Determination of liver function tests and liver ultrasonographic findings in patients with leptospirosis in a Tertiary Hospital

Introduction@#ILeptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention. @*Objective@#To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratoryconfirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil’s syndrome, and mortality) was also investigated. @*Methods@#This retrospective cross-sectional study reviewed all available cases of adult patients with laboratoryconfirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil’s syndrome) was done via Students’ t-test for continuous variables, and calculation of the Odds Ratio for categorical variables.@*Results@#Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum aminotransferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome.@*Conclusion@#To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality.

Predictors and outcomes of hospitalized COVID-19 patients with liver injury

Objective@#To determine incidence, predictors, and impact of liver injury among hospitalized COVID-19 patients@*Methods@#This is a retrospective cohort study of hospitalized COVID-19 patients at the University of the PhilippinesPhilippine General Hospital. Liver injury (LI) was defined as ALT elevation above institutional cut-off (>50 u/L) and was classified as mild (>1x to 3x ULN), moderate (>3x to 5x ULN), or severe (>5x ULN). Significant liver injury (SLI) was defined as moderate to severe LI. Univariate analysis of SLI predictors was performed. The impact of LI on clinical outcomes was determined and adjusted for known predictors -age, sex, and comorbidities.@*Results@#Of the 1,131 patients, 565 (50.04%) developed LI. SLI was associated with male sex, alcohol use, chronic liver disease, increasing COVID-19 severity, high bilirubin, AST, LDH, CRP, and low lymphocyte count and albumin. An increasing degree of LI correlated with ICU admission. Only severe LI was associated with the risk of invasive ventilation (OR: 3.54, p=0.01) and mortality (OR: 2.76, p=0.01). Severe LI, male sex, cardiovascular disease, and malignancy were associated with longer hospital stay among survivors.@*Conclusion@#The liver injury occurred commonly among COVID-19 patients and was associated with important clinicodemographic characteristics. Severe liver injury increases the risk of adverse outcomes among hospitalized patients.

The effectiveness of Pentoxifylline in NAFLD: A meta-analysis

Introduction@#Rising prevalence of non-alcoholic fatty liver disease (NAFLD) suggests its correlation with liver failure worldwide. To date, there is no proven pharmacologic therapy for NAFLD. Pentoxifylline (PTX) with its anti-tumor necrosis factor properties has shown improvement of histological parameters, reductions in transaminase levels and serum cytokines among patients with NAFLD. The main objective is to determine the effectiveness of PTX in the reduction of progression of NAFLD in terms of reducing levels of aspartate transaminase (AST) and alanine transaminase (ALT), improving liver histology parameters and in decreasing TNF-α, IL-6 and IL-8.@*Methods@#A comprehensive literature search showed seven randomized controlled trials (N=222) comparing PTX (1,200mg/day) with placebo. Two reviewers independently selected studies, assessed quality, and extracted and pooled outcomes including AST levels, ALT levels, serum cytokines and liver histology. All selected studies were found to be of low risk of bias based on Cochrane risk of bias assessment tool for randomized trials. Statistical analysis and forrest plot generation were done using the Review Manager Software 5.3.@*Results@#Pooled results showed that PTX significantly reduced the ALT (WMD= -20.08; 95% CI: -40.20, 0.05; p=0.05) and AST (WMD= -11.38; 95% CI: -20.47, -2.29; p=0.01) in NAFLD patients. PTX significantly improved lobular inflammation (WMD= -0.45; 95% CI: -0.89, -0.01; p=0.04), fibrosis (WMD= -0.39; 95% CI: 0.83, 0.05; p=0.08) and NAS score (WMD= -0.52; 95% CI: -1.06, 0.0; p=0.051). Among serum cytokines, greater reduction was demonstrated in TNF-α (WMD= -20.20; 95% CI: -50.46, 10.41; p=0.20).@*Conclusion@#Pentoxifylline (PTX) decreases the aminotransferase activities, improves the liver histology and TNF-α of NAFLD patients. Demonstrating effects on serum TNF-α which plays a key role in progression to hepatic steatosis, it may be used as an adjunct to diet and lifestyle modifications in the treatment of NAFLD.