ABSTRACT
Aim of the study: To evaluate the diagnostic performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), albumin-bilirubin ratio (ABR) and albumin-bilirubin score (ALBI) in different outcomes of liver cirrhosis, including decompensated liver cirrhosis (DLC), acute-on-chronic liver failure (ACLF), hepatocellular carcinoma (HCC), and spontaneous bacterial peritonitis (SBP). A second objective was to find their cut-off values. Finally, we aimed to correlate these indices with the severity of liver cirrhosis. Material and methods: The study included 149 patients with hepatitis C virus (HCV)-related liver cirrhosis. They were categorized into 3 groups according to severity of cirrhosis as compensated cirrhosis, decompensated liver cirrhosis and acute-on-chronic liver failure based on Child-Turcotte-Pugh (CTP) and MELD-Na scores. Patients were categorized according to presence of HCC and spontaneous bacterial peritonitis. All patients had a complete blood picture and liver profile. NLR, PLR, ALBI and ABR were calculated. Results: NLR, PLR, ALBI and ABR correlated with CTP, and MELD-Na scores. NLR > 6.27 can be used to predict SBP in patients with ascites. NLR cut-off value > 3.61 and > 5.26 can be used to predict DLC and ACLF respectively in liver cirrhosis. ABR < 0.90 discriminated ACLF from DLC with OR = 2.93 (95% CI). Conclusions: The simple inflammatory scores NLR and PLR together with simple ABR and ALBI scores can be used as quick tools to assess severity of liver cirrhosis. NLR can predict the presence of SBP in patients with ascites. ABR is superior to ALBI in discriminating ACLF from DLC.
ABSTRACT
The coronavirus pandemic has changed the priorities of the whole medical society. During the clinical course of COVID-19, it has been observed that hepatic injury occurs in a significant proportion of patients, particularly in those with severe or critical illness. In this literature review, we summarize the most recent studies, which covered the pathophysiology of COVID-19 induced liver injury including; hepatic pathological findings, therapy related liver damage, and the effects of the viral infection on pre-existing liver diseasesin context of the most recent recommendations. Conclusions: This review sheds light on the impact of COVID-19 infection on the liver, as well as the prognostic effect of liver laboratory markers on disease outcome. Temporal variations in liver parameters during disease course as well as different patterns of derangement are depicted. More intensive surveillance and individualized therapeutic approaches should be tailored for immunocompromised patients with advanced liver disease, hepatocellular carcinoma, and liver transplant patients. Despite the limited studies on COVID-19 infected patients with preexisting liver disease, this comprehensive overview provides a perspective on the management of liver disease during COVID-19.
