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1.
Zhonghua Gan Zang Bing Za Zhi ; 30(5): 513-519, 2022 May 20.
Article in Chinese | MEDLINE | ID: covidwho-1911772

ABSTRACT

Objective: To investigate the clinical features and influencing factors of liver function injury in patients with 2019-nCoV/SARS-CoV-2 Omicron mutant strains. Methods: 1 183 confirmed imported cases of SARS-CoV-2 who were admitted at Shanghai Public Health Clinical Center (affiliated to Fudan University) from July 1, 2021 to January 15, 2022 were collected. Clinical data, viral genotyping and laboratory test results were collected to retrospectively analyze the basic condition and clinical characteristics of liver function injury. Statistical analysis was performed using t-test or Wilcoxon rank-sum test, χ2 test or Fisher's exact test, Pearson correlation test and logistic regression analysis. Results: 125 (10.6%) cases had raised baseline ALT level and 60 (5.1%) cases had abnormal baseline AST level. Among them, 33 cases (2.8%) had received hepatoprotective drugs. Liver function injury was generally mild in SARS-CoV-2 infection and minimal in Omicron mutant strains. Leukocyte count was increased in patients with raised alanine aminotransferase (ALT) [(6.96±1.78)×109/L vs. (6.41±1.96)×109/L, P=0.005 2], CT scan showed the proportion of liver hypodensity was significantly increased (2.4% vs. 0.3%, P=0.018 0). High-sensitivity C-reactive protein [(7.83±22.36) mg/L vs. (2.68±6.21) mg/L, P=0.007 8] and D-dimer [(0.34±0.39) µg/ml vs. (0.31±0.75) µg/ml, P=0.047 5] levels were higher in patients with raised AST than normal group. 26 cases had normal liver function at hospital admission; however, abnormal liver function was occurred during the course of the disease. Another 8 patients had abnormal liver function at hospital admission, and reduced liver function further during the course of treatment. Recovery time and length of hospital stay was significantly affected in patients with worsened liver function. Baseline body mass index value [odds ratio (OR)]=1.80, P=0.047), non-Omicron strains (OR=12.63, P=0.046), D-dimer (OR=2.36, P=0.047) and interleukin-6 levels (OR=1.03, P=0.009), and those who used glucocorticoids and/or ulinastatin after hospital admission (OR=6.89, P=0.034) had a higher risk of worsening liver function. Conclusions: Liver dysfunction could be observed among COVID-19 patients. Patients infected with omicron variant generally showed mild liver injury. Dynamic monitoring of liver function is necessary, especially among those with baseline elevated IL-6, D-Dimer level and use of antiinflammation medication during treatment.


Subject(s)
COVID-19 , Liver Diseases , Aspartate Aminotransferases , China/epidemiology , Humans , Interleukin-6 , Retrospective Studies , SARS-CoV-2
2.
Zhonghua Gan Zang Bing Za Zhi ; 30(5): 527-533, 2022 May 20.
Article in Chinese | MEDLINE | ID: covidwho-1911771

ABSTRACT

Objective: To retrospectively analyze the characteristics and influencing factors of liver function changes in 111 elderly patients with COVID-19 pneumonia. Methods: 111 elderly patients with COVID-19 admitted to the Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 5 to March 3, 2020 were enrolled. According to the severity of disease and liver function condition, they were divided into severe group (n=40), normal group (n=71), abnormal liver function group (n=86) and normal liver function group (n=25). The indexes related to liver function changes [total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and γ-glutamyl transferase (GGT)] and related influencing factors were analyzed. Results: Among 111 cases, 86 (77.5%) had abnormal liver function of varying degrees, and 28 (25.2%) had liver injury. The abnormal rates of TBil, AST, ALP and GGT were significantly higher in the severe group than normal group (P<0.05). There were no significant differences in age, ribavirin, glucocorticoid and the application of lopinavir-ritonavir tablets between the abnormal liver function and the normal group (P>0.05). The proportion of male was significantly higher in the abnormal liver function than normal liver function group (P<0.05). Conclusion: Elderly COVID-19 patients have a higher proportion of abnormal liver function, and patients in the severe group are more likely to have higher level of TB, AST, ALP and GGT. The abnormal liver function may be related to the direct viral infection of the liver and the inflammatory immune response of the body after infection in elderly patients.


Subject(s)
COVID-19 , Liver Diseases , Aged , Alkaline Phosphatase , Aspartate Aminotransferases , Bilirubin , Humans , Liver Function Tests , Male , Retrospective Studies , gamma-Glutamyltransferase
3.
Medicina (Kaunas) ; 58(7)2022 Jun 23.
Article in English | MEDLINE | ID: covidwho-1911467

ABSTRACT

BACKGROUND: This study aimed to calculate the frequency of elevated liver enzymes in hospitalized patients with coronavirus disease 2019 (COVID-19) infection and to test if liver enzyme biochemistry levels on admission could predict the computed tomography (CT) scan severity score of bilateral interstitial pneumonia. METHODS: This single-center study comprised of 323 patients including their demographic data, laboratory analyses, and radiological findings. All the information was taken from electronic health records, followed by statistical analysis. RESULTS: Out of 323 patients, 115 of them (35.60%) had aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) over 40 U/L on admission. AST was the best predictor of CT scan severity score of bilateral interstitial pneumonia (R2 = 0.313, Adjusted R2 = 0.299). CT scan severity score in the peak of the infection could be predicted with the value of AST, neutrophils, platelets, and monocytes count (R2 = 0.535, Adjusted R2 = 0.495). CONCLUSION: AST, neutrophils, platelets, and monocytes count on admission can account for almost half (49.5%) of the variability in CT scan severity score at peak of the disease, predicting the extensiveness of interstitial pneumonia related to COVID-19 infection. Liver enzymes should be closely monitored in order to stratify COVID-19 patients with a higher risk of developing severe forms of the disease and to plan the beforehand step-up treatment.


Subject(s)
COVID-19 , Pneumonia , Alanine Transaminase , Aspartate Aminotransferases , Humans , Retrospective Studies , SARS-CoV-2
4.
Front Cell Infect Microbiol ; 12: 725642, 2022.
Article in English | MEDLINE | ID: covidwho-1902921

ABSTRACT

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS), a widely prevalent infectious disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV) that carries with it a high mortality rate, has emerged to be a public health concern. This study aimed to investigate the epidemiological and clinical characteristics of patients infected with SFTSV, seeking novel prognostic risk factors for SFTS. METHODS: In this retrospective and cross-sectional study, confirmed SFTS patients from the First Affiliated Hospital of Anhui Medical University were enrolled from September 1, 2019, to December 12, 2020. Cases were analyzed for epidemiological, demographic, clinical, and laboratory data. Logistic regression models were used to assess the association between predictors and outcome variables. A generalized additive mixed model (GAMM) was conducted to analyze the trending shift of aspartate aminotransferase/alanine transaminase-ratio (AST/ALT-ratio) and platelet (PLT) in SFTS patients treated with ribavirin. p values ≤ 0.05 were considered statistically significant. RESULTS: Clinical and laboratory results of 107 hospitalized patients with SFTSV infection were retrospectively described. The mean age at onset of disease was 60.38 ± 11.29 years old and the ratio between male and female was 1:1.2. Fever and thrombocytopenia are hallmark features of SFTS. Furthermore, multiple cases also experienced neurological complications, gastrointestinal/skeletal muscle symptoms together with other non-specific clinical manifestations; laboratory dataset outcomes reported dysregulated levels for routine blood biomarkers, coagulation function, and biochemistry. Overall, 107 patients were segregated into two groups according to patient condition at the clinical endpoint (survivors/non-survivors). SFTS survivors had a higher level of PLT- counts, total protein (TP), and estimated glomerular filtration rate (eGFR), while levels of activated partial thromboplastin time (APTT), thrombin time (TT), D-dimer (D-D), fibrinogen degradation products (FDP), ALT, AST, AST/ALT-ratio, creatinine (Cr), creatine phosphokinase (CK) and procalcitonin (PCT) was higher in non-survivors. Results from univariate Cox regression revealed that elevated levels of FDP, TT, AST/ALT-ratio, PCT, as well as decreased eGFR level and presence of central nervous system symptoms (CNS), were significant predictors for SFTS prognostic, results from multivariate logistic regression analysis in three adjusted models showed AST/ALT-ratio and PCT were independent risk factors for the prognosis of SFTS patients. Kaplan-Meier survival analysis showed that SFTS patients with AST/ALT-ratio >2.683 were associated with a shorter futime (means survival time), therefore indicating an unfavorable prognosis. Treatment with ribavirin could increase PLT count while decreasing AST/ALT-ratio within SFTS patients. CONCLUSION: SFTS is an emerging infectious disease, possibly leading to multiple-organ injury; AST/ALT-ratio was an independent risk factor for the prognosis of SFTS patients. Further investigation should be performed in order to gain more knowledge on this disease and guide clinical management.


Subject(s)
Phlebovirus , Severe Fever with Thrombocytopenia Syndrome , Aged , Aspartate Aminotransferases , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Phlebovirus/metabolism , Retrospective Studies
5.
World J Gastroenterol ; 28(16): 1671-1680, 2022 Apr 28.
Article in English | MEDLINE | ID: covidwho-1855874

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system. Blood biomarkers are affordable, rapid, objective, and useful in the evaluation and prognostication of COVID-19 patients. AIM: To investigate the association between aspartate transferase-to-platelet ratio index (APRI) and in-hospital mortality to develop a COVID-19 mortality prediction model. METHODS: A multicenter cohort study with a retrospective design was conducted. Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital (Assiut, Egypt) and Chest Hospital (Assiut, Egypt) with confirmed COVID-19 from July 1, 2020 to October 1, 2020, were retrieved and analyzed. The patient cohort was classified into the following two categories based on the APRI: (1) COVID-19 presenting with APRI ≤ 0.5; and (2) COVID-19 presenting with APRI (> 0.5 and ≤ 1.5). The association between APRI and all-cause in-hospital mortality was analyzed, and the new model was developed through logistic regression analyses. RESULTS: Of the 353 patients who satisfied the inclusion criteria, 10% were admitted to the intensive care unit (n = 36) and 7% died during the hospital stay (n = 25). The median age was 40 years and 50.7% were male. On admission, 49% had aspartate transferase-dominant liver injury. On admission, APRI (> 0.5 and ≤ 1.5) was independently associated with all-cause in-hospital mortality in unadjusted regression analysis and after adjustment for age and sex; after stepwise adjustment for several clinically relevant confounders, APRI was still significantly associated with all-cause in-hospital mortality. On admission, APRI (> 0.5 and ≤ 1.5) increased the odds of mortality by five-times (P < 0.006). From these results, we developed a new predictive model, the APRI-plus, which includes the four predictors of age, aspartate transferase, platelets, and serum ferritin. Performance for mortality was very good, with an area under the receiver operating curve of 0.90. CONCLUSION: APRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality, independent of other relevant predictors.


Subject(s)
COVID-19 , Adult , Aspartate Aminotransferases , Aspartic Acid , Biomarkers , Blood Platelets , Cohort Studies , Female , Humans , Liver Cirrhosis , Male , Platelet Count , Retrospective Studies , Risk Factors , Transferases
6.
Int J Mol Sci ; 23(9)2022 Apr 27.
Article in English | MEDLINE | ID: covidwho-1809943

ABSTRACT

Patients with coronavirus disease 19 (COVID-19) commonly show abnormalities of liver tests (LTs) of undetermined cause. Considering drugs as tentative culprits, the current systematic review searched for published COVID-19 cases with suspected drug-induced liver injury (DILI) and established diagnosis using the diagnostic algorithm of RUCAM (Roussel Uclaf Causality Assessment Method). Data worldwide on DILI cases assessed by RUCAM in COVID-19 patients were sparse. A total of 6/200 reports with initially suspected 996 DILI cases in COVID-19 patients and using all RUCAM-based DILI cases allowed for a clear description of clinical features of RUCAM-based DILI cases among COVID-19 patients: (1) The updated RUCAM published in 2016 was equally often used as the original RUCAM of 1993, with both identifying DILI and other liver diseases as confounders; (2) RUCAM also worked well in patients treated with up to 18 drugs and provided for most DILI cases a probable or highly probable causality level for drugs; (3) DILI was preferentially caused by antiviral drugs given empirically due to their known therapeutic efficacy in other virus infections; (4) hepatocellular injury was more often reported than cholestatic or mixed injury; (5) maximum LT values were found for alanine aminotransferase (ALT) 1.541 U/L and aspartate aminotransferase (AST) 1.076 U/L; (6) the ALT/AST ratio was variable and ranged from 0.4 to 1.4; (7) the mean or median age of the COVID-19 patients with DILI ranged from 54.3 to 56 years; (8) the ratio of males to females was 1.8-3.4:1; (9) outcome was favorable for most patients, likely due to careful selection of the drugs and quick cessation of drug treatment with emerging DILI, but it was fatal in 19 patients; (10) countries reporting RUCAM-based DILI cases in COVID-19 patients included China, India, Japan, Montenegro, and Spain; (11) robust estimation of the percentage contribution of RUCAM-based DILI for the increased LTs in COVID-19 patients is outside of the current scope. In conclusion, RUCAM-based DILI with its clinical characteristics in COVID-19 patients and its classification as a confounding variable is now well defined, requiring a new correct description of COVID-19 features by removing DILI characteristics as confounders.


Subject(s)
Antiviral Agents , COVID-19 , Chemical and Drug Induced Liver Injury , Alanine Transaminase , Antiviral Agents/adverse effects , Aspartate Aminotransferases , COVID-19/drug therapy , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/epidemiology , Chemical and Drug Induced Liver Injury/etiology , Female , Humans , Male , Middle Aged , Publications
7.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801776

ABSTRACT

Coronavirus disease which is caused by the SARS CoV2 virus has been spreading rapidly all over the world and is posing threat to public health. There is a need to identify potentially severe or critical cases early using a novel test for preventing fatality. Coronavirus utilizes angiotens in converting enzyme receptors (ACE) for gaining entry to host cells and leads to multiorgan failure. ACE 2 receptors are present in the liver, cardia, skeletal muscles, kidneys, brain, RBCs. These organs also have high concentrations of aspartate aminotransferase enzyme. It is worth noting the increase in AST which would indirectly be used as evidence for severity. MATERIAL: This a cross-sectional retrospective study including 120 non-alcoholic Covid 19 patients (50 survivors and 70 non-survivors), aged > 18 years tested positive for RTPCR and were admitted to our hospital. The results of tests like neutrophil/lymphocyte ratio, CRP, D Dimer, LDH, ferritin, albumin, AST, ALT, AST/ALT ratio, bilirubin, urea, and creatinine values were noted from the case records. All the tests were done on the day of admission. Receiver operator curve analysis was plotted for these parameters and their usefulness in predicting mortality was deduced and compared with AST/ALT ratio. OBSERVATION: The mean age of the study group was 50.63 years with 60 % males and 40 % females. Using Mann Whitney test statistical significance of studied parameters was proved with a p-value of <0.005. The ROC curve analysis was performed for all the tests and clinical relevance of the same in terms of predicting mortality between survivors and non-survivors is determined. DE RITIS ratio had the best utility as a predictor of poor prognosis with sensitivity and specificity of 83% and 88% respectively (p-value > 0.001). It surpassed the N/L ratio and CRP for predicting mortality in COVID patients. Cut -off value of the DE RITIS ratio for predicting fatality was 1.28 with a significant p-value of < 0.001. CONCLUSION: DE RITIS ratio can be used as the best parameter among the other novel tests for predicting severity in covid patients for effective resource allocation and timely intervention.


Subject(s)
COVID-19 , Aspartate Aminotransferases , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies
8.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801469

ABSTRACT

Corona virus disease is a global pandemic. One of the key issues has been the very high volume of patients presenting to health centres or hospitals during the outbreak. It clearly overwhelms the human and mechanistic capacities available. Therefore, early and effective predictors of clinical outcomes are required for risk stratification. MATERIAL: This is hospital based retrospective study on patients who were admitted in Covid wards/ICU at IGGMC. Patients were divided into 3 groups- mild-moderate; severe; and critical based on their clinical presentation on admission. Several biomarkers like WBC, platelets, N/L, CRP, LDH, S. ferritin, d-dimer, CPK-MB, Serum creatinine, BUL, SGOT, SGPT, Serum albumin were analysed before and after treatment. OBSERVATION: 110 patients were enrolled in this study, 36 were classified into mild-moderate, 56 into severe and 18 into critical. As all of mild-moderate patients were discharged and majority of critical patients expired, biomarkers were compared between severe patients who were discharged vs severe patients who died. Out of these biomarkers, CRP was significantly decreased during course of treatment in severe patients who were discharged (p = 0.004) in comparison to severe patients who died where CRP was significantly increased (p = 0.001) (p value of difference being 0.00001). There was also significant change in ferritin levels (p = 0.006), while other biomarkers like WBC (p = 0.07), platelets (p = 0.066), N/L (p = 0.3), LDH (p = 0.06), d-dimer (p = 0.1), CPK-MB (p = 0.49), serum creatinine (p = 0.05), urea (p = 0.06), S. albumin (p= 0.3), SGOT (p =0.07), SGPT (p=0.25) did not show promising results. In addition, various treatment protocols were analysed by comparing CRP before and after treatment. Severe patients were divided into 2 groups, who took injection Remdesivir along with antibiotics, LMWH, systemic steroids vs who didn't, and CRP level were compared, but the difference was not significant (p = 0.06). Pre and post treatment CRP was also compared for Tocilizumab, Fevipiravir, Hydroxychloroquine, Doxycyline, but none of them were able to decrease CRP significantly (p > 0.05) in the severe or critical group but these drugs were effective in reducing CRP significantly (p<0.05) when given in mild-moderate group or if the treatment was started early. CONCLUSION: Increment in CRP and ferritin could effectively predict clinical outcome and could be used for risk stratification but no available drug is effective in reducing these biomarkers significantly in severe or critical group.


Subject(s)
COVID-19 , Heparin, Low-Molecular-Weight , Alanine Transaminase , Aspartate Aminotransferases , Biomarkers , Creatinine , Ferritins , Humans , Prognosis , Retrospective Studies
9.
Liver Int ; 42(6): 1297-1307, 2022 06.
Article in English | MEDLINE | ID: covidwho-1784710

ABSTRACT

BACKGROUND AND AIMS: The coronavirus disease of 2019 (COVID-19) causes considerable mortality worldwide. We aimed to investigate the frequency and predictive role of abnormal liver chemistries in different age groups. METHODS: Patients with positive severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) polymerase chain reaction (PCR) test between 03/2020-07/2021 at the Vienna General Hospital were included. Patients were stratified for age: 18-39 vs. 40-69 vs. ≥70 years (y). Aspartate aminotransferase (AST), alanine-aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and total bilirubin (BIL) were recorded. RESULTS: 900 patients (18-39 years: 32.2%, 40-69 years: 39.7%, ≥70 years: 28.1%) were included. Number of comorbidities, median D-dimer and C-reactive protein increased with age. During COVID-19, AST/ALT and ALP/GGT levels significantly increased. Elevated hepatocellular transaminases (AST/ALT) and cholestasis parameters (ALP/GGT/BIL) were observed in 40.3% (n  = 262/650) and 45.0% (n  = 287/638) of patients respectively. Liver-related mortality was highest among patients with pre-existing decompensated liver disease (28.6%, p < .001). 1.7% of patients without pre-existing liver disease died of liver-related causes, that is consequences of hepatic dysfunction or acute liver failure. Importantly, COVID-19-associated liver injury (16.0%, p < .001), abnormal liver chemistries and liver-related mortality (6.5%, p < .001) were most frequent among 40-69 years old patients. Elevated AST and BIL after the first positive SARS-CoV-2 PCR independently predicted mortality in the overall cohort and in 40-69 years old patients. CONCLUSIONS: Almost half of the COVID-19 patients exhibit abnormal hepatocellular and cholestasis-related liver chemistries with 40-69 years old patients being at particularly high risk for COVID-19-related liver injury and liver-related mortality. Elevated AST and BIL after SARS-CoV-2 infection are independent predictors of mortality, especially in patients aged 40-69 years.


Subject(s)
COVID-19 , Cholestasis , Liver Diseases , Adolescent , Adult , Aged , Alanine Transaminase , Alkaline Phosphatase , Aspartate Aminotransferases , Bilirubin/metabolism , Humans , Liver , Liver Diseases/metabolism , Middle Aged , SARS-CoV-2 , Young Adult , gamma-Glutamyltransferase/metabolism
10.
Klin Lab Diagn ; 66(3): 133-138, 2021 Mar 30.
Article in English | MEDLINE | ID: covidwho-1780501

ABSTRACT

Oral fluid is an alternative biological material that confirms correlations with blood parameters in various pathological conditions of the body. In order to find a non-invasive approach to stratification of patients with COVID-19 disease, molecular biomarkers of the oral fluid have been determined in patients with moderate coronavirus infection in comparison with clinically healthy individuals. It has been shown that proteomic, carbohydrate, macro- and microelement profiles of the oral fluid in coronavirus infection can be used for diagnostics. The features of protein metabolism were revealed: an increase in the content of total protein, urea; increased activity of enzymes aspartate aminotransferase, gamma glutamyl transpeptidase, creatine phosphokinase, alkaline phosphatase; changes in carbohydrate metabolism, which is expressed by an increase in glucose and lactate levels, an increase in lactate dehydrogenase activity, sodium, chloride, calcium, magnesium, iron content.


Subject(s)
COVID-19 , Coronavirus Infections , Coronavirus , Aspartate Aminotransferases , Humans , Proteomics , SARS-CoV-2
11.
Sci Rep ; 12(1): 5547, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1768849

ABSTRACT

The mechanisms underlying liver disease in patients with COVID-19 are not entirely known. The aim is to investigate, by means of novel statistical techniques, the changes over time in the relationship between inflammation markers and liver damage markers in relation to survival in COVID-19. The study included 221 consecutive patients admitted to the hospital during the first COVID-19 wave in Spain. Generalized additive mixed models were used to investigate the influence of time and inflammation markers on liver damage markers in relation to survival. Joint modeling regression was used to evaluate the temporal correlations between inflammation markers (serum C-reactive protein [CRP], interleukin-6, plasma D-dimer, and blood lymphocyte count) and liver damage markers, after adjusting for age, sex, and therapy. The patients who died showed a significant elevation in serum aspartate transaminase (AST) and alkaline phosphatase levels over time. Conversely, a decrease in serum AST levels was observed in the survivors, who showed a negative correlation between inflammation markers and liver damage markers (CRP with serum AST, alanine transaminase [ALT], and gamma-glutamyl transferase [GGT]; and D-dimer with AST and ALT) after a week of hospitalization. Conversely, most correlations were positive in the patients who died, except lymphocyte count, which was negatively correlated with AST, GGT, and alkaline phosphatase. These correlations were attenuated with age. The patients who died during COVID-19 infection displayed a significant elevation of liver damage markers, which is correlated with inflammation markers over time. These results are consistent with the role of systemic inflammation in liver damage during COVID-19.


Subject(s)
COVID-19 , Liver Diseases , Aspartate Aminotransferases , Biomarkers , COVID-19/complications , Humans , Inflammation/metabolism , Liver/metabolism , Liver Diseases/etiology
15.
World J Gastroenterol ; 28(5): 570-587, 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1674889

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.


Subject(s)
COVID-19 , Liver/chemistry , Alanine Transaminase , Alkaline Phosphatase , Aspartate Aminotransferases , Baltimore , Bilirubin , COVID-19/diagnosis , COVID-19/therapy , Hospitalization , Humans , Retrospective Studies , Severity of Illness Index
16.
Clin Lab ; 68(1)2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1614248

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on health, the economy, and social life throughout the world. COVID-19 pathology mainly involves the lungs. However, other organs can also be involved, including the liver, resulting in liver injury, elevated liver enzymes and reduced albumin levels. Involvement of the liver may increase the possibility of a misdiagnosis due to atypical presentations. This re-view article aimed to highlight the impact of COVID-19 on the liver, focusing on liver injury and its effect on severity and prognosis. METHODS: The author reviewed all published and in-press articles about COVID-19-associated liver injury using four electronic databases. A total of 55 articles were included in this review after removing duplicate records and establishing the necessary relevance. This review summarizes the recent studies focusing on how SARS-CoV-2 infection affects liver histology, liver enzymes, and albumin levels. RESULTS: COVID-19 is associated with varying degrees of liver injury, most notably increased levels of aspartate transaminase and alanine transaminase. Patients with severe COVID-19 are more likely to develop liver injury, elevation in the liver enzymes, and reduction in the albumin levels. In addition, COVID-19 patients with pre-existing liver injury are predisposed to develop more severe disease and have a poorer prognosis and higher mortality. Portal inflammation and focal hepatic necrosis are the most common histopathological characteristics observed among COVID-19-associated liver injury patients. The mechanisms of liver injury in COVID-19 are thought to arise from systemic inflammatory responses, hypoxia-reperfusion dysfunction, drug-induced liver injury, and/or a direct effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CONCLUSIONS: Clinicians need to be alert when dealing with COVID-19 patients who have chronic liver disease, particularly when prescribing medications to avoid the risk of drug-induced liver injury. Monitoring liver enzymes and albumin levels during COVD-19 illness is essential, as it predicts disease severity and prognosis.


Subject(s)
COVID-19 , Liver Diseases , Aspartate Aminotransferases , Humans , Liver , Pandemics , SARS-CoV-2
17.
Lab Med ; 52(5): 493-498, 2021 Sep 01.
Article in English | MEDLINE | ID: covidwho-1526169

ABSTRACT

OBJECTIVE: The aim of the study was to assess the role of midregional proadrenomedullin (MR-proADM) in patients with COVID-19. METHODS: We included 110 patients hospitalized for COVID-19. Biochemical biomarkers, including MR-proADM, were measured at admission. The association of plasma MR-proADM levels with COVID-19 severity, defined as a requirement for mechanical ventilation or in-hospital mortality, was evaluated. RESULTS: Patients showed increased levels of MR-proADM. In addition, MR-proADM was higher in patients who died during hospitalization than in patients who survived (median, 2.59 nmol/L; interquartile range, 2.3-2.95 vs median, 0.82 nmol/L; interquartile range, 0.57-1.03; P <.0001). Receiver operating characteristic curve analysis showed good accuracy of MR-proADM for predicting mortality. A MR-proADM value of 1.73 nmol/L was established as the best cutoff value, with 90% sensitivity and 95% specificity (P <.0001). CONCLUSION: We found that MR-proADM could represent a prognostic biomarker of COVID-19.


Subject(s)
Adrenomedullin/blood , COVID-19/diagnosis , Hypertension/diagnosis , Lung Diseases/diagnosis , Protein Precursors/blood , Aged , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/mortality , COVID-19/virology , Comorbidity , Female , Humans , Hypertension/blood , Hypertension/mortality , Hypertension/virology , Interleukin-6/blood , Lung Diseases/blood , Lung Diseases/mortality , Lung Diseases/virology , Male , Middle Aged , Patient Selection , Prognosis , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Survival Analysis , Triage/methods
18.
Eur Rev Med Pharmacol Sci ; 25(21): 6813-6824, 2021 11.
Article in English | MEDLINE | ID: covidwho-1524868

ABSTRACT

OBJECTIVE: The aim of the study was to appraise the capacity of serum aminotransferases to discriminate between hepatic and other extra-pulmonary COVID-19-related manifestations and, potentially, to serve as predictors of poor clinical outcomes. MATERIALS AND METHODS: Ninety-eight studies were identified (79% from China), including 43,554 patients (57% males), 9,983 (62% males) with poor outcomes and 33,571 (50% males) with favorable outcomes. After splitting studies depending on whether serum alanine aminotransferase (ALT) concentrations were statistically different between patients with poor vs. favorable outcomes, the 35 'hepatic involvement' articles (p<0.05) included 28,510 patients (51% males), 5,279 (66% males) and 23,231 subjects (48% males) with poor and favorable outcomes, respectively. The 63 'extra-hepatic involvement' studies (p>0.05) included 15,044 patients (54% males), 4,704 (60% males) with poor outcomes and 10,340 (51% males) with favorable outcomes. RESULTS: The meta-analysis shows that serum aspartate aminotransferase (AST) concentrations were significantly higher in patients with poor outcomes than those with favorable outcomes (WMD 12.5 UI/L, 95% CI 10.9 to 14.1 p<0.001). Similarly, AST concentrations were significantly higher in the 'hepatic involvement' studies (WMD 16.3 UI/L, 95% CI 13.4 to 19.2 p<0.001) and in the 'extra-hepatic involvement' studies (WMD 10.3 UI/L, 95% CI 8.6 to 12.0 p<0.001). CONCLUSIONS: The different association of serum AST concentrations with some clinical, demographic, and biochemical factors in the two clusters suggests that in COVID-19 patients, serum AST elevation is not necessarily linked to real liver damage.


Subject(s)
Alanine Transaminase/blood , Aspartate Aminotransferases/blood , COVID-19/pathology , COVID-19/therapy , COVID-19/virology , Databases, Factual , Humans , SARS-CoV-2/isolation & purification , Treatment Outcome
20.
BMC Infect Dis ; 21(1): 818, 2021 Aug 16.
Article in English | MEDLINE | ID: covidwho-1477280

ABSTRACT

BACKGROUND: Liver injuries have been reported in patients with coronavirus disease 2019 (COVID-19). This study aimed to investigate the clinical role played by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: In this multicentre, retrospective study, the parameters of liver function tests in COVID-19 inpatients were compared between various time-points in reference to SARS-CoV-2 shedding, and 3 to 7 days before the first detection of viral shedding was regarded as the reference baseline. RESULTS: In total, 70 COVID-19 inpatients were enrolled. Twenty-two (31.4%) patients had a self-medication history after illness. At baseline, 10 (14.3%), 7 (10%), 9 (12.9%), 2 (2.9%), 15 (21.4%), and 4 (5.7%) patients already had abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, and total bilirubin (TBIL) values, respectively. ALT and AST abnormal rates and levels did not show any significant dynamic changes during the full period of viral shedding (all p > 0.05). The GGT abnormal rate (p = 0.008) and level (p = 0.033) significantly increased on day 10 of viral shedding. Meanwhile, no simultaneous significant increases in abnormal ALP rates and levels were observed. TBIL abnormal rates and levels significantly increased on days 1 and 5 of viral shedding (all p < 0.05). Albumin abnormal decrease rates increased, and levels decreased consistently from baseline to SARS-CoV-2 clearance day (all p < 0.05). Thirteen (18.6%) patients had chronic liver disease, two of whom died. The ALT and AST abnormal rates and levels did not increase in patients with chronic liver disease during SARS-CoV-2 shedding. CONCLUSIONS: SARS-CoV-2 does not directly lead to elevations in ALT and AST but may result in elevations in GGT and TBIL; albumin decreased extraordinarily even when SARS-CoV-2 shedding ended.


Subject(s)
COVID-19/complications , Liver/virology , Adult , Aged , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Biomarkers/blood , COVID-19/blood , COVID-19/epidemiology , Female , Humans , Liver/pathology , Liver Function Tests/methods , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
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