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Liver Injury in COVID-19 Patients with Drugs as Causatives: A Systematic Review of 996 DILI Cases Published 2020/2021 Based on RUCAM as Causality Assessment Method.
Teschke, Rolf; Méndez-Sánchez, Nahum; Eickhoff, Axel.
  • Teschke R; Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt, 63450 Hanau, Germany.
  • Méndez-Sánchez N; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
  • Eickhoff A; Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico.
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 1.8-3.41; (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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antiviral Agents / Chemical and Drug Induced Liver Injury / COVID-19 Type of study: Diagnostic study / Etiology study / Prognostic study / Reviews / Systematic review Limits: Female / Humans / Male / Middle aged Language: English Year: 2022 Document Type: Article Affiliation country: Ijms23094828

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antiviral Agents / Chemical and Drug Induced Liver Injury / COVID-19 Type of study: Diagnostic study / Etiology study / Prognostic study / Reviews / Systematic review Limits: Female / Humans / Male / Middle aged Language: English Year: 2022 Document Type: Article Affiliation country: Ijms23094828