Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 28
Filter
1.
Semin Dial ; 34(6): 457-471, 2021 11.
Article in English | MEDLINE | ID: covidwho-1376444

ABSTRACT

Continuous renal replacement therapy (CRRT) in sepsis does have a role in removing excessive fluid, and also role in removal of mediators although not proven today, and to allow fluid space in order to feed. In these conditions, continuous renal replacement therapy can improve morbidity but never mortality so far. Regarding sepsis, timing has become a more important issue after decades and is currently more discussed than dosing. Rationale of blood purification has evolved a lot in the last years regarding sepsis with the discovery of many types of sorbent allowing ideas from science fiction to become reality in 2021. Undoubtedly, COVID-19 has reactivated the interest of blood purification in sepsis but also in COVID-19. Burn is even more dependent about removal of excessive fluid as compared to sepsis. Regarding cardiac failure, ultrafiltration can improve the quality of life and morbidity when diuretics are becoming inefficient but can never improve mortality. Regarding brain injury, CRRTs have several advantages as compared to intermittent hemodialysis. In liver failure, there have been no randomized controlled trials to examine whether single-pass albumin dialysis offers advantages over standard supportive care, and there is always the cost of albumin.


Subject(s)
Acute Kidney Injury , Burns , COVID-19 , Continuous Renal Replacement Therapy , Heart Failure , Liver Failure , Sepsis , Acute Kidney Injury/therapy , Heart Failure/therapy , Humans , Quality of Life , Renal Dialysis , SARS-CoV-2 , Sepsis/therapy
2.
Dig Liver Dis ; 53(9): 1071-1072, 2021 09.
Article in English | MEDLINE | ID: covidwho-1284034
5.
World J Gastroenterol ; 27(17): 1905-1919, 2021 May 07.
Article in English | MEDLINE | ID: covidwho-1227081

ABSTRACT

Due to their immunomodulatory potential and release of trophic factors that promote healing, mesenchymal stromal cells (MSCs) are considered important players in tissue homeostasis and regeneration. MSCs have been widely used in clinical trials to treat multiple conditions associated with inflammation and tissue damage. Recent evidence suggests that most of the MSC therapeutic effects are derived from their secretome, including the extracellular vesicles, representing a promising approach in regenerative medicine application to treat organ failure as a result of inflammation/fibrosis. The recent outbreak of respiratory syndrome coronavirus, caused by the newly identified agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has forced scientists worldwide to use all available instruments to fight the infection, including the inflammatory cascade caused by this pandemic disease. The use of MSCs is a valid approach to combat organ inflammation in different compartments. In addition to the lungs, which are considered the main inflammatory target for this virus, other organs are compromised by the infection. In particular, the liver is involved in the inflammatory response to SARS-CoV-2 infection, which causes organ failure, leading to death in coronavirus disease 2019 (COVID-19) patients. We herein summarize the current implications derived from the use of MSCs and their soluble derivatives in COVID-19 treatment, and emphasize the potential of MSC-based therapy in this clinical setting.


Subject(s)
COVID-19 , Liver Failure , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , COVID-19/drug therapy , Humans , SARS-CoV-2
6.
Cells ; 10(5)2021 05 04.
Article in English | MEDLINE | ID: covidwho-1223957

ABSTRACT

Liver injury in COVID-19 patients has progressively emerged, even in those without a history of liver disease, yet the mechanism of liver pathogenicity is still controversial. COVID-19 is frequently associated with increased serum ferritin levels, and hyperferritinemia was shown to correlate with illness severity. The liver is the major site for iron storage, and conditions of iron overload have been established to have a pathogenic role in development of liver diseases. We presented here six patients who developed severe COVID-19, with biochemical evidence of liver failure. Three cases were survived patients, who underwent liver biopsy; the other three were deceased patients, who were autopsied. None of the patients suffered underlying liver pathologies. Histopathological and ultrastructural analyses were performed. The most striking finding we demonstrated in all patients was iron accumulation into hepatocytes, associated with degenerative changes. Abundant ferritin particles were found enclosed in siderosomes, and large aggregates of hemosiderin were found, often in close contact with damaged mitochondria. Iron-caused oxidative stress may be responsible for mitochondria metabolic dysfunction. In agreement with this, association between mitochondria and lipid droplets was also found. Overall, our data suggest that hepatic iron overload could be the pathogenic trigger of liver injury associated to COVID-19.


Subject(s)
COVID-19/diagnosis , Iron Overload/etiology , Liver Failure/etiology , Liver/pathology , Severity of Illness Index , Adult , Aged , Antiviral Agents , Biopsy , COVID-19/complications , COVID-19/mortality , COVID-19/therapy , Female , Ferritins/analysis , Hepatocytes/cytology , Hepatocytes/pathology , Humans , Iron/analysis , Iron/metabolism , Iron Overload/mortality , Iron Overload/pathology , Iron Overload/therapy , Liver/cytology , Liver/metabolism , Liver Failure/mortality , Liver Failure/pathology , Liver Failure/therapy , Liver Function Tests , Male , Middle Aged , Mitochondria/pathology , Positive-Pressure Respiration , SARS-CoV-2/isolation & purification
7.
Transplant Proc ; 53(4): 1175-1179, 2021 May.
Article in English | MEDLINE | ID: covidwho-1199109

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19 has taken the lives of more than 2.1 million people worldwide, with a global mortality rate of 2.2%. Current COVID-19 treatment options include supportive respiratory care, parenteral corticosteroids, and remdesivir. Although COVID-19 is associated with increased risk of morbidity and mortality in patients with comorbidities, the vulnerability, clinical course, optimal management, and prognosis of COVID-19 infection in patients with organ transplants has not been well described in the literature. The treatment of COVID-19 differs based on the organ(s) transplanted. Preliminary data suggested that liver transplant patients with COVID-19 did not have higher mortality rates than untransplanted COVID-19 patients. Table 1 depicts a compiled list of current published data on COVID-19 liver transplant patients. Most of these studies included both recent and old liver transplant patients. No distinction was made for early liver transplant patients who contract COVID-19 within their posttransplant hospitalization course. This potential differentiation needs to be further explored. Here, we report 2 patients who underwent liver transplantation who acquired COVID-19 during their posttransplant recovery period in the hospital. CASE DESCRIPTIONS: Two patients who underwent liver transplant and contracted COVID-19 in the early posttransplant period and were treated with hydroxychloroquine, methylprednisolone, tocilizumab, and convalescent plasma. This article includes a description of their hospital course, including treatment and recovery. CONCLUSION: The management of post-liver transplant patients with COVID-19 infection is complicated. Strict exposure precaution practice after organ transplantation is highly recommended. Widespread vaccination will help with prevention, but there will continue to be patients who contract COVID-19. Therefore, continued research into appropriate treatments is still relevant and critical. A temporary dose reduction of immunosuppression and continued administration of low-dose methylprednisolone, remdesivir, monoclonal antibodies, and convalescent plasma might be helpful in the management and recovery of severe COVID-19 pneumonia in post-liver transplant patients. Future studies and experiences from posttransplant patients are warranted to better delineate the clinical features and optimal management of COVID-19 infection in liver transplant recipients.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Liver Transplantation , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Aged , Alanine/analogs & derivatives , Alanine/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/complications , COVID-19/therapy , COVID-19/virology , Female , Humans , Hydroxychloroquine/therapeutic use , Immunization, Passive , Immunosuppressive Agents/therapeutic use , Liver Failure/complications , Liver Failure/therapy , Methylprednisolone/therapeutic use , Middle Aged , SARS-CoV-2/isolation & purification
9.
World J Gastroenterol ; 27(5): 377-390, 2021 Feb 07.
Article in English | MEDLINE | ID: covidwho-1081093

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has undoubtedly revolutionized the whole globe and given a new point of view on respiratory tract infections. Nevertheless, coronavirus disease 2019 (COVID-19) cannot be perceived as a disease limited only to pneumonia with diverse severity. More and more reports have demonstrated a wide range of possible systemic symptoms, including hepatic complications. Liver injury has been observed in a significant proportion of patients, especially in those with a severe or critical illness. COVID-19 might provoke a deterioration of liver function in patients with already diagnosed chronic liver diseases and without pre-existing liver disorders. The deterioration of liver function worsens the prognosis, increases the risk of a severe course of SARS-CoV-2 infection and prolongs the hospital stay. In general, patients who develop liver dysfunction in COVID-19 are mainly males, elderly people, and those with higher body mass index. The underlying mechanisms for hepatic failure in patients infected with SARS-CoV-2 are still unclear, nevertheless liver damage appears to be directly connected with virus-induced cytopathic effects. A liver injury observed during hospitalization might be simultaneously caused by the use of potentially hepatotoxic drugs, mainly antiviral agents. This minireview focuses on a possible relationship between COVID-19 and the liver, potential molecular mechanisms of liver damage, the characteristics of liver injury and suggested factors predisposing to hepatic manifestations in COVID-19 patients.


Subject(s)
COVID-19/complications , Liver Failure/virology , Antiviral Agents/adverse effects , COVID-19/drug therapy , COVID-19/pathology , COVID-19/physiopathology , Gastrointestinal Tract/physiopathology , Host-Pathogen Interactions , Humans , Inflammation/complications , Liver/pathology , Liver Failure/chemically induced , Metabolic Syndrome/complications , Prognosis , SARS-CoV-2/physiology
10.
Stroke ; 52(3): 905-912, 2021 03.
Article in English | MEDLINE | ID: covidwho-1066984

ABSTRACT

BACKGROUND AND PURPOSE: Acute ischemic stroke may occur in patients with coronavirus disease 2019 (COVID-19), but risk factors, in-hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, comorbidities, and outcomes in patients with COVID-19 with or without acute ischemic stroke and compared with patients without COVID-19 and acute ischemic stroke. METHODS: We analyzed the data from 54 health care facilities using the Cerner deidentified COVID-19 dataset. The dataset included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated to suspicion of or exposure to COVID-19 or confirmed COVID-19. RESULTS: A total of 103 (1.3%) patients developed acute ischemic stroke among 8163 patients with COVID-19. Among all patients with COVID-19, the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fibrillation, and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk, 2.1 [95% CI, 1.6-2.4]; P<0.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19 513 patients without COVID-19. Among all ischemic stroke patients, COVID-19 was associated with discharge to destination other than home or death (relative risk, 1.2 [95% CI, 1.0-1.3]; P=0.03) after adjusting for potential confounders. CONCLUSIONS: Acute ischemic stroke was infrequent in patients with COVID-19 and usually occurs in the presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased 2-fold with occurrence of acute ischemic stroke in patients with COVID-19.


Subject(s)
Atrial Fibrillation/epidemiology , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Heart Failure/epidemiology , Hospital Mortality , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Ischemic Stroke/epidemiology , Acute Kidney Injury/epidemiology , Adult , African Americans , Aged , Aged, 80 and over , Brain Edema/epidemiology , COVID-19/ethnology , Cerebral Hemorrhage/epidemiology , Cohort Studies , Comorbidity , Female , Hospitals, Rehabilitation/statistics & numerical data , Humans , Ischemic Stroke/ethnology , Liver Failure/epidemiology , Male , Middle Aged , Myocardial Infarction/epidemiology , Nursing Homes/statistics & numerical data , Patient Discharge , Respiratory Insufficiency/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Skilled Nursing Facilities/statistics & numerical data , United States/epidemiology
12.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066836

ABSTRACT

This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.


Subject(s)
Bacillus cereus/genetics , Exotoxins/genetics , Foodborne Diseases/diagnosis , Acetylcysteine/therapeutic use , Acidosis/physiopathology , Acidosis/therapy , Adult , Anti-Arrhythmia Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Bacillus cereus/isolation & purification , Blood Coagulation Disorders/physiopathology , Blood Coagulation Disorders/therapy , Blood Transfusion , Brain Diseases , Continuous Renal Replacement Therapy , Fatal Outcome , Female , Foodborne Diseases/microbiology , Foodborne Diseases/physiopathology , Foodborne Diseases/therapy , Free Radical Scavengers/therapeutic use , Humans , Immunocompetence , Liver Failure/physiopathology , Liver Failure/therapy , Multiple Organ Failure/physiopathology , Multiple Organ Failure/therapy , Plasmapheresis , Renal Insufficiency/physiopathology , Renal Insufficiency/therapy , Rhabdomyolysis/physiopathology , Rhabdomyolysis/therapy , Sepsis/physiopathology , Sepsis/therapy , Shock/physiopathology , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Whole Genome Sequencing
13.
Medicina (Kaunas) ; 57(2)2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1061108

ABSTRACT

Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.


Subject(s)
Anticoagulants/therapeutic use , Fibrinolytic Agents/therapeutic use , Pulmonary Embolism/drug therapy , Administration, Oral , Anticoagulants/administration & dosage , COVID-19/complications , Fibrinolytic Agents/administration & dosage , Humans , Liver Failure/complications , Neoplasms/complications , Renal Insufficiency/complications , Risk Factors , SARS-CoV-2
14.
Swiss Med Wkly ; 151: w20420, 2021 01 18.
Article in English | MEDLINE | ID: covidwho-1055196

ABSTRACT

The authors present the case of a 58-year-old man with the unique combination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, later on, haemophagocytic lymphohistiocytosis admitted to the intensive care unit. During his ICU stay the patient developed a variety of complications including acute respiratory distress syndrome, pulmonary embolism, right heart failure and suspected HLH leading to multiorgan failure and death. Despite the proven diagnosis of haemophagocytic lymphohistiocytosis, the excessively high ferritin levels of the patient did not seem fully explained by this diagnosis. Therefore, the authors want to highlight different causes of hyperferritinaemia in critically ill patients and underline the importance of differential diagnoses when interpreting continuously rising ferritin levels.


Subject(s)
Acute Kidney Injury/physiopathology , COVID-19/physiopathology , Heart Failure/physiopathology , Hyperferritinemia/blood , Liver Failure/physiopathology , Lymphohistiocytosis, Hemophagocytic/physiopathology , Pulmonary Embolism/physiopathology , Acute Kidney Injury/blood , Acute Kidney Injury/etiology , Alanine Transaminase/blood , COVID-19/blood , COVID-19/complications , COVID-19/therapy , Creatinine/blood , Disease Progression , Fatal Outcome , Heart Failure/etiology , Humans , Hyperferritinemia/etiology , Liver Failure/blood , Liver Failure/etiology , Lymphohistiocytosis, Hemophagocytic/etiology , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/physiopathology , Pulmonary Embolism/etiology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy , SARS-CoV-2
16.
Clin Transplant ; 35(2): e14169, 2021 02.
Article in English | MEDLINE | ID: covidwho-947755

ABSTRACT

Transplant recipients are vulnerable to infections, including COVID-19, given their comorbidities and chronic immunosuppression. In this study, all hospitalized renal transplant recipients (RTR) with a positive nasal swab for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV2) seen consecutively between 03/01/2020 and 05/01/2020 at the Detroit Medical Center were included. Data on demographics, clinical presentation, laboratory findings, management, and outcomes were collected. Twenty-five patients were included, all African American (AA) and deceased-donor transplant recipients. The most common presenting symptom was dyspnea, followed by fever, cough and diarrhea. Multifocal opacities on initial chest x-ray were seen in 52% patients and 44% of patients had a presenting oxygen saturation of less than or equal to 94%. Four patients (16%) required transfer to the intensive care unit, one required intubation and one expired. COVID-19-infected RTR in this cohort had low mortality of 4% (n = 1). Despite multiple comorbidities and chronic immunosuppression, our cohort of African American RTR had favorable outcomes compared to other reports on COVID-19 in RTR.


Subject(s)
African Americans , COVID-19/ethnology , Intensive Care Units , Kidney Transplantation , Liver Failure/ethnology , Transplant Recipients , Aged , Comorbidity , Female , Humans , Liver Failure/surgery , Male , Michigan/epidemiology , Middle Aged , RNA, Viral/analysis , SARS-CoV-2/genetics
17.
BMJ Open ; 10(9): e038976, 2020 09 17.
Article in English | MEDLINE | ID: covidwho-781179

ABSTRACT

OBJECTIVE: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. SETTING: A nested case-control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. PARTICIPANTS: Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. OUTCOME MEASURES: Patient demographics, survival time and status, and history of comorbidities. METHOD: A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. RESULTS: Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). CONCLUSION: Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.


Subject(s)
Coronary Disease/epidemiology , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Bronchitis, Chronic/epidemiology , COVID-19 , Case-Control Studies , Cerebral Infarction/epidemiology , China/epidemiology , Comorbidity , Diabetes Mellitus/epidemiology , Female , Heart Failure/epidemiology , Humans , Liver Failure/epidemiology , Male , Middle Aged , Pandemics , Proportional Hazards Models , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency/epidemiology , SARS-CoV-2 , Young Adult
18.
Clin Pharmacol Ther ; 108(6): 1135-1149, 2020 12.
Article in English | MEDLINE | ID: covidwho-657047

ABSTRACT

Chloroquine and hydroxychloroquine are quinoline derivatives used to treat malaria. To date, these medications are not approved for the treatment of viral infections, and there are no well-controlled, prospective, randomized clinical studies or evidence to support their use in patients with coronavirus disease 2019 (COVID-19). Nevertheless, chloroquine and hydroxychloroquine are being studied alone or in combination with other agents to assess their effectiveness in the treatment or prophylaxis for COVID-19. The effective use of any medication involves an understanding of its pharmacokinetics, safety, and mechanism of action. This work provides basic clinical pharmacology information relevant for planning and initiating COVID-19 clinical studies with chloroquine or hydroxychloroquine, summarizes safety data from healthy volunteer studies, and summarizes safety data from phase II and phase II/III clinical studies in patients with uncomplicated malaria, including a phase II/III study in pediatric patients following administration of azithromycin and chloroquine in combination. In addition, this work presents data describing the proposed mechanisms of action against the severe acute respiratory distress syndrome coronavirus-2 and summarizes clinical efficacy to date.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Chloroquine/pharmacology , Chloroquine/therapeutic use , Hydroxychloroquine/pharmacology , Hydroxychloroquine/therapeutic use , Age Factors , Aging , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Chloroquine/adverse effects , Chloroquine/pharmacokinetics , Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic , Drug Interactions , Drug Therapy, Combination , Humans , Hydroxychloroquine/adverse effects , Hydroxychloroquine/pharmacokinetics , Liver Failure/epidemiology , Malaria/drug therapy , Prospective Studies , Renal Insufficiency/epidemiology , SARS-CoV-2
19.
Intern Emerg Med ; 15(8): 1399-1407, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-639375

ABSTRACT

Little is known regarding coronavirus disease 2019 (COVID-19) clinical spectrum in non-Asian populations. We herein describe the impact of COVID-19 on liver function in 100 COVID-19 consecutive patients (median age 70 years, range 25-97; 79 males) who were admitted to our internal medicine unit in March 2020. We retrospectively assessed liver function tests, taking into account demographic characteristics and clinical outcome. A patient was considered as having liver injury when alanine aminotransferase (ALT) was > 50 mU/ml, gamma-glutamyl transpeptidase (GGT) > 50 mU/ml, or total bilirubin > 1.1 mg/dl. Spearman correlation coefficient for laboratory data and bivariable analysis for mortality and/or need for intensive care were assessed. A minority of patients (18.6%) were obese, and most patients were non- or moderate-drinkers (88.5%). Liver function tests were altered in 62.4% of patients, and improved during follow-up. None of the seven patients with known chronic liver disease had liver decompensation. Only one patient developed acute liver failure. In patients with altered liver function tests, PaO2/FiO2 < 200 was associated with greater mortality and need for intensive care (HR 2.34, 95% CI 1.07-5.11, p = 0.033). To conclude, a high prevalence of altered liver function tests was noticed in Italian patients with COVID-19, and this was associated with worse outcomes when developing severe acute respiratory distress syndrome.


Subject(s)
Coronavirus Infections/complications , Liver Failure/complications , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Female , Hospitalization/statistics & numerical data , Humans , Internal Medicine/methods , Internal Medicine/trends , Italy/epidemiology , Liver/physiopathology , Liver Failure/epidemiology , Liver Failure/physiopathology , Male , Middle Aged , Pandemics , Patients' Rooms/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Retrospective Studies
20.
Pediatr Transplant ; 24(8): e13778, 2020 12.
Article in English | MEDLINE | ID: covidwho-607319

ABSTRACT

We present a case of a pediatric liver transplant recipient diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection four days after receiving a living donor liver allograft from her mother. The recipient was a 6-month-old with end-stage liver disease due to biliary atresia and failed Kasai. The infant had an uncomplicated implantation, excellent graft function and down-trending liver enzymes until developing fevers, diarrhea, and moderate respiratory distress requiring non-invasive respiratory support. SARS-CoV-2 testing (nasal swab Polymerase Chain Reaction) was positive on post-operative day (POD) 4. Liver enzymes peaked ~1000 U/L (5-fold higher than the previous day) on POD 6. Histology demonstrated a mixed picture of moderate acute hepatitis and classical elements of mild to moderate acute cellular rejection. Her hepatitis and respiratory symptoms improved coincident with completing treatment with hydroxychloroquine, reduced immunosuppression, and intravenous gamma globulin (IVIG).


Subject(s)
COVID-19/diagnosis , COVID-19/therapy , Liver Failure/surgery , Liver Transplantation , Biliary Atresia/complications , Biliary Atresia/surgery , COVID-19 Testing , Female , Graft Rejection , Humans , Hydroxychloroquine/therapeutic use , Immunoglobulins, Intravenous , Immunosuppressive Agents/administration & dosage , Infant , Liver Failure/etiology , Liver Function Tests , Living Donors , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL
...