The features of the liver function tests in patients with COVID-19

It is known that SARS-CoV-2 can cause liver damage due to the tropism of the virus to cholangiocytes and hepatocytes, the development of a cytokine storm, organ ischemia, aggravated in existing chronic liver disease and increasing during hospitalization, which probably can be related to the current drug intake or comorbidity. Evaluation of the frequency of abnormal liver function tests prior to the drugs administration in the hospital would allow to exclude a possible toxic effect. Aim of the study is to establish the prevalence and features of liver function tests (LFT) abnormalities and factors associated with in hospitalized patients with COVID-19. Methods. 248 adult patients with confirmed COVID-19 were admitted to the infectious diseases hospital were selected for an observational cross-sectional study. Patients clinical and laboratory characteristics, the frequency of liver damage are presented, and the relationship with such risk factors as age, gender, comorbidity, prehospital drug intake, COVID-19 severity, oxygen saturation (SaO2), need for admission in intensive care unit is assessed. Results. 41.2% of patients with COVID-19 had LFT abnormalities at the time of admission. Liver damage, represented mainly by cholestatic (76.9%) and hepatocellular (27.4%) patterns, was mild in the most cases. Patients over 50 years were more than twice as likely to show liver damage compared to younger patients (OR 2.24, 95% CI 1.03-4.9). There were no differences in the frequency of liver damage in patients depending on gender (OR 1.3, 95% CI 0.74-2.27), comorbidity (OR 0.91, 95% CI 0.5-1.6), pregnancy (OR 0.85, 95% CI 0.45-1.7), taking drugs before hospitalization (OR 1.3, 95% CI 0.6-2.7), including based on the drugs hepatotoxicity. The prevalence of LFT abnormalities is almost twice as high in patients with severe COVID-19 (OR 1.9, 95% CI 1.1-3.4), not associated with the level of hypoxia (OR 0.7, 95% CI 0.1-7.8), and the need for intensive care (OR 2.8, 95% CI 0.3-32.4). Conclusion. As a result of the study, it was found that at the time of admission to the hospital, most patients with COVID-19 have mild LFT abnormalities, which increase with age and severity of COVID-19. A cohort study should be conducted to overcome the limitations of the current cross-sectional study and draw more definitive conclusions.Copyright © Eco-Vector, 2022.

Features of liver injury related to COVID-19

Objective — to study the character of liver function tests' changes in patients with COVID — 19, assess the rate of their onset, their clinical and laboratory manifestations and degree of COVID-19 effects on the liver function with the purpose to implement treatment and preventive measures. Materials and methods. The study included 120 medical records of inpatients with COVID-19, hospitalized in the departments of Clinical Hospital № 8, reprofiled to the infectious wards in the period between November 2020 and April 2021. The most patients were aged 60—69 years (41.7 %) and older than 70 years (25.0 %), the minor portion was younger than 40 years (1.7 %);women prevailed (65.0 %). Results. The increased hepatic transaminases levels were revealed in 52 % of patients, and total bilirubin (especially indirect) was raised in 15 %. Higher transaminases levels, severe course of coronaviral disease and unfavorable prognosis were more common in male patients. Frequency of SARS-CoV-2 — associated liver injury with minimal grade of activity of liver transaminases prevailed in women older than 60 years and men aged 50 to 69 years. COVID¬19-associated hepatitis with moderate activity was observed in women aged 50—69 years and men of working age (40—49 years) and elderly (> 70 years) patients, high degree of transaminases' activity against COVID¬19 background was registered only in men aged 40—59 years with moderate to severe COVID¬19 course. Lethal outcomes due to severe pulmonary injury were registered in 19 patients with severe COVID¬19 course;they also had liver dysfunction. From them, 11 had diagnosed liver steatosis before COVID-19. The most part of deсeased due to COVID-19 were older than 60 years and had a history of comorbidities (type 2 diabetes mellitus, hypertension, coronary heart disease, non-alcoholic fatty liver disease, liver cirrhosis and 2—3 grade obesity). Conclusions. Hepatic impairment occurred in 52 % of inpatients with COVID-19. All patients with moderate course of coronaviral disease demonstrated positive dynamics of transaminases and bilirubin levels and favorable prognosis after hospitalization due to COVID-19. Most of them hadn't had liver injuries before coronaviral disease and six patients had been diagnosed with liver diseases before COVID-19. No cases of fatal liver failure were registered. After in-hospital treatment, the transaminases levels were lower in patients, who hadn't had history of liver diseases before COVID-19 and received hepatoprotective drugs. Treatment with glutathione and ursodeoxycholic acid was confirmed as the most effective therapy in patients with coronaviral disease. © Сучасна гастроентерологія, 2022.

The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections.

BACKGROUND: liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. AIMS: we aimed to compare patterns of abnormal liver function tests in patients suffering from COVID-19 infection and seasonal respiratory viruses: respiratory syncytial virus (RSV) and influenza (A and B). METHODS: a retrospective cohort study was performed including 4140 patients admitted to a tertiary medical center between 2010-2020. Liver test abnormalities were classified as hepatocellular, cholestatic or mixed type. Clinical outcomes were defined as 30-day mortality and mechanical ventilation. RESULTS: liver function abnormalities were mild to moderate in most patients, and mainly cholestatic. Hepatocellular injury was far less frequent but had a strong association with adverse clinical outcome in RSV, COVID-19 and influenza (odds ratio 5.29 (CI 1.2-22), 3.45 (CI 1.7-7), 3.1 (CI 1.7-6), respectively) COVID-19 and influenza patients whose liver functions did not improve or alternatively worsened after 48 h had a significantly higher risk of death or ventilation. CONCLUSION: liver function test abnormalities are frequent among patients with COVID-19 and seasonal respiratory viruses, and are associated with poor clinical outcome. The late liver tests' peak had a twofold risk for adverse outcome. Though cholestatic injury was more common, hepatocellular injury had the greatest prognostic significance 48 h after admission. Our study may provide a viral specific auxiliary prognostic tool for clinicians facing patients with a respiratory virus.

Liver and Renal Injury with Remdesivir treatment in SARS-CoV-2 Patients

ABSTRACT Objective: To determine the effect of Remdesivir on liver enzymes and renal functions in SARS-CoV-2 patients. Methods: This prospective cohort study was conducted at Dr. Ruth KM Pfau, Civil Hospital Karachi between 1st December 2021 to 31st January, 2022. All patients of severe SARS-CoV-2 infection who received Inj. Remdesivir for five days as per protocol of SARS-CoV-2 management were included. Biodata of selected patients including age, gender, diabetic, hypertensive status was recorded. Patients Liver Function Tests and Serum Creatinine were performed on days 0, 3, 5, 7 and 14. Results: This study included 85 patients, out of which 55 (64.7%) were males and 30 (35.3%) were females. Out of 85 patients, Remdesivir was stopped in 3 (3.5%) patients. Among these three patients Remdesivir was stopped in one patient on day three because of decrease in CrCl to <30 ml/min. His CrCl improved after stopping Remdesivir. In the remaining two patients, Remdesivir was stopped due to increase in ALT to greater than 10 times from normal values on day three. Similarly, in these two patients the ALT improved after stopping Remdesivir. Conclusion: Only three patients developed adverse effects resulting in stopping of Remdesivir, however these were reversible on stopping the drug. Therefore, Remdesivir is a relatively safe drug and well tolerated in SARS-CoV-2 patients.

Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

Objective: Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. Methods: Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. Results: One hundred seventy-eight patients were males (58.7%). The age range was 17-95 years (mean +or- SD, 55.9 +or- 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035);whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. Conclusion: GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.

Study of liver function test in COVID-19 patients and its correlation with inflammatory markers from Hubballi, Karnataka

BACKGROUND: Since its reporting in December 2019, SARC-COV-2 (COVID -19) has infected more than 230 million people over the world by colonising the respiratory tract, however very little is known about its effect on liver and how the liver injury affects disease prognosis. This study was done to assess the hepatic profile in SARC-COV-2 infection along with inflammatory markers. METHODS: This is a single centred prospective observational study. 400 patients with real time polymerase chain reaction (PCR) confirmed COVID 19 infection admitted in KIMS, Hubballi were taken for study. Patients with decompensated liver disease were excluded from the study. Clinical examination and laboratory investigations including liver function test (LFT), renal function test (RFT), complete blood count (CBC), chest X-ray, D-dimer, ferritin, lactate dehydrogenase (LDH), C reactive protein (CRP) was done for all the patients. RESULTS: Out of the 400 covid-19 positive patients admitted, 286 (71.5%) had abnormal liver enzymes. Significantly raised liver enzymes were seen in males. Raised liver enzymes and inflammatory markers were associated with poor outcome of the disease. Significant reduced albumin was associated with poor outcome of the disease. Significantly raised aspartate transaminase (AST), alanine transaminase (ALT) levels were associated with increased severity of the disease. (P = 0.009 and 0.029 respectively). Significant positive relation was found between liver profile and inflammatory markers. CONCLUSIONS: Majority of patients admitted with SARS-CoV-2 had deranged liver profile. Higher proportion of abnormal liver enzymes were seen in males. Degree of liver injury increases with increasing severity of the disease. Even though abnormal liver enzymes were positively associated with elevated inflammatory markers and severity of the disease, more studies are needed to study implications of liver injury in prognosis of SARS-CoV-2 infection.

Liver and Renal Injury with Remdesivir Treatment in SARS-CoV-2 Patients.

Objective: To determine the effect of Remdesivir on liver enzymes and renal functions in SARS-CoV-2 patients. Methods: This prospective cohort study was conducted at Dr. Ruth KM Pfau, Civil Hospital Karachi between 1st December 2021 to 31st January, 2022. All patients of severe SARS-CoV-2 infection who received Inj. Remdesivir for five days as per protocol of SARS-CoV-2 management were included. Biodata of selected patients including age, gender, diabetic, hypertensive status was recorded. Patients Liver Function Tests and Serum Creatinine were performed on days 0, 3, 5, 7 and 14. Result: This study included 85 patients, out of which 55 (64.7%) were males and 30 (35.3%) were females. Out of 85 patients, Remdesivir was stopped in 3 (3.5%) patients. Among these three patients Remdesivir was stopped in one patient on day three because of decrease in CrCl to <30 ml/min. His CrCl improved after stopping Remdesivir. In the remaining two patients, Remdesivir was stopped due to increase in ALT to greater than 10 times from normal values on day three. Similarly, in these two patients the ALT improved after stopping Remdesivir. Conclusion: Only three patients developed adverse effects resulting in stopping of Remdesivir, however these were reversible on stopping the drug. Therefore, Remdesivir is a relatively safe drug and well tolerated in SARS-CoV-2 patients.

Liver Injury in Patients with COVID-19: A Retrospective Study.

Objectives: The objective of this study is to explore the incidence, characteristics, risk factors, and prognosis of liver injury in patients with COVID-19. Methods: We collected clinical data of 384 cases of COVID-19 and retrospectively analyzed the incidence, characteristics, and risk factors of liver injury of the patients. In addition, we followed the patient two months after discharge. Results: A total of 23.7% of the patients with COVID-19 had liver injury, with higher serum AST (P < 0.001), ALT (P < 0.001), ALP (P = 0.004), GGT (P < 0.001), total bilirubin (P = 0.002), indirect bilirubin (P = 0.025) and direct bilirubin (P < 0.001) than the control group. The median serum AST and ALT of COVID-19 patients with liver injury were mildly elevated. Risk factors of liver injury in COVID-19 patients were age (P = 0.001), history of liver diseases (P = 0.002), alcoholic abuse (P = 0.036), body mass index (P = 0.037), severity of COVID-19 (P < 0.001), C-reactive protein (P < 0.001), erythrocyte sedimentation rate (P < 0.001), Qing-Fei-Pai-Du-Tang treatment (P = 0.032), mechanical ventilation (P < 0.001), and ICU admission (P < 0.001). Most of the patients (92.3%) with liver injury were treated with hepatoprotective drugs. 95.6% of the patients returned to normal liver function tests at 2 months after discharge. Conclusions: Liver injury was commen in COVID-19 patients with risk factors, most of them have mild elevations in transaminases, and conservative treatment has a good short-term prognosis.

Remdesivir Use in Low Weight, Premature, and Renally Impaired Infants With SARS-CoV-2 Infection in Sheikh Khalifa Medical City, UAE: Case Series.

Remdesivir possesses in vitro inhibitory effect against severe acute respiratory syndrome coronavirus 2 and the Middle East respiratory syndrome. It works by inhibiting severe acute respiratory syndrome coronavirus 2 RNA-dependent RNA polymerase that is essential for viral replication. Remdesivir is approved by Food and Drug Administration for treating COVID-19 in hospitalized adult and pediatric patients aged 28 days and more and weighing 3 kg and more. This case series is describing two cases of low-weight, premature, and renally impaired infants where Remdesivir is used in Sheikh Khalifa Medical City pediatric intensive care unit. Upon completion of the Remdesivir course of treatment, there were no Remdesivir-related adverse outcomes noted in the two cases. Remdesivir was tolerated by both patients. However, clinical improvement and measurement of safety and efficacy will require further randomized, placebo-controlled trials.

Pattern of liver function test variations in COVID-19 infection & its clinical significance: A study from a dedicated COVID-19 tertiary care centre from India.

Background & objectives: Coronavirus disease 2019 (COVID-19) affects respiratory, gastrointestinal, cardiovascular and other systems disease. Studies describing liver involvement and liver function test (LFT) abnormalities are sparse from our population. This study was undertaken to estimate the LFT abnormalities in patients with COVID-19 in a tertiary care set up in India. Methods: In this retrospective study conducted at a tertiary care centre in Mumbai, India, all consecutive patients with proven COVID-19 by reverse transcriptase-PCR from March 23 to October 31, 2020 were enrolled. Of the 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Results: Overall 681 (46%) patient had deranged LFTs. 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). Advanced age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), lower oxygen saturation levels at admission (P<0.001), higher neutrophil-lymphocyte ratio (P<0.001), history of diabetes mellitus and cirrhosiss were associated with deranged LFTs. Acute liver injury was seen in 65 (4.3%) cases on admission and 57 (3.5%) cases during hospital stay. On multivariate analysis for predicting mortality, age >60 yr serum creatinine >2 mg%, PaO2/FiO2 ratio ≤200 and raised AST >50 IU/l (OR: 2.34, CI: 1.59-3.48, P<0.001) were found to be significant. Interpretation & conclusions: In COVID-19, LFT abnormalities were common, and derangement increased as severity progressed. The presence of deranged LFT worsens the clinical outcome and predicts in-hospital mortality.

The features of the liver function tests in patients with COVID-19

It is known that SARS-CoV-2 can cause liver damage due to the tropism of the virus to cholangiocytes and hepatocytes, the development of a cytokine storm, organ ischemia, aggravated in existing chronic liver disease and increasing during hospitalization, which probably can be related to the current drug intake or comorbidity. Evaluation of the frequency of abnormal liver function tests prior to the drugs administration in the hospital would allow to exclude a possible toxic effect. Aim of the study is to establish the prevalence and features of liver function tests (LFT) abnormalities and factors associated with in hospitalized patients with COVID-19. Methods. 248 adult patients with confirmed COVID-19 were admitted to the infectious diseases hospital were selected for an observational cross-sectional study. Patients clinical and laboratory characteristics, the frequency of liver damage are presented, and the relationship with such risk factors as age, gender, comorbidity, prehospital drug intake, COVID-19 severity, oxygen saturation (SaO2), need for admission in intensive care unit is assessed. Results. 41.2% of patients with COVID-19 had LFT abnormalities at the time of admission. Liver damage, represented mainly by cholestatic (76.9%) and hepatocellular (27.4%) patterns, was mild in the most cases. Patients over 50 years were more than twice as likely to show liver damage compared to younger patients (OR 2.24, 95% CI 1.03–4.9). There were no differences in the frequency of liver damage in patients depending on gender (OR 1.3, 95% CI 0.74–2.27), comorbidity (OR 0.91, 95% CI 0.5–1.6), pregnancy (OR 0.85, 95% CI 0.45–1.7), taking drugs before hospitalization (OR 1.3, 95% CI 0.6–2.7), including based on the drugs hepatotoxicity. The prevalence of LFT abnormalities is almost twice as high in patients with severe COVID-19 (OR 1.9, 95% CI 1.1–3.4), not associated with the level of hypoxia (OR 0.7, 95% CI 0.1–7.8), and the need for intensive care (OR 2.8, 95% CI 0.3–32.4). Conclusion. As a result of the study, it was found that at the time of admission to the hospital, most patients with COVID-19 have mild LFT abnormalities, which increase with age and severity of COVID-19. A cohort study should be conducted to overcome the limitations of the current cross-sectional study and draw more definitive conclusions. © Eco-Vector, 2022.

SARS-CoV-2 associated liver injury: a six-month follow-up analysis of liver function recovery.

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.

The effect of Favipiravir on liver enzyme among patients with mild to moderate COVID-19 infection: A prospective cohort study

Teratogenicity and hyperuricemia are considered as the major adverse effects of favipiravir, but less is known about other possible side effects which includes drug-induced liver damage and renal injury. In the current research, assessment of favipiravir-induced liver injury was performed by evaluating liver enzymes among patients with mild to moderate COVID-19 infection. A prospective cohort study was conducted on 66 patients diagnosed with mild to moderate COVID-19 infection who were treated with favipiravir for 5 days. During this period, a baseline assessment of liver enzymes (aspartate aminotransferase - AST, ala-nine transaminase - ALT and alkaline phosphatase - ALP) in addition to bilirubin before initiation of therapy and after 1 day of completion of therapy were carried out. The comparison of all measured parameters among all patients before and after receiving the treatment showed that non-significant differences were obtained in their levels. It was noticed that COVID-19 patients demonstrated high AST levels in which only 16 patients out of the all-subjected cases (66 patients) had AST levels of less than 45 U/L whereas the major-ity of patients showed normal ALT, ALP, and bilirubin levels. It was concluded that 5 days administration of favipiravir in mild to moderate COVID-19 patients who had no previous liver diseases did not affect the liver enzymes significantly and only transient elevations were occurred. Copyright © 2022.

Abnormal liver function tests in patients with COVID-19

Aim: To evaluate features of changes of liver function tests (LFTs) in COVID-19. Methods: We included 50 patients with confirmed COVID-19 and abnormal LFTs. The average age was 55 [46;66]. 45 patients (90%) were with COVID-19 associated pneumonia. Lung damage involvement according to lungs computed tomography ranged from 5% to 70%. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), quik's prothrombin and total protein were analyzed. Results: The debut of liver cytolysis was on average 8 [7;11] sick days of COVID-19. ALT levels elevated on average 2, 28 [1, 41;3, 27] times. An increase in AST correlated with changes in ALT (r=0, 86;p<0, 05), it was 2, 08 [1, 44;3] times. De Ritis ratio was 0, 73 [0, 49;1, 15]. Only 2 patients (4%) had hyperbilirubinemia. 60% patients had an increase in GGT - 1, 92 [0, 79;3, 05] times. 1, 79 times ALP was in one patient only. Many patients had not signs of hepatocellular insufficiency - only 5 patients (10%) had decrease in Quik's prothrombin;hypoproteinemia was observed in 7 patients (14%). The changes in LFTs were reversible, normalization of ALT was achieved in 67%, AST - in 76% of patients within a month. The levels of ALT (r=0, 52;p<0, 05) and AST (r=0, 48;p<0, 05) correlated with ferritin. Conclusions: Abnormal LFTs in COVID-19 were characterized by increase in ALT, AST, GGT and decreased de Ritis ratio. Total bilirubin, ALP, Quik's prothrombin were normal in most patients. The identified changes in the majority of cases returned to normal within the month. © 2022 Global Media Technologies. All Rights Reserved.

Hepatic manifestations of coronavirus disease 2019 infection: Clinical and laboratory perspective.

The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has become a global challenge of unprecedented nature since December 2019. Although most patients with COVID-19 exhibit mild clinical manifestations and upper respiratory tract involvement, in approximately 5%-10% of patients, the disease is severe and involves multiple organs, leading to multi-organ dysfunction and failure. The liver and gastrointestinal tract are also frequently involved in COVID-19. In the context of liver involvement in patients with COVID-19, many key aspects need to be addressed in both native and transplanted organs. This review focuses on the clinical presentations and laboratory abnormalities of liver function tests in patients with COVID-19 with no prior liver disease, patients with pre-existing liver diseases and liver transplant recipients. A brief overview of the history of COVID-19 and etiopathogenesis of the liver injury will also be described as a prelude to better understanding the above aspects.

Correlation of Biomarkers in Severe COVID-19 Patients Cross-sectional Study

BACKGROUND: In patients with coronavirus disease-19 (COVID-19), serious biomarkers (liver function tests and renal functions tests) (urea, creatinine, GOT, GPT, and LDH) are determined immediate to assess in prognosis of the severity of disease. AIM: The aim of the study was to determine correlation between biomarkers (liver function tests and renal functions tests) (urea, creatinine, GOT, GPT, and LDH) among COVID-19 patients. METHOD(S): A cross-sectional study, a total of 90 COVID-19 patients who attending in the Al-Hussein Medical City in Karbala, Iraq, participated in the present study within a month's time in late December 2021 to early January of 2022. All COVID-19 patients with positive SARS-COV-2 real-time RT-PCR results were reviewed. The patients were classifying according SPO2 into three groups (mild, moderate, and severe groups). The demographic data (sex, age, and SPO2 ) were collected while the biomarkers (liver function tests and renal functions tests) for all patients were done by bio-base instrument (ACCENT-200 ALAT KIT). RESULT(S): The white blood cell "WBC" and neutrophil in moderate and severe groups had substantially greater counts (p = 0.005) when compared with mild group while lymphocytes were considerably decreased in the severe and moderate groups (p = 0.005). In the moderate group, there was positive significant correlation among neutrophils and serum LDH (r = 0.451*, p = 0.014). There was no significant correlation between neutrophils and liver function tests. Furthermore, in the moderate patient group, a strong positively correlating notably among lymphocytes and serum LDH. Moreover, the concentration of serum GOT, GPT, and LDH (p = 0.05, p = 0.08, and p = 0.5) was higher levels in severe group when compared to moderate and mild groups, on the other hand, the renal function tests (urea and creatinine) were high serum levels in severe group than mild and moderate groups. CONCLUSION(S): The serum concentration of urea, creatinine, GOPT, GPT, and LDH was high in severe COVID-19 patients group, although there was no statistically significant in ALP, GPT, and urea among COVID-19 patient's groups (mild, moderate, and severe group). The present study found no significant correlation between biomarkers (liver function tests and renal function test). Copyright © 2022 Nawras A. Esmaeel, Aqeel Salman Abd Alsalam.

The effect of Favipiravir on liver enzyme among patients with mild to moderate COVID-19 infection: A prospective cohort study.

Teratogenicity and hyperuricemia are considered as the major adverse effects of favipiravir, but less is known about other possible side effects which includes drug-induced liver damage and renal injury. In the current research, assessment of favipiravir-induced liver injury was performed by evaluating liver enzymes among patients with mild to moderate COVID-19 infection. A prospective cohort study was conducted on 66 patients diagnosed with mild to moderate COVID-19 infection who were treated with favipiravir for 5 days. During this period, a baseline assessment of liver enzymes (aspartate aminotransferase - AST, alanine transaminase - ALT and alkaline phosphatase - ALP) in addition to bilirubin before initiation of therapy and after 1 day of completion of therapy were carried out. The comparison of all measured parameters among all patients before and after receiving the treatment showed that non-significant differences were obtained in their levels. It was noticed that COVID-19 patients demonstrated high AST levels in which only 16 patients out of the all-subjected cases (66 patients) had AST levels of less than 45 U/L whereas the majority of patients showed normal ALT, ALP, and bilirubin levels. It was concluded that 5 days administration of favipiravir in mild to moderate COVID-19 patients who had no previous liver diseases did not affect the liver enzymes significantly and only transient elevations were occurred.

Drug-induced liver injury after covid-19 mRNA vaccine: case report.

Case description: A 22-year-old female patient received the first dose of Pfizer-BioNTech vaccine (RNAm) against COVID-19; 6 days later, she presented abdominal pain located in the right hypochondrium and epigastrium, associated with emetic episodes. Re-consultation 21 days later due to the same symptoms; three days after the second dose of the vaccine was administered. Clinical findings: Pain on palpation in the right hypochondrium. Laboratories reported hepatocellular lesion and cholestasis, with negative amylase, hepatotropic virus and autoimmune hepatitis tests. Liver and biliary tract ultrasound and cholangioresonance were normal. Treatment and Results: Hyoscine and intravenous fluids as support therapy. She presented improvement in abdominal pain and progressive decrease of transaminases and bilirubin levels until normalization, and was discharged on the fifth day of hospitalization. A drug-associated hepatotoxicity (DILI) diagnosis was considered probable, in this case, secondary to vaccination against COVID-19. Clinical Relevance: The current SARS CoV-2 pandemic has spurred the development of new vaccines, the safety of which remains a concern. There is a likely causal relationship between vaccination and liver involvement in this clinical case, rather than simply a sporadic occurrence.

Descripción del caso: Paciente femenina de 22 años, quien recibió primera dosis de vacuna Pfizer-BioNTech (RNAm) contra COVID-19; presenta 6 días después, dolor abdominal localizado en hipocondrio derecho y epigastrio, asociado a episodios eméticos. Reconsulta a los 21 días por la misma sintomatología; tres días posteriores a la aplicación de la segunda dosis de la vacuna. Hallazgos clínicos: dolor a la palpación en hipocondrio derecho. Los laboratorios reportaron lesión hepatocelular y colestasis, con amilasa, estudios para virus hepatotrópos y hepatitis autoinmune negativos. La ecografía de hígado, vías biliares y colangioresonancia fueron normales. Tratamiento y Resultados: hioscina 20 mg vía oral cada 8 horas y líquidos endovenosos como terapia de soporte. Presentó mejoría del dolor abdominal y descenso progresivo de transaminasas y bilirrubinas, hasta su normalización y se dio egreso al quinto día de hospitalización. Se consideró probable diagnóstico de hepatotoxicidad asociada a medicamentos (DILI), en este caso, secundario a la vacunación contra COVID-19. Relevancia Clínica: La pandemia actual por el virus SARS CoV-2 ha impulsado el desarrollo de nuevas vacunas, cuya seguridad sigue siendo un motivo de preocupación. En este caso clínico, hay una probable relación causal entre la vacunación y el compromiso hepático, en lugar de una simple aparición esporádica.