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1.
Med J Armed Forces India ; 2022 May 13.
Article in English | MEDLINE | ID: covidwho-1946073

ABSTRACT

Background: COVID-19 is a multi system disorder and causes various abnormalities in liver function tests. The aim of this study was to estimate the prevalence of abnormal liver function tests in patients of COVID-19 and to describe the association of liver function tests with clinical features and disease severity in these patients. Methods: We retrospectively evaluated and analyzed the liver function tests of all real-time polymerase chain reaction (RT-PCR) positive COVID-19 patients admitted to a tertiary care hospital in Western Maharashtra. The Institutional Ethics Committee of our hospital approved the study. Results: Of the 533 patients included in our study, 50% had abnormal albumin levels while 40.1%, 43.5%, 9.3%, and 6.3% patients had deranged alanine transaminase (ALT) aspartate transaminase (AST), total protein and bilirubin levels, respectively. Hepatocellular injury was observed in 21 (3.9%) patients, and cholestatic liver injury was observed in seven (1.3%) patients. Abnormal liver function test (LFT) was significantly associated with disease severity but not with mortality. Conclusion: Abnormal LFT in patients of COVID-19 is associated with severe disease but not mortality. Liver injury is common in patients of COVID-19.

2.
J Viral Hepat ; 2022 Jun 16.
Article in English | MEDLINE | ID: covidwho-1896011

ABSTRACT

Abnormal liver function tests (A-LFTs) during admission for coronavirus disease-19 (COVID-19) are frequent, but its evolution after COVID-19 resolution remains unexplored. We evaluated factors related to A-LFTs during COVID-19 and assessed the liver outcome after patients' discharge. This is a observational study including: (1) retrospective analysis of variables related to A-LFTs during COVID-19; and (2) follow-up evaluation with blood test, transient elastography and liver biopsy in those with persistent A-LFTs. A-LFTs were defined according to CTCAEv4.0. Among 595 patients, 366 (61.5%) showed A-LFTs. The ratio of partial pressure of oxygen and inspired oxygen fraction (P/F) below 200, ferritin ≥1000 ng/mL, male gender and antibiotic and immunomodulatory treatments were related to A-LFTs. Follow-up evaluation was performed in 153 individuals. Persistent A-LFTs at follow-up was similar in patients with/without A-LFTs during admission (14.1% vs. 4.9%, p = 0.104). Fifteen (93%) and 58 (39%) patients with/without A-LFTs at follow-up showed metabolic fatty liver disease criteria (p < 0.001), which were histologically confirmed. In conclusion, A-LFTs during COVID-19 were related to infection severity. Abnormalities remitted at follow-up in >80% of patients, and no correlation between A-LFTs at admission and at follow-up was found. Most patients with A-LFTs at follow-up had non-invasive and histologically proven fatty liver disease.

3.
Asian Journal of Medical Sciences ; 13(5):13-17, 2022.
Article in English | Academic Search Complete | ID: covidwho-1847117

ABSTRACT

Background: At Ujjain district, in which the current study is based, has no prior studies examining the variations of liver function tests in the resident population. Aims and Objectives: The present study was undertaken to assess the variation in selective biochemical parameters and their correlation with age and gender in COVID-19 patients of Ujjain district: A retrospective study. Materials and Methods: 199 cases of confirmed COVID-19 patients from June 2020 to November 2020 were admitted to R. D. Gardi Medical College, Ujjain, Madhya Pradesh, were part of the study. Aspartate aminotransferases (AST), Alanine aminotransferases (ALT), Alkaline phosphatases (ALP), Total protein (TP), Total bilirubin (TB), C-reactive protein (CRP), Lactate dehydrogenase (LDH), sodium, and potassium parameters were recorded in the study participants. AST, ALT, TP, TB, CRP, and LDH were analyzed using vitros 5600 integrated system which is a dry chemistry autoanalyzer of ortho clinical diagnostics. Sodium and potassium analysis were analyzed on the vitros 5600 integrated system by using the direct potentiometry principle. The data were obtained from the patient information sheet from the MRD of our hospital. Results: The study results present the age-wise and genderwise correlation of the parameters. There was an increase in the AST, ALT, CRP, and LDH levels in both male and female participants. However, the difference is not statistically significant. ALP, TP, TB, and potassium levels are within the normal limits in male and female participants. Albumin levels were decreased in male and female participants. However, the difference was not statistically significant. Sodium levels were significantly decreased (P<0.05) in males when compared with females. Conclusion: The study assessed the variations in selective biochemical parameters and their correlation with inflammatory markers in COVID-19 patients of the Ujjain district. The study results help to understand the biochemical aspects of the Covid disease. Further, detailed studies are recommended to understand the role of the biochemical parameter which helps for early diagnosis to save the life of the covid patients in general. [ FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

4.
Iranian Journal of Medical Microbiology ; 16(3):259-266, 2022.
Article in English | CINAHL | ID: covidwho-1836483

ABSTRACT

Background and Aim: In December 2019, a new type of Coronavirus (SARS-CoV-2) pneumonia (COVID-19) was reported in Wuhan and quickly spread worldwide. This study was designed to investigate the clinical symptoms of the COVID-19 patients. Materials and Methods: In this retrospective study, we collected data of 132 COVID-19 dead patients. Demographic, epidemiological, and clinical data and laboratory test results were analyzed on days 1, 3, and 6 of admission. Results: Most cases were in the 66-75 age group, 64.39% of which were males. Three days after admission, 55.3% of patients died. The most frequent clinical manifestations were dry cough (70.45%) and fever (54.54%), which increased during hospitalization. Diabetes and blood pressure were reported as the most prevalent underlying diseases. Lymphopenia and an increase in leucocyte number were observed in most patients. ESR (92.5%) and LDH (94.64%) levels were above normal. Furthermore, 42.85% and 44.73% of patients had elevated ALT and AST levels, respectively. Conclusion: The results of this study revealed that males are more likely to be infected with SARS-CoV-19. Underlying diseases were common among patients and clinical and laboratory symptoms aggravated with a rise in hospitalization time.

5.
Ann Gastroenterol ; 35(3): 290-296, 2022.
Article in English | MEDLINE | ID: covidwho-1791580

ABSTRACT

Background: Abnormalities in aminotransferases are frequently observed in hospitalized COVID-19 patients, but their clinical impact is poorly characterized. Methods: A total of 1046 patients hospitalized to the non-intensive care unit ward with documented COVID-19 were included retrospectively. Demographic, clinical and laboratory characteristics on admission and during hospital stay, including the presence of liver injury (LI), defined as aspartate aminotransferase (AST) >200 IU/L, were recorded. Results: On admission, 363 (34.7%) and 269 (25.7%) patients had abnormal AST and ALT values (i.e., >40 IU/L), respectively, while during hospitalization 53 (5%) patients fulfilled the criteria for LI. In multivariate logistic regression analysis, AST (odds ratio [OR] 1.023, 95% confidence interval [CI] 1.016-1.029; P<0.001), and ferritin (OR 1.01, 95%CI 1.001-1.02; P<0.001) were the baseline factors independently associated with the development of LI during hospital stay. One hundred twenty-three (11.7%) patients died during hospitalization. The independent variables associated with mortality were: age (hazard ratio [HR] 1.043, 95%CI 1.029-1.056; P<0.001), ferritin (HR 1.1, 95%CI 1.05-1.2; P<0.001), platelets (HR 0.996, 95%CI 0.994-0.999; P=0.003), and administration of remdesivir (HR 0.50, 95%CI 0.30-0.85; P=0.009). The patients with abnormal baseline AST (i.e., >40 IU/L), compared to those with normal AST values, had worse outcomes (log rank test: 8.8, P=0.003). Conclusions: Elevated aminotransferases are commonly seen in COVID-19 patients. They possibly reflect disease severity and may be associated with in-hospital mortality.

6.
Biomark Med ; 16(6): 417-426, 2022 04.
Article in English | MEDLINE | ID: covidwho-1789312

ABSTRACT

Background: The aim of this study was to determine the magnitude of abnormal organ function tests and biomarkers in hospitalized patients with confirmed COVID-19 and to define the association among markers of organ failure, disease severity and its outcome in hospitalized COVID-19 patients in Ethiopia. Methods: A prospective cohort study was conducted among COVID-19 patients admitted to Millennium COVID-19 Treatment Center from December 2020 to June 2021. Results: The median age of the 440 study participants was 60.3 ± 1.3 years, and from these 71.3% of patients were male. Disease severity: p-value: 0.032; adjusted odds ratio (AOR) (95% CI): 4.4 (0.022-0.085); and the presence of any co-morbidity; p-value: 0.012; AOR (95% CI): 0.80 (0.47-0.83) was significantly associated with mortality. Aspartate transaminase, alanine transaminase and alkaline phosphatase parameter values of patients overall, were elevated - mainly among critical patients (56.9 ± 57.7, 58.5 ± 63 and 114.6 ± 60, respectively).


Subject(s)
COVID-19 , Biomarkers , COVID-19/drug therapy , Humans , Male , Middle Aged , Prospective Studies , SARS-CoV-2
7.
J Clin Exp Hepatol ; 12(2): 390-397, 2022.
Article in English | MEDLINE | ID: covidwho-1751085

ABSTRACT

AIM: The severe acute respiratory syndrome coronavirus 2 outbreak resulted in severe health impact with the loss of many lives across the world. Pulmonary parenchyma suffers the most from the brunt of the infection. However, evidence suggested a systemic involvement during the course of illness. Information on morphological changes of the liver is sparse in the literature. We aimed to evaluate the pathological findings in the liver by minimally invasive autopsies. METHODS: Postmortem core biopsies of the liver obtained from patients who succumbed to coronavirus disease 2019 disease were studied. Demographic findings, comorbidities, and relevant laboratory tests were collected. Detailed histopathological changes were assessed. RESULTS: Liver function tests were available in 40 cases, and it was deranged in 80% cases. A spectrum of histological changes was observed. Macrovesicular steatosis and nonspecific portal inflammation of mild degree were the common morphological changes. Features suggestive of vascular alteration were noted in more than half of the cases. These included increased portal vein branches, irregular luminal dilation, and herniation of portal veins into the periportal hepatocytes. In addition, we observed morphological changes attributed to terminal shock-related changes. CONCLUSION: The present study results highlight that liver parenchyma changes may be related to multiple pathogenic mechanisms. The presence of vascular alteration in portal tracts suggests derangement of hepatic vasculature related to systemic hypercoagulable state induced by the viral infection. It remains to be established if the histological changes are related to direct viral insult or to the systemic response caused by the viral attack.

8.
Cureus ; 14(1): e21302, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1705538

ABSTRACT

Introduction The pandemic of coronavirus disease 2019 (COVID-19) has caused over four million deaths, depleting resources and healthcare workers; therefore, in an attempt to stratify patients, the relationship between liver enzymes and clinical outcome was studied. This study aimed to assess the pattern and impact of liver enzymes on the clinical outcome of hospitalized patients with COVID-19 in Lebanon and look for possible confounding factors. Methodology This was a single-centered retrospective cohort study conducted between December 2020 and March 2021 on 230 patients diagnosed with COVID-19. Liver function tests (LFTs) and other laboratory values on admission and peak hospitalization were analyzed using SPSS. Results The prevalence of abnormal liver tests among the sample population with severe COVID-19 infection were as follows: aspartate aminotransferase (AST), 77%; alanine aminotransferase (ALT), 49%; alkaline phosphatase (ALP), 12%; and gamma-glutamyl transferase (GGT), 37%. A severe COVID-19 infection was more likely present in patients with abnormal levels of AST (p = 0.015), ALP (p = 0.03), and GGT (p = 0.022). ANOVA test revealed no significant relationship between AST levels at peak hospitalization and the treatments received by the patient. Conclusion Abnormal liver function tests of patients at admission may be an indicator of more severe disease. In the context of scarce resources created by the pandemic, it becomes essential to establish a reliable predictor for a severe outcome of COVID-19 infection and manage accordingly.

9.
Clin Res Hepatol Gastroenterol ; 46(5): 101894, 2022 05.
Article in English | MEDLINE | ID: covidwho-1700280

ABSTRACT

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) is a serious public health issue that became rapidly pandemic. Liver injury and comorbidities, including metabolic syndrome, are associated with severe forms of the disease. This study sought to investigate liver injury, clinical features, and risk factors in patients with mild, moderate, and severe COVID-19. METHODS: We retrospectively included all consecutive patients hospitalized with laboratory-confirmed COVID-19 between February, 22 and May 15, 2020 at the emergency rooms of a French tertiary hospital. Medical history, symptoms, biological and imaging data were collected. RESULTS: Among the 1381 hospitalizations for COVID-19, 719 patients underwent liver tests on admission and 496 (68.9%) patients displayed abnormal liver tests. Aspartate aminotransferase was most commonly abnormal in 57% of cases, followed by gamma-glutamyl transferase, alanine aminotransferase, albumin, alkaline phosphatase, and total bilirubin in 56.5%, 35.9%, 18.4%, 11.4%, and 5.8%. The presence of hepatocellular type more than 2xULN was associated with a higher risk of hospitalization and a worse course of severe disease (odd ratio [OR] 5.599; 95%CI: 1.27-23.86; p = 0.021; OR 3.404; 95% CI: 2.12-5.47; p < 0.001, respectively). A higher NAFLD fibrosis score was associated with a higher risk of hospitalization (OR 1.754; 95%CI: 1.27-2.43, p < 0.001). In multivariate analyses, patients with high fibrosis-4 index had a 3-fold greater risk of severe disease (p < 0.001). CONCLUSION: Abnormal liver tests are common in patients with COVID-19 and could predict the outcome. Patients with non-alcoholic fatty liver disease and liver fibrosis are at higher risk of progressing to severe COVID-19.


Subject(s)
COVID-19 , Non-alcoholic Fatty Liver Disease , COVID-19/complications , Disease Progression , Humans , Liver , Liver Cirrhosis , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/diagnosis , Retrospective Studies , SARS-CoV-2
10.
Egypt Liver J ; 12(1): 9, 2022.
Article in English | MEDLINE | ID: covidwho-1649788

ABSTRACT

BACKGROUND: The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been predominantly linked to respiratory distress syndrome, but hepatic injury has also been reported. The mechanism of liver injury is poorly understood.This review aimed to systematically review the current data through laboratory tests and liver tissue pathology to ascertain the correlation of liver involvement in SARS-CoV-2 infection patients. METHODS: The PubMed, Scopus, Science Direct, and Web of Science databases were searched systematically. We included peer-reviewed published papers available online as clinical cases, cohort studies, and retrospective studies, for both in vitro and in vivo human studies. Independent extraction of the data was done by two independent authors. RESULTS: A total of 15 articles were finally included in the systematic review process and meta-analysis after exclusion of studies that did not meet the eligibility criteria, summarized in a PRISMA flow diagram.The meta-analysis showed that patients with underlying abnormal liver function and/or histopathological finding had a statistically significant 8.08 times higher odds of severe COVID-19 outcomes when data from the individual studies were pooled (OR 8.08; 95% CI,3.43, 19.03; p = 0.00001). Five of these studies showed histopathological changes on autopsy from cases with severe COVID-19, and in four of these five studies, the histopathology was associated with a history of abnormal liver function after affection with COVID-19. SHORT CONCLUSION: The study observed that the severity of COVID-19 was associated with more patients with aberrant liver function tests.

11.
Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru ; 41(2):86-93, 2021.
Article in English | Scopus | ID: covidwho-1602241

ABSTRACT

INTRODUCTION: COVID-19 affects the liver, causing alteration in liver biochemistry tests such as aspartate transferase (AST), alanine transferase (ALT), alkaline phosphatase (ALP), total bilirubin and albumin. OBJECTIVE: To determine the prevalence of alteration in liver functions tests and associated factors for severity among Peruvian COVID-19 patients. MATERIALS AND METHODS: A descriptive, retrospective and cross-sectional study was performed in 4 public hospitals in Peru. Patients admitted to hospitalization wards and intensive care units with a diagnosis COVID-19 were enrolled. The evaluation of AST, ALT, ALP, totalbilirubin and albumin was performed. Associations with demographic and medical data were assessed. RESULTS: 1,100 patients were enrolled, of which 81.7% had altered liver function tests. Only 2.8% of the patients had cirrhosis and 2.1% hepatitis B/C virus. AST and ALT were altered at admission in 64.7% and 63.7%, of the patients respectively. Factors associated with liver injury were: being female OR=0.53 (95% CI: 0.39-0.73;p<0.01), dyslipidemia OR=1.72 (95% CI: 1.10-2.70;p=0.01), previous medication OR=1.56 (95% CI: 1.12 -2.16, p<0.01) and fever OR=1.43 (95% CI: 1.03-1.199, p=0.03). Disease severity was associated with levels of AST and ALT (p<0.01). Patients taking self-medication OR=1.56 (95% CI: 1.12-2.16;p<0.01) and paracetamol OR= 1.41 (95% CI:1.01-1.98;p=0.04) had higher risk of liver injury. Meanwhile, corticosteroids OR=0.55 (95% CI: 0.38-0.78;p<0.01) and enoxaparin OR=0.53 (95% CI: 0.35- 0.81;p<0.01) were protective factors. CONCLUSIONS: Peruvian patients with COVID-19 presented high prevalence of alteration in liver function tests, high levels of AST and ALT were related to disease severity.

12.
Dig Liver Dis ; 54(5): 565-571, 2022 05.
Article in English | MEDLINE | ID: covidwho-1587951

ABSTRACT

BACKGROUND: Prevalence and clinical impact of increased liver function tests in patients affected by Coronavirus disease 2019 (COVID-19) is controversial. AIMS: This observational study evaluates the prevalence of transaminases elevation in hospitalized patients affected by COVID-19 and investigates the presence of factors associated with hepatocellular injury and with mortality. METHODS: Data of 292 adult patients with confirmed COVID-19 admitted to the Ente Ospedaliero Cantonale (Switzerland) were retrospectively analyzed. RESULTS: Transaminases were increased in about one-third of patients on hospital admission and two-thirds of patients during the hospital stay. On hospital admission, transaminases were more commonly elevated in younger patients, who also reported elevated C reactive protein and a higher degree of respiratory failure. Independent factors associated with abnormal transaminases during hospitalization were drugs, in particular paracetamol (OR=2.67; 95% CI=1.38-5.18; p = 0.004) and remdesivir (OR=5.16; 95% CI=1.10-24.26; p = 0.04). Mortality was independently associated to age (OR = 1.09; 95% CI=1.05-1.13; p<0.001), admission to intensive care unit (OR=5.22; 95% CI=2.28-11.90; p<0.001) and alkaline phosphatase peak (OR=1.01; 95% CI=1.00- 1.01; p = 0.01). CONCLUSIONS: On hospital admission, factors associated with liver damage were linked to demographic and clinical characteristics (age, inflammation and hypoxia) while, during hospitalization, drug treatment was related to development and progression of hepatocellular damage. Mortality was associated with alkaline phosphate peak value.


Subject(s)
COVID-19 , Carcinoma, Hepatocellular , Liver Neoplasms , Adult , Hospital Mortality , Hospitalization , Humans , Retrospective Studies , Risk Factors , SARS-CoV-2 , Transaminases
13.
Infez Med ; 29(4): 550-556, 2021.
Article in English | MEDLINE | ID: covidwho-1579084

ABSTRACT

BACKGROUND: The spectrum of gastrointestinal (GI) injuries by the SARS-CoV-2 remain largely unknown. Ethnicity data is missing or unspecified. We analyzed GI involvement in American minority patients with COVID-19 infection. METHODS: Retrospective study of hospitalized patients with confirmed COVID-19 in March-April 2020. RESULTS: 183 patients included: 114 (62.30%) African-Americans, 58 (31.69%) Hispanics and 11 (6.01%) Asians. 73 females, 110 males; mean age 64.77, mean BMI 29.03 (50.82%); GI manifestations upon presentation: anorexia (29.51%), diarrhea (22.40%), nausea/vomiting (18.03%), abdominal pain (9.84%). No difference observed between three ethnical groups for GI symptoms and liver function tests. C Reactive Protein (CPR) (P=0.008), Lactate (P=0.03) and Prothrombin Time (PT) (P=0.03) were significantly elevated in patients without GI symptoms. No difference was observed for other laboratory tests. Patients with severe disease course/intubated had higher levels of Aspartate Transaminase (AST) (109.17 vs 53.97, P=0.018), Alanine Transaminase (ALT) (79.53 vs 40.03, P=0.02) and total bilirubin (0.82 vs 0.60, P=0.03) vs non-intubated patents as well as body temperature (101.38 vs 100.70, p=0.0006), CRP (24.06 v 15.96, P=0.019) and lactate (3.28 vs 2.13, P=0.009). There was no correlation between severity of the disease and GI symptoms, PT, platelets and albumin. However, CRP and lactate were markedly elevated in deceased vs survived patients: (27.09 vs 16.39, P=0.008) and (3.33 vs 2.10 P=0.005) respectively. CONCLUSIONS: ~ 50% of patients presented with GI symptoms and they had lower levels of inflammatory markers, better liver synthetic function, indicating less overall inflammatory response and direct viral damage. Our results suggest that SARS-CoV-2 virus targets GI tract along with the lung tissue, and the degree of hepatocyte damage correlated well with more severe disease.

14.
Revista Colombiana de Gastroenterologia ; 36(3):302-312, 2021.
Article in Spanish | Scopus | ID: covidwho-1573067

ABSTRACT

Introduction: In March 2020, the World Health Organization declared COVID-19, a disease caused by SARS-CoV-2 infection, a global pandemic. This virus uses human angiotensin-converting enzyme 2 (ACE2) as its receptor for entry. ACE2 is found in pulmonary, cardiac, gastrointestinal, hepatic, renal and vascular tissues, thus posing a potential risk for multisystemic involvement. The excessive release of inflammatory cytokines in COVID-19, as well as the use of medicines with hepatotoxic potential for the treatment of its symptoms, can damage the liver. Objective: To analyze the relationship between changes in liver function tests caused by SARS-CoV-2 infection and their impact on patient prognosis. Methodology: This is a systematic review of stu-dies selected from the PMC, LILACS and SciELO databases. After applying the inclusion and exclusion criteria, 30 articles were included in the final sample for analysis. Results: Elevated AST (aspartate aminotransferase) enzyme levels were reported most frequently and were found in 4 695 cases, while ALT (alanine aminotrans-ferase) elevation was described in 3 226 cases. It was observed that patients with digestive symptoms were more likely to present hepatocellular damage and, consequently, enzymatic alterations. Furthermore, 28.9 % of individuals with impaired liver function died, compared to 9 % of patients with normal function. Conclusion: It is evident that there is a relationship between liver involvement in COVID-19 and mortality. However, there is still a limitation in the number and, more importantly, the homogeneity of the research that performed this assessment. © 2021 Asociación Colombiana de Gastroenterología.

15.
Tomography ; 7(4): 972-979, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1572631

ABSTRACT

We sought to determine relative utilization of abdominal imaging modalities in coronavirus disease 2019 (COVID-19) patients at a single institution during the first surge and evaluate whether abdominal magnetic resonance imaging (MRI) changed diagnosis and management. 1107 COVID-19 patients who had abdominal imaging were analyzed for modality and imaging setting. Patients who underwent abdominal MRI were reviewed to determine impact on management. Of 2259 examinations, 80% were inpatient, 14% were emergency, and 6% were outpatient consisting of 55% radiograph (XR), 31% computed tomography (CT), 13% ultrasound (US), and 0.6% MRI. Among 1107 patients, abdominal MRI was performed in 12 within 100 days of positive SARS-CoV-2 PCR. Indications were unrelated to COVID-19 in 75% while MRI was performed for workup of acute liver dysfunction in 25%. In 1 of 12 patients, MRI resulted in change to management unrelated to COVID-19 diagnosis. During the first surge of COVID-19 at one institution, the most common abdominal imaging examinations were radiographs and CT followed by ultrasound with the majority being performed as inpatients. Future COVID-19 surges may place disproportionate demands on inpatient abdominal radiography and CT resources. Abdominal MRI was rarely performed and did not lead to change in diagnosis or management related to COVID-19 but needs higher patient numbers for accurate assessment of utility.


Subject(s)
COVID-19 , COVID-19 Testing , Humans , Magnetic Resonance Imaging , SARS-CoV-2 , Ultrasonography
16.
J Clin Exp Hepatol ; 11(6): 732-738, 2021.
Article in English | MEDLINE | ID: covidwho-1525841

ABSTRACT

The COVID-19 pandemic has resulted in widespread use of complementary and alternative medicines. Tinospora cordifolia is a widely grown shrub which has been commonly used in India's traditional system of Ayurveda for its immune booster properties and has been extensively used as prophylaxis against COVID-19. Six patients (4 women, 2 men) with a median (IQR) age of 55 years (45-56) and with an history of Tinospora cordifolia consumption presented with symptoms of acute hepatitis during the study period of 4 months in the COVID-19 pandemic. The median (IQR) duration of Tinospora cordifolia consumption was 90 days (21-210). The median (IQR) peak bilirubin and AST were 17.5 mg/dl (12.2-24.9) and 1350 IU/ml (1099-1773), respectively. The patients had either a definite (n = 4) or probable (n = 2) revised autoimmune hepatitis score with an autoimmune pattern of drug-induced liver injury on biopsy. Four of these patients (all women) had underlying silent chronic liver disease of possible autoimmune etiology associated with other autoimmune diseases - hypothyroidism and type 2 diabetes mellitus. One of the three patients treated with steroids decompensated on steroid tapering. The other five patients had resolution of symptoms, liver profile, and autoimmune serological markers on drug withdrawal/continuing steroid treatment. The median (IQR) time to resolution from discontinuing the herb was 86.5 days (53-111). Tinospora cordifolia consumption seems to induce an autoimmune-like hepatitis or unmask an underlying autoimmune chronic liver disease, which may support its immune stimulant mechanism. However, the same mechanism can cause significant liver toxicity, and we recommend that caution be exercised in the use of this herb, especially in those predisposed to autoimmune disorders. Besides, in patients presenting with acute hepatitis, even in the presence of autoimmune markers, a detailed complementary and alternative medicine history needs to be elicited.

17.
J Clin Exp Hepatol ; 11(6): 713-719, 2021.
Article in English | MEDLINE | ID: covidwho-1525839

ABSTRACT

Coronavirus disease 2019 (COVID-19) is associated with a significant morbidity and mortality in patients with cirrhosis. There is a significantly higher morbidity and mortality due to COVID-19 in patients with decompensated cirrhosis as compared to compensated cirrhosis, and in patients with cirrhosis as compared to noncirrhotic chronic liver disease. The fear of COVID-19 before or after liver transplantation has lead to a significant reduction in liver transplantation numbers, and patients with decompensated cirrhosis remain at risk of wait list mortality. The studies in liver transplantation recipients show that risk of mortality due to COVID-19 is generally driven by higher age and comorbidities. The current review discusses available literature regarding outcomes of COVID-19 in patients with cirrhosis and outcomes in liver transplant recipients.

18.
Clin Exp Hepatol ; 7(3): 297-304, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1472468

ABSTRACT

AIM OF THE STUDY: We aimed to study liver function test abnormalities in our COVID-19 patients and factors affecting them and to evaluate whether liver function test abnormalities are related to the severity of COVID-19. MATERIAL AND METHODS: Our retrospective study included 118 patients who were SARS-CoV-2 positive. Their median age was 40 years. Fifty percent were male. Clinical and biochemical data were collected from patient records during the period from the start of June 2020 to the end of July 2020. Liver function test abnormalities included: alanine aminotransferase (ALT) > 40 U/l, aspartate aminotransferase (AST) > 40 U/l, serum albumin < 3.5 mg/dl, total bilirubin > 1.2 mg/dl, and international normalized ratio (INR) > 1.2. RESULTS: Forty-four percent of COVID-19 patients had liver function test (LFT) abnormalities. In patients with severe SARS-CoV-2, AST, total bilirubin and INR levels were significantly higher than in patients with the non-severe disease. Levels of hemoglobin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum ferritin, D-dimer, and serum glucose were significantly higher in SARS-CoV-2 patients with LFT abnormalities than those with normal liver function. CONCLUSIONS: LFT abnormalities are very common in SARS-CoV2 positive patients, especially those with the severe form. Levels of ESR, CRP, serum ferritin, and D-dimer were higher in COVID-19 patients with LFT abnormalities than those with normal LFT. High serum ferritin levels might be potential risk factors for LFT abnormalities.

19.
Liver Int ; 41(11): 2560-2577, 2021 11.
Article in English | MEDLINE | ID: covidwho-1434779

ABSTRACT

Metabolic diseases are associated with a higher risk of a severer coronavirus disease 2019 (COVID-19) course, since fatty liver is commonly associated with metabolic disorders, fatty liver itself is considered as a major contributor to low-grade inflammation in obesity and diabetes. Recently a comprehensive term, metabolic (dysfunction) associated fatty liver disease (MAFLD), has been proposed. The hepatic inflammatory status observed in MAFLD patients is amplified in presence of severe acute respiratory syndrome coronavirus 2 infection. Intestinal dysbiosis is a powerful activator of inflammatory mediator production of liver macrophages. The intestinal microbiome plays a key role in MAFLD progression, which results in non-alcoholic steatohepatitis and liver fibrosis. Therefore, patients with metabolic disorders and COVID-19 can have a worse outcome of COVID-19. This literature review attempts to disentangle the mechanistic link of MAFLD from COVID-19 complexity and to improve knowledge on its pathophysiology.


Subject(s)
COVID-19 , Metabolic Diseases , Non-alcoholic Fatty Liver Disease , Humans , Immunity , SARS-CoV-2
20.
Diagnostics (Basel) ; 11(9)2021 Sep 17.
Article in English | MEDLINE | ID: covidwho-1430804

ABSTRACT

A high prevalence of hepatic pathology (in 17 of 19 cases) was reported in post-mortem (PM) examinations of COVID-19 patients, undertaken between March 2020 and February 2021 by a single autopsy pathologist in two English Coronial jurisdictions. The patients in our cohort demonstrated high levels of recognised COVID-19 risk factors, including hypertension (8/16, 50%), type 2 diabetes mellitus (8/16, 50%) and evidence of arteriopathy 6/16 (38%). Hepatic abnormalities included steatosis (12/19; 63%), moderate to severe venous congestion (5/19; 26%) and cirrhosis (4/19; 21%). A subsequent literature review indicated a significantly increased prevalence of steatosis (49%), venous congestion (34%) and cirrhosis (9.3%) in COVID-19 PM cases, compared with a pre-pandemic PM cohort (33%, 16%, and 2.6%, respectively), likely reflecting an increased mortality risk in SARS-CoV-2 infection for patients with pre-existing liver disease. To corroborate this observation, we retrospectively analysed the admission liver function test (LFT) results of 276 consecutive, anonymised COVID-19 hospital patients in our centre, for whom outcome data were available. Of these patients, 236 (85.5%) had significantly reduced albumin levels at the time of admission to hospital, which was likely indicative of pre-existing chronic liver or renal disease. There was a strong correlation between patient outcome (length of hospital admission or death) and abnormal albumin at the time of hospital admission (p = 0.000012). We discuss potential mechanisms by which our observations of hepatic dysfunction are linked to a risk of COVID-19 mortality, speculating on the importance of recently identified anti-interferon antibodies.

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