ABSTRACT
Although children with COVID-19 make up a small proportion of patients and have milder symptoms than adults, liver damage is a well-documented side effect of COVID-19 infection. Most liver damage caused by COVID-19 is modest. In this report, a case of a 6-year-old child who was hospitalised to a paediatric intensive care unit (PICU) with COVID-19 manifested as acute liver failure is de-scribed. © 2022 Nawghare et al.
ABSTRACT
Background: COVID-19 has become a major health emergency worldwide. The characteristics and outcome of COVID-19 in patients with CLD remain unclear. Aims: CLD represents a major disease burden globally. Given this high burden, how different underlying liver conditions influence the outcome in patients with COVID-19 needs to be meticulously evaluated. So, we conducted this study to see the outcome of the patient and to look for predictors of severity and mortality in patients with CLD with COVID-19 infection. Methods: This was a single-center, observational study conducted at a tertiary care center. We recruit 50 consecutive patients of COVID-19 with CLD. Matched comparison group patients with CLD without COVID-19 collected retrospectively from historical data with 1:2 ratio using stratified sampling. Results: Mean age of the study population was 51 ± 12 years with the majority were male. Most patients (21/50) were presented with predominantly respiratory symptoms of which fever was the most common symptom (85%). Jaundice (70%) was the most common GI symptom. Twenty patients had ACLF. All patients with ACLF were having severe COVID-19 infection and succumb to multi-organ failure. Mortality was double in a patient with CLD with COVID-19 infection than historical control. Diabetes was the only comorbidity which was associated with severe infection. Patients in the severely ill subgroup had higher mortality, high creatinine, and raised D-dimer but lower lymphocytes count. (P <0.05). Multivariate logistic regression for severity showed that only D-dimer reached significance. CURB-65 score on admission and Child Turcotte Pugh score on admission correlates with mortality (P <0.05). Serum D-dimer level and reduced lymphocyte counts were associated with mortality on multivariate analysis. Conclusion: The presence of CLD in covid-19 patients was associated with a poor outcome. Raised D-dimer on admission can predict severe infection. Child-Pugh and CRUB65 scores were highly associated with non-survival among these patients.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a respiratory system trophic disease. Liver involvement is emerging from recent data. Studies describing liver function test (LFT) abnormalities are sparse from our population. Aims: We studied LFT abnormalities in different categories of COVID-19 and its significance in relation to primary outcomes of in-hospital mortality. Methods: It was a retrospective study from a single center of a metropolitan city. All consecutive patients with proven COVID19 by reverse transcriptase-polymerase chain reaction from 23rd March 2020 till 31stOctober 2020 were enrolled. Of 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Results: Deranged LFTs were present in 681/1474 (46%) patients. Hepatocellular type of injury was most common (93%). Patients with deranged LFTs had more probability of developing severe disease (P<0.001) and mortality (P<0.001). Higher mean age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), chronic kidney disease (P<0.02) cirrhosis (P<0.001), lower oxygen saturation (SpO2) levels at admission (P<0.001), higher serum creatinine (P value<0.001), D-dimer levels (P<0.001) and positive radiological findings on Chest X-ray (P<0.001) were associated with deranged LFTs. Acute liver injury was seen in 65 (4.33%) cases on admission and 57(3.5%) cases during hospital stay. On admission, raised serum bilirubin, aspartate and alanine transaminases, international normalized ratio and low serum albumin were found to be significant. However, on multivariate analysis for predicting mortality, age, serum creatinine, and PaO2/FiO2 ratio only were found to be significant (P<0.001). Conclusion: In COVID-19, LFT abnormalities are common and multifactorial. As severity of disease progresses, derangement in LFT’s increase. However, it is not associated with in- hospital mortality.