytes and cholangiocytes, renders the liver as an extra-respiratory organ with increased susceptibility to pathological outcomes. But, underlying COVID-19-linked liver disease pathogenesis with abnormal liver function tests (LFTs) is incompletely understood. Hence, we collated COVID-19-associated liver injuries with increased LFTs at the nexus of pre-existing liver diseases and COVID-19, and defining a plausible pathophysiological triad of COVID-19, hepatocellular damage, and liver disease. This review summarizes recent findings of the exacerbating role of COVID-19 in pre-existing liver disease and vice versa as well as international guidelines of clinical care, management, and treatment recommendations for COVID-19 patients with liver disease.
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Affiliation(s)
- Aqsa Ahmad
- Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
| | - Syeda Momna Ishtiaq
- Institute of Physiology and Pharmacology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
| | - Junaid Ali Khan
- Institute of Physiology and Pharmacology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
| | - Rizwan Aslam
- Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
| | - Sultan Ali
- Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
| | - Muhammad Imran Arshad
- Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad 38040, Punjab, Pakistan
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Yip TCF, Lui GCY, Wong VWS, Chow VCY, Ho THY, Li TCM, Tse YK, Hui DSC, Chan HLY, Wong GLH. Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19. Gut 2021; 70:733-742. [PMID: 32641471 PMCID: PMC7371491 DOI: 10.1136/gutjnl-2020-321726] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear. DESIGN This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death. RESULTS We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation. CONCLUSION ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.
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Affiliation(s)
- Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Viola Chi-Ying Chow
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tracy Hang-Yee Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Yadav DK, Singh A, Zhang Q, Bai X, Zhang W, Yadav RK, Singh A, Zhiwei L, Adhikari VP, Liang T. Involvement of liver in COVID-19: systematic review and meta-analysis. Gut 2021; 70:807-809. [PMID: 32669289 PMCID: PMC7948176 DOI: 10.1136/gutjnl-2020-322072] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Dipesh Kumar Yadav
- Department of Hepatobiliary Surgery & Liver Transplantation, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Disease, Hangzhou, China
| | - Akanand Singh
- Liver Transplantation, Hepatobiliary and Pancreatic Surgery Unit, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Qi Zhang
- Department of Hepatobiliary Surgery & Liver Transplantation, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Disease, Hangzhou, China
| | - Xueli Bai
- Department of Hepatobiliary Surgery & Liver Transplantation, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Disease, Hangzhou, China
| | - Wei Zhang
- Department of Hepatobiliary Surgery & Liver Transplantation, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Disease, Hangzhou, China
| | - Rajesh Kumar Yadav
- Department of Pharmacology, Gandaki Medical College Teaching Hospital and Research Centre, Tribhuwan University, Pokhara, Nepal
| | - Alina Singh
- Department of Surgery, Gandaki Medical College Teaching Hospital and Research Centre, Tribhuwan University, Pokhara, Nepal
| | - Li Zhiwei
- Department of Hepatobiliary Surgery & Liver Transplantation, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Disease, Hangzhou, China
| | - Vishnu Prasad Adhikari
- Department of Hepatobiliary Surgery & Liver Transplantation, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Disease, Hangzhou, China
| | - Tingbo Liang
- Department of Hepatobiliary Surgery & Liver Transplantation, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China .,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China.,Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Disease, Hangzhou, China
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Shafran N, Issachar A, Shochat T, Shafran IH, Bursztyn M, Shlomai A. Abnormal liver tests in patients with SARS-CoV-2 or influenza - prognostic similarities and temporal disparities. JHEP Rep 2021; 3:100258. [PMID: 33644724 PMCID: PMC7902222 DOI: 10.1016/j.jhepr.2021.100258] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background & Aims Abnormal liver tests are common in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but a possible direct role of the virus in liver injury and its association with short-term outcomes are controversial. Therefore, we aimed to compare the pattern of abnormal liver tests in patients with SARS-CoV-2 with those of patients infected with influenza, a non-hepatotropic respiratory virus, and their association with worse outcomes during hospitalisation. Methods We performed a retrospective cohort study of 1,737 hospitalised patients (865 with influenza and 872 with SARS-CoV-2) in a tertiary medical centre. We defined abnormal liver tests as alanine transaminase or aspartate transaminase ≥40 IU/ml at any time-point during hospitalisation. Results Abnormal liver tests were mild to moderate in most patients regardless of infection type, but the majority of patients with influenza had a transaminase peak earlier during hospitalisation compared with patients with SARS-CoV-2. Abnormal liver tests correlated with markers of severe disease in either influenza or SARS-CoV-2 infections, and were associated with death, occurring mainly in patients with severe liver test abnormalities (>200 IU/L) (38.7% and 60% of patients with influenza or SARS-CoV-2, respectively). In multivariate analysis, controlling for age, sex, lymphopaenia, and C-reactive protein, liver test abnormalities remained significantly associated with death for influenza (odds ratio 4.344; 95% CI 2.218-8.508) and SARS-CoV-2 (odds ratio 3.898; 95% CI 2.203-6.896). These results were confirmed upon propensity score matching. Conclusions Abnormal liver tests during hospitalisation with SARS-CoV-2 or influenza infections are common, may differ in their time course, and reflect disease severity. They are associated with worse outcomes, mainly in patients with severe liver test abnormalities, regardless of infection type. Lay summary Coronavirus disease 2019 (COVID-19) is a serious global health pandemic, the causative agent of which is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Abnormal liver tests are common among SARS-CoV-2 infected patients and are often associated with worse outcomes. Herein, we compare the pattern of abnormal liver tests and their association with disease severity between 2 major non-hepatotropic respiratory viruses: SARS-CoV-2 and influenza. We show that abnormal liver tests are common in both infections, may slightly differ in their kinetics, and are associated with worse outcomes, especially in patients with severe liver test abnormalities. These results strongly suggest that abnormal liver tests in SARS-CoV-2 patients reflect disease severity, rather than a virus-mediated direct liver injury, and should be closely followed in admitted patients.
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Key Words
- ALKP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate transaminase
- BOSmin, minimal blood oxygen saturation
- COVID-19
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- GGT, gamma-glutamyl transferase
- Liver injury
- Respiratory tract infections
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SBPmin, minimal systolic blood pressure
- WBC count, white blood cell count
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Affiliation(s)
- Noa Shafran
- Department of Medicine D, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Assaf Issachar
- The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Tzippy Shochat
- Bio-Statistical Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Inbal Haya Shafran
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Bursztyn
- Department of Medicine D, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel
| | - Amir Shlomai
- Department of Medicine D, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Bennett S, Tafuro J, Mayer J, Darlington D, Wong CW, Muntean E, Wong N, Mallen C, Kwok CS. Clinical features and outcomes of adults with coronavirus disease 2019: A systematic review and pooled analysis of the literature. Int J Clin Pract 2021; 75:e13725. [PMID: 32965728 PMCID: PMC7536970 DOI: 10.1111/ijcp.13725] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) has become a global pandemic and the published literature describing the virus has grown exponentially. METHODS We conducted a systematic review of the literature to identify the symptoms, comorbidities present, radiological features and outcomes for adults testing positive for COVID-19 admitted to hospital. The results across multiple studies were numerically pooled to yield total estimated. RESULTS A total of 45 studies were included in this review with 14 358 adult participants (average age 51 years, male 51%). The pooled findings suggest that the most common symptom among patients was fever (81.2%) followed by cough (62.9%), fatigue (38.0%) and anorexia/loss of appetite (33.7%). The comorbidities that were most prevalent among patients with the virus were hypertension (19.1%), cardiovascular disease (17.9%), endocrine disorder (9.3%) and diabetes (9.2%). Abnormal chest X-ray findings were present in 27.7% of patients and ground-glass opacity was demonstrated on chest computerized tomography in 63.0% of patients. The most frequent adverse outcomes were acute respiratory distress syndrome (27.4%), acute cardiac injury (16.2%) and acute kidney injury (12.6%). Death occurred in 8.2% of patients and 16.3% required intensive care admission and 11.7% had mechanical ventilation. Bacterial or secondary infections affected 8.5% of patients and 6.9% developed shock. CONCLUSIONS COVID-19 most commonly presents with fever, cough, fatigue and anorexia and among patients with existing hypertension and cardiovascular disease. It is important as serious adverse outcomes can develop such as acute respiratory distress syndrome, acute cardiac injury, acute kidney injury and death.
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Affiliation(s)
- Sadie Bennett
- Department of CardiologyRoyal Stoke University HospitalStoke‐on‐TrentUK
| | - Jacopo Tafuro
- Department of CardiologyRoyal Stoke University HospitalStoke‐on‐TrentUK
| | - Joseph Mayer
- Department of CardiologyRoyal Stoke University HospitalStoke‐on‐TrentUK
| | - Daniel Darlington
- Department of CardiologyRoyal Stoke University HospitalStoke‐on‐TrentUK
| | - Chun Wai Wong
- Department of CardiologyRoyal Stoke University HospitalStoke‐on‐TrentUK
| | | | - Nicholas Wong
- Department of Infectious Disease and Tropical MedicineLeicester Royal InfirmaryLeicesterUK
| | | | - Chun Shing Kwok
- Department of CardiologyRoyal Stoke University HospitalStoke‐on‐TrentUK
- Keele School of MedicineKeele UniversityStoke‐on‐TrentUK
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Skladany L, Koller T, Adamcova Selcanova S, Vnencakova J, Jancekova D, Durajova V, Laffers L, Svac J, Janickova K, Palkovič M, Kohout P, Golubnitschaja O. Challenging management of severe chronic disorders in acute pandemic situation: Chronic liver disease under COVID-19 pandemic as the proof-of-principle model to orchestrate the measures in 3PM context. EPMA J 2021; 12:1-14. [PMID: 33680218 PMCID: PMC7926196 DOI: 10.1007/s13167-021-00231-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 02/06/2023]
Abstract
Chronic liver disease management is a comprehensive approach requiring multi-professional expertise and well-orchestrated healthcare measures thoroughly organized by responsible medical units. Contextually, the corresponding multi-faceted chain of healthcare events is likely to be severely disturbed or even temporarily broken under the force majeure conditions such as global pandemics. Consequently, the chronic liver disease is highly representative for the management of any severe chronic disorder under lasting pandemics with unprecedented numbers of acutely diseased persons who, together with the chronically sick patient cohorts, have to be treated using the given capacity of healthcare systems with their limited resources. Current study aimed at exploring potentially negative impacts of the SARS CoV-2 outbreak on the quality of the advanced chronic liver disease (ACLD) management considering two well-classified parameters, namely, (1) the continuity of the patient registrations and (2) the level of mortality rates, comparing pre-COVID-19 statistics with these under the current pandemic in Slovak Republic. Altogether 1091 registrations to cirrhosis registry (with 60.8% versus 39.2% males to females ratio) were included with a median age of 57 years for patients under consideration. Already within the very first 3 months of the pandemic outbreak in Slovakia (lockdown declared from March 16, 2020, until May 20, 2020), the continuity of the patient registrations has been broken followed by significantly increased ACLD-related death rates. During this period of time, the total number of new registrations decreased by about 60% (15 registrations in 2020 versus 38 in 2018 and 38 in 2019). Corresponding mortality increased by about 52% (23 deaths in 2020 versus 10 in 2018 and 12 in 2019). Based on these results and in line with the framework of 3PM guidelines, the pandemic priority pathways (PPP) are strongly recommended for maintaining tertiary care uninterrupted. For the evidence-based implementation of PPP, creation of predictive algorithms and individualized care strategy tailored to the patient is essential. Resulting classification of measures is summarized as follows:The Green PPP Line is reserved for prioritized (urgent and comprehensive) treatment of patients at highest risk to die from ACLD (tertiary care) as compared to the risk from possible COVID-19 infection.The Orange PPP Line considers patients at middle risk of adverse outcomes from ACLD with re-addressing them to the secondary care. As further deterioration of ACLD is still probable, pro-active management is ascertained with tertiary center serving as the 24/7 telemedicine consultation hub for a secondary facility (on a physician-physician level).The Red PPP Line is related to the patients at low risk to die from ACLD, re-addressing them to the primary care. Since patients with stable chronic liver diseases without advanced fibrosis are at trivial inherent risk, they should be kept out of the healthcare setting as far as possible by the telemedical (patient-nurse or patient- physician) measurements. The assigned priority has to be monitored and re-evaluated individually-in intervals based on the baseline prognostic score such as MELD. The approach is conform with principles of predictive, preventive and personalized medicine (PPPM / 3PM) and demonstrates a potential of great clinical utility for an optimal management of any severe chronic disorder (cardiovascular, neurological and cancer) under lasting pandemics.
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Affiliation(s)
- Lubomir Skladany
- HEGITO (Div. Hepatology, Gastroenterology, and Liver Transplantation) of the Department of Internal Medicine II, Faculty of Medicine, Slovak Medical University, F. D. Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
| | - Tomas Koller
- 5th Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava Ruzinov, Bratislava, Slovakia
| | - Svetlana Adamcova Selcanova
- HEGITO (Div. Hepatology, Gastroenterology, and Liver Transplantation) of the Department of Internal Medicine II, Faculty of Medicine, Slovak Medical University, F. D. Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
| | - Janka Vnencakova
- HEGITO (Div. Hepatology, Gastroenterology, and Liver Transplantation) of the Department of Internal Medicine II, Faculty of Medicine, Slovak Medical University, F. D. Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
| | - Daniela Jancekova
- HEGITO (Div. Hepatology, Gastroenterology, and Liver Transplantation) of the Department of Internal Medicine II, Faculty of Medicine, Slovak Medical University, F. D. Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
| | - Viktoria Durajova
- Department of Science and Research, F.D. Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
| | - Lukas Laffers
- Department of Mathematics, Faculty of Natural Sciences, Matej Bel University, Banska Bystrica, Slovakia
| | - Juraj Svac
- HEGITO (Div. Hepatology, Gastroenterology, and Liver Transplantation) of the Department of Internal Medicine II, Faculty of Medicine, Slovak Medical University, F. D. Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
| | - Katarina Janickova
- Central Evidence Department, Health Care Surveillance Authority (HCSA), Bratislava, Slovakia
| | - Michal Palkovič
- Forensic Medicine and Pathological Anatomy Department, Health Care Surveillance Authority (HCSA), Bratislava, Slovakia
| | - Pavel Kohout
- Department of Internal Medicine, 3Rd Medical Faculty Charles University, Thomayer Hospital Prague, Prague, Czech Republic
| | - Olga Golubnitschaja
- Predictive, Preventive Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- 3PM Research Unit, Department of Radiation Oncology, University Hospital, Medical Faculty, Rheinische Friedrich-Wilhelms-Universität Bonn, 53107 Bonn, Germany
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Zhan K, Liao S, Li J, Bai Y, Lv L, Yu K, Qiu L, Li C, Yuan G, Zhang A, Mei Z. Risk factors in patients with COVID-19 developing severe liver injury during hospitalisation. Gut 2021; 70:628-629. [PMID: 32571973 PMCID: PMC7873415 DOI: 10.1136/gutjnl-2020-321913] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Ke Zhan
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shengtao Liao
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinfang Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Lv
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Keqi Yu
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liewang Qiu
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,Department of Gastroenterology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanfei Li
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guodan Yuan
- Department of Critical Care Medicine, Chongqing Public Health Medical Center, Chongqing, China
| | - An Zhang
- Department of Critical Care Medicine, Chongqing Medical University Affiliated Second Hospital, Chongqing, China
| | - Zhechuan Mei
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Mendizabal M, Piñero F, Ridruejo E, Anders M, Silveyra MD, Torre A, Montes P, Urzúa A, Pages J, Toro LG, Díaz J, Gonzalez Ballerga E, Miranda-Zazueta G, Peralta M, Gutiérrez I, Michelato D, Venturelli MG, Varón A, Vera-Pozo E, Tagle M, García M, Tassara A, Brutti J, Ruiz García S, Bustios C, Escajadillo N, Macias Y, Higuera-de la Tijera F, Gómez AJ, Dominguez A, Castillo-Barradas M, Contreras F, Scarpin A, Schinoni MI, Toledo C, Girala M, Mainardi V, Sanchez A, Bessone F, Rubinstein F, Silva MO. Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission. Ann Hepatol 2021; 21:100298. [PMID: 33359234 PMCID: PMC7832153 DOI: 10.1016/j.aohep.2020.100298] [Citation(s) in RCA: 24] [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: 11/17/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION & OBJECTIVES The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. MATERIALS & METHODS We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. RESULTS Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7-47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4-16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9-21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1-14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1-2.0); P = 0.01], and severe COVID-19 (2.6 [2.0-3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. CONCLUSIONS The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. CLINICALTRIALS.GOV: NCT04358380.
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Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN).
| | - Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)
| | - Ezequiel Ridruejo
- Latin American Liver Research Educational and Awareness Network (LALREAN); Liver Section, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires Argentina
| | - Margarita Anders
- Latin American Liver Research Educational and Awareness Network (LALREAN); Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | - Aldo Torre
- Department of Internal Medicine, Centro Médico ABC, Ciudad de México, México
| | - Pedro Montes
- Gastroenterology Unit, Hospital Nacional Daniel A. Carrión, Callao, Perú
| | - Alvaro Urzúa
- Gastroenterology Section, Internal Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Josefina Pages
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)
| | - Luis G Toro
- Hepatology and Liver Transplant Unit, Hospitales de San Vicente Fundación de Medellín y Rionegro, Medellín, Colombia
| | - Javier Díaz
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Esteban Gonzalez Ballerga
- Department of Gastroenterology, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Godolfino Miranda-Zazueta
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición, Ciudad de México, México
| | - Mirta Peralta
- Latin American Liver Research Educational and Awareness Network (LALREAN); Intensive Care Unit, Hospital de Infecciosas Francisco J Muñiz, Buenos Aires, Argentina
| | - Isabel Gutiérrez
- Department of Internal Medicine, Centro Médico ABC, Ciudad de México, México
| | - Douglas Michelato
- Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia, Salvador de Bahía, Brazil
| | | | - Adriana Varón
- Latin American Liver Research Educational and Awareness Network (LALREAN); Liver Unit, Fundación Cardio-Infantil, Bogotá, Colombia
| | - Emilia Vera-Pozo
- Hospital Regional Dr. Teodoro Maldonado Carbo del IESS, Guayaquil, Ecuador
| | - Martín Tagle
- Gastroenterology Unit, Clínica Anglo-Americana, Lima, Perú
| | - Matías García
- Liver Section, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires Argentina
| | - Alfredo Tassara
- Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Julia Brutti
- Department of Internal Medicine, Sanatorio Anchorena, Buenos Aires, Argentina
| | - Sandro Ruiz García
- Gastroenterology Unit, Hospital de Víctor Lazarte Echegaray, Trujillo, Perú
| | | | - Nataly Escajadillo
- Gastroenterology Unit, Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú
| | - Yuridia Macias
- Department of Medicine, IMSS Hospital General Regional No.1 "Dr. Carlos Mc Gregor Sánchez", Ciudad de México, Mexico
| | - Fátima Higuera-de la Tijera
- Department of Gastroenterology and Hepatology, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Andrés J Gómez
- Endoscopy and Transplant Service, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | | | - Mauricio Castillo-Barradas
- Gastroenterology Unit, Hospital de Especialidades del Centro Médico Nacional La Raza IMSS, Ciudad de México, México
| | - Fernando Contreras
- Department of Gastroenterology, CEDIMAT, Santo Domingo, Dominican Republic
| | - Aldana Scarpin
- Liver Section, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires Argentina
| | - Maria Isabel Schinoni
- Latin American Liver Research Educational and Awareness Network (LALREAN); Department of Gastroenterology, Hospital Alianza, Bahía, Brazil
| | - Claudio Toledo
- Gastroenterology Unit, Hospital Valdivia, Universidad Austral de Chile, Valdivia, Chile
| | - Marcos Girala
- Department of Gastroenterology, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Victoria Mainardi
- Hepatology and Liver Transplant Unit, Hospital Central De las Fuerzas Armadas, Montevideo, Uruguay
| | - Abel Sanchez
- Department of Gastroenterology, Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Fernando Bessone
- Department of Gastroenterology, Hospital Provincial del Centenario, Rosario, Argentina
| | | | - Marcelo O Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)
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Liu X, Li X, Sun T, Qin H, Zhou Y, Zou C, Cao J, Zhang H. East-West differences in clinical manifestations of COVID-19 patients: A systematic literature review and meta-analysis. J Med Virol 2021; 93:2683-2693. [PMID: 33325107 DOI: 10.1002/jmv.26737] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is currently not under control. We aimed to assess whether there are differences in clinical manifestations between COVID-19 patients from the East (East and South-East Asian countries including China, South Korea, and Thailand) and the West (North American, European, and Middle East countries, including the United States, Italy, France, and Iran). For this meta-analysis, we searched for eligible studies about COVID-19 in three databases: PubMed, EMBASE, and the Cochrane Library. Studies were divided into two cohorts for analysis: the East and the West. Stata 13.1 software was used for the meta-analysis. Of the 1527 studies initially identified by the literature search, 169 full-text articles were retrieved and screened for eligibility. Fifty-seven of these, describing 19,353 patients, were deemed eligible for inclusion. Of these, 45 studies with 8416 patients were from the East while 12 studies with 10,937 patients were from the West. The results indicated that the incidences of cough, headache, dizziness, nasal congestion, and digestive symptoms in COVID-19 patients from the East were lower than those in the West. The laboratory data showed that there were no significant differences in the levels of lymphocytes, leukocytes, C-reactive protein, and platelet counts between the two groups. In addition, our results also showed that the incidence of cardiac and kidney injury, as well as increased levels of creatinine, alanine transaminase, and aspartate transaminase, were significantly higher in patients from the West than from the East. Our meta-analysis indicated that there are differences in the clinical manifestations of COVID-19 in patients from the East and the West. COVID-19 patients from the West appear to suffer more severe liver, kidney, and heart damage due to SARS-CoV-2.
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Affiliation(s)
- Xiucheng Liu
- Department of Thoracic Surgery, Affifiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiang Li
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Teng Sun
- Department of Thoracic Surgery, Affifiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hao Qin
- Department of Thoracic Surgery, Affifiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yeqing Zhou
- Department of Thoracic Surgery, Affifiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | | | - Junli Cao
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hao Zhang
- Department of Thoracic Surgery, Affifiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Effenberger M, Grander C, Grabherr F, Griesmacher A, Ploner T, Hartig F, Bellmann-Weiler R, Joannidis M, Zoller H, Weiss G, Adolph TE, Tilg H. Systemic inflammation as fuel for acute liver injury in COVID-19. Dig Liver Dis 2021; 53:158-165. [PMID: 32873520 PMCID: PMC7416681 DOI: 10.1016/j.dld.2020.08.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A cytokine storm conceivably contributes to manifestations of corona virus disease (COVID-19). Inflammatory cytokines such as interleukin-6 (IL-6) cause acute liver injury while serum detectability indicates systemic inflammation. AIMS We explored a link between systemic IL-6, related acute phase proteins and liver injury in hospitalized COVID-19 patients. METHODS 655 patients with suspected COVID-19 were screened in the emergency department at the University Hospital of Innsbruck, Austria, between February and April 2020. 96 patients (∼15%) were hospitalized with COVID-19. 15 patients required intensive-care treatment (ICT). Plasma aminotransferases, alkaline phosphatase, bilirubin, and gamma glutamyl transferase, as well as IL-6, C-reactive protein (CRP), ferritin and lactate dehydrogenase (LDH) were determined by standard clinical assays. RESULTS Of all hospitalized COVID-19 patients, 41 (42%) showed elevated aspartate aminotransferase (AST) concentration. COVID-19 patients with elevated AST exhibited significantly higher IL-6 (p < 0.001), ferritin (p < 0.001), LDH (p < 0.001) and CRP (p < 0.05) serum concentrations compared to patients with normal AST. Liver injury correlated with systemic IL-6 (p < 0.001), CRP (p < 0.001), ferritin (p < 0.001) and LDH (p < 0.001) concentration. In COVID-19 patients requiring ICT, correlations were more pronounced. CONCLUSION Systemic inflammation could be a fuel for hepatic injury in COVID-19.
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Affiliation(s)
- Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Christoph Grander
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Felix Grabherr
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Andrea Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Thomas Ploner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Frank Hartig
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Michael Joannidis
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Heinz Zoller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Disease, Pulmonology & Rheumatology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Timon Erik Adolph
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
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Zhao X, Lei Z, Gao F, Xie Q, Jang K, Gong J. The impact of coronavirus disease 2019 (COVID-19) on liver injury in China: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24369. [PMID: 33530232 PMCID: PMC7850764 DOI: 10.1097/md.0000000000024369] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/09/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The evidence for the incidence and severity of liver injury in Chinese patients with coronavirus disease 2019 (COVID-19) is still controversial. The purpose of this study was to summarize the incidence of liver injury and the differences between liver injury markers among different patients with COVID-19 in China. METHODS Computer searches of PubMed, Embase, China National Knowledge Infrastructure (CNKI) and medRxiv were used to obtain reports on the incidence and markers of liver injury in Chinese patients with COVID-19, from January 1, 2020 to April 10, 2020. (No. CRD42020181350). RESULTS A total of 57 reports from China were included, including 9889 confirmed cases of COVID-19 infection. The results of the meta-analysis showed that among the patients with early COVID-19 infection in China, the incidence of liver injury events was 24.7% (95% CI, 23.4%-26.4%). Liver injury in severe patients was more common than that in non-severe patients, with a risk ratio of 2.07 (95% CI, 1.77-2.43). Quantitative analysis showed that the severe the coronavirus infection, the higher the level of alanine aminotransferase (ALT), aspertate aminotransferase (AST), total bilirubin (TB), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), and the lower the level of albumin (ALB). CONCLUSION There is a certain risk of liver injury in Chinese patients with COVID-19, and the risk and degree of liver injury are related to the severity of COVID-19.
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Affiliation(s)
- Xin Zhao
- Department of Hepatobiliary Surgery, Peoples Hospital of Leshan
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases, Leshan City, Sichuan Province, China
| | - Zehua Lei
- Department of Hepatobiliary Surgery, Peoples Hospital of Leshan
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases, Leshan City, Sichuan Province, China
| | - Fengwei Gao
- Department of Hepatobiliary Surgery, Peoples Hospital of Leshan
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases, Leshan City, Sichuan Province, China
| | - Qingyun Xie
- Department of Hepatobiliary Surgery, Peoples Hospital of Leshan
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases, Leshan City, Sichuan Province, China
| | - Kangyi Jang
- Department of Hepatobiliary Surgery, Peoples Hospital of Leshan
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases, Leshan City, Sichuan Province, China
| | - Jie Gong
- Department of Hepatobiliary Surgery, Peoples Hospital of Leshan
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases, Leshan City, Sichuan Province, China
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Han MW, Wang M, Xu MY, Qi WP, Wang P, Xi D. Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury. World J Clin Cases 2021; 9:528-539. [PMID: 33553391 PMCID: PMC7829721 DOI: 10.12998/wjcc.v9.i3.528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/10/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has posed a serious threat to global public health security. With the increase in the number of confirmed cases globally, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Despite atypical pneumonia as the primary symptom, liver dysfunction has also been observed in many clinical cases and is associated with the mortality risk in patients with COVID-19, like severe acute respiratory syndrome and Middle East respiratory syndrome. Here we will provide a schematic overview of the clinical characteristics and the possible mechanisms of liver injury caused by severe acute respiratory syndrome coronavirus 2 infection, which may provide help for optimizing the management of liver injury and reducing mortality in COVID-19 patients.
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Affiliation(s)
- Mei-Wen Han
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ming Wang
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Meng-Ying Xu
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Wei-Peng Qi
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Peng Wang
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Dong Xi
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Fan H, Cai J, Tian A, Li Y, Yuan H, Jiang Z, Yu Y, Ruan L, Hu P, Yue M, Chen N, Li J, Zhu C. Comparison of Liver Biomarkers in 288 COVID-19 Patients: A Mono-Centric Study in the Early Phase of Pandemic. Front Med (Lausanne) 2021; 7:584888. [PMID: 33521010 PMCID: PMC7843802 DOI: 10.3389/fmed.2020.584888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Recent reports have indicated that hepatic dysfunction occurred in a proportion of patients with coronavirus disease 2019 (COVID-19). We aimed to compare and describe the liver biomarkers in different subtypes of COVID-19 patients. Methods: This study enrolled 288 COVID-19 patients in Huangshi Hospital of Traditional Chinese Medicine. All patients were divided into ordinary, severe, and critical groups according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). Demographic, clinical characteristics and liver biomarkers were compared among the three groups. Results: During hospitalization, AST, TBiL, and ALP levels in ordinary and severe patients fluctuated within the normal range with a rising trend in critical patients except AST. ALT and GGT levels fluctuated within the normal range showing an upward trend, while LDH levels in the critical group exceeded the normal range. Prealbumin showed an upward trend, especially in the severe group. At discharge, AST and LDH levels in ordinary and severe groups were lower than their baselines but increased in the critical group. In contrast to albumin, TBiL levels were increased in ordinary and critical groups while decreased in the severe group. The stratified analysis revealed factors affecting liver function in critical cases included highest temperature ≥38.0°C, age ≥60 and symptom of hypoxemia. Conclusions: COVID-19 can cause severe hepatic dysfunction in critical patients, requiring early monitoring and intervention. LDH, ALP, GGT, TBiL, prealbumin, and albumin may be helpful for evaluating and predicting disease prognosis due to their correlation with disease severity in COVID-19.
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Affiliation(s)
- Haozhi Fan
- Department of Information, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinyuan Cai
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Anran Tian
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuwen Li
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Yuan
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhengyi Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yunxi Yu
- Emergency Department, Huangshi Hospital of Traditional Chinese Medicine, Huangshi, China
| | - Lili Ruan
- Department of Anesthesiology, The Fifth Hospital of Huangshi, Huangshi, China
| | - Pingping Hu
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Yue
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nian Chen
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Li
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chuanlong Zhu
- Department of Infectious Disease, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Tropical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
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50
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Hayashi Y, Wagatsuma K, Nojima M, Yamakawa T, Ichimiya T, Yokoyama Y, Kazama T, Hirayama D, Nakase H. The characteristics of gastrointestinal symptoms in patients with severe COVID-19: a systematic review and meta-analysis. J Gastroenterol 2021; 56:409-420. [PMID: 33759041 PMCID: PMC7987120 DOI: 10.1007/s00535-021-01778-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
Although primarily a respiratory illness, several studies have shown that COVID-19 causes elevation of liver enzymes and various gastrointestinal (GI) symptoms. The aim of this study was to undertake a systematic review and meta-analysis to determine whether the presence of gastrointestinal (GI) symptoms contributed toward COVID-19 severity, and identify the GI symptoms characteristic of severe COVID-19. We conducted a literature search of PubMed from December 1, 2019, to June 30, 2020, and identified all reports with GI symptoms reported. A meta-analysis comparing the severity of COVID-19 with the presence of liver enzyme elevation and GI symptoms was performed using RevMan version 5.4. Pooled data from 15,305 unique reverse transcriptase-polymerase chain reaction positive COVID-19 patients from 44 studies were analyzed. We found that the severe COVID-19 patients significantly had abdominal pain compared to the non-severe COVID-19 patients (OR = 2.70, 95% CI 1.17-6.27, Z = 2.32, p = 0.02, I2 = 0%) by analyzed 609 patients of 4 studies who reported both abdominal pain and COVID-19 severity. However, there was no significant difference in the incidence of diarrhea, nausea, or vomiting between the two groups. Thus, this systematic review and meta-analysis demonstrated that abdominal pain could be characteristic of severe COVID-19 infections. Compared with other viral infections that primarily infect the respiratory system, patients with COVID-19 have a slightly lower frequency of diarrheal symptoms with abdominal pain. However, to confirm this, further studies with COVID-19 patients across various countries and ethnicities are required.
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Affiliation(s)
- Yuki Hayashi
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Kohei Wagatsuma
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Masanori Nojima
- grid.26999.3d0000 0001 2151 536XCenter for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639 Japan
| | - Tsukasa Yamakawa
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Tadashi Ichimiya
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Yoshihiro Yokoyama
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Tomoe Kazama
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Daisuke Hirayama
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
| | - Hiroshi Nakase
- grid.263171.00000 0001 0691 0855Department of Gastroenterology and Hepatology, Sapporo Medical University of Medicine, S-1, W16, Chuoku, Sapporo, Hokkaido 060-8543 Japan
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