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Choe JW, Jung YK, Yim HJ, Seo GH. Clinical Effect of Hepatitis B Virus on COVID-19 Infected Patients: A Nationwide Population-Based Study Using the Health Insurance Review & Assessment Service Database. J Korean Med Sci 2022; 37:e29. [PMID: 35075828 PMCID: PMC8787805 DOI: 10.3346/jkms.2022.37.e29] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Several studies have recently suggested that liver disease and cirrhosis were risk factors for poor outcomes in patients with coronavirus disease 2019 (COVID-19) infections. However, no large data study has reported the clinical course of COVID-19 patients with chronic hepatitis B virus (HBV) infections. This study investigated whether HBV infection had negative impacts on the clinical outcomes of COVID-19 patients. METHODS We performed a nationwide population-based cohort study with 19,160 COVID-19-infected patients in 2020 from the Korean Health Insurance Review and Assessment database. The clinical outcomes of COVID-19 patients with chronic HBV infections were assessed and compared to those of non-HBV-infected patients. RESULTS Of the 19,160 patients diagnosed with COVID-19, 675 (3.5%) patients had chronic HBV infections. The HBV-infected patients were older and had more commodities than the non-HBV infected COVID-19 patients. During the observation period, COVID-19-related mortality was seen in 1,524 (8.2%) of the non-HBV-infected 18,485 patients, whereas 91 (13.5%) in HBV-infected 675 patients died of COVID-19 infection. Compared to patients without HBV infections, a higher proportion of patients with chronic HBV infections required intensive care unit (ICU) admission and had organ failures. However, odds ratios for mortality, ICU admission, and organ failure were comparable between the two groups after adjusting for age, sex, and comorbid diseases including liver cirrhosis and hepatocellular carcinoma. CONCLUSION COVID-19-infected patients with HBV infections showed worse clinical courses than non-HBV-infected COVID-19 patients. However, after adjustment, chronic HBV infection itself does not seem to affect the clinical outcomes in COVID-19 patients.
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Affiliation(s)
- Jung Wan Choe
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Young Kul Jung
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Wonju, Korea.
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Nawghare P, Jain S, Chandnani S, Bansal S, Patel S, Debnath P, Rane S, Deshmukh R, Rathi P, Contractor Q. Predictors of Severity and Mortality in Chronic Liver Disease Patients With COVID-19 During the Second Wave of the Pandemic in India. Cureus 2022; 14:e20891. [PMID: 35145796 PMCID: PMC8809206 DOI: 10.7759/cureus.20891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) infection in chronic liver disease patients is associated with poor outcomes. In this study, we aimed to evaluate the predictors of severity and mortality in this group of patients during the second wave of the COVID-19 pandemic in India. In addition, we compared cirrhotic patients with COVID-19 with cirrhotic patients from the pre-COVID-19 period. Methodology This was a single-center observational study. We included data from 50 patients with cirrhosis and COVID-19 retrospectively from the discharge/death files. A comparison group of 100 patients with cirrhosis from the pre-COVID period was also analyzed retrospectively. Results The majority of patients had predominantly respiratory symptoms, with fever being the most common symptom (85%). The most common presentation was acute on chronic liver failure (ACLF). The most common form of decompensation was jaundice followed by hepatic encephalopathy. The overall mortality in cirrhotic patients with COVID-19 was double than that in cirrhotic patients from the pre-COVID-19 period. All patients with ACLF succumbed to multiorgan failure. Diabetes was the only comorbidity that was associated with severe infection. Higher creatinine on admission and high D-dimer levels correlated with severity. D-dimer was the only parameter that correlated with severity and mortality on multivariate analysis. None of the comorbidities predicted mortality. Among various composite scores, the Child-Turcotte-Pugh (CTP) score and CURB-65 correlated with mortality. On the area under the receiver operating characteristic analysis, a D-dimer level of >1.1 mg/L was associated with mortality. Conclusions COVID-19 infection in patients with cirrhosis is associated with poor outcomes. D-dimer levels of >1.1 mg/L on admission are a simple parameter to predict mortality. CTP and CURB-65 are composite scores that correlate with mortality in this group of patients.
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103
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Management of COVID-19 patients with chronic liver diseases and liver transplants. Ann Hepatol 2022; 27:100653. [PMID: 34929350 PMCID: PMC8683212 DOI: 10.1016/j.aohep.2021.100653] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 02/04/2023]
Abstract
The epidemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has increasingly attracted worldwide concern. Liver damage or dysfunction occurred in patients with COVID-19 (mainly characterized by moderately elevated serum aspartate aminotransferase levels). However, it is not yet clear whether the COVID-19-related liver injury is mainly caused by the virus infection, potentially hepatotoxic drugs, or other coexisting conditions. Progression of pre-existing chronic liver disease (CLD) may be the underlying mechanism of liver injury. Although COVID-19 patients with CLD, such as nonalcoholic fatty liver disease, liver cirrhosis, and liver cancer, have been deemed at increased risk for serious illness in many studies, little is known about the impact of CLD on the natural history and outcome of COVID-19 patients. Thereby, based on the latest evidence from case reports and case series, this paper discusses the clinical manifestations, treatment, prognosis, and management of the COVID-19 patients with different CLD. This article also reviews the effect of COVID-19 on liver transplantation patients (LT), hoping to work for future prevention, management, and control measures of COVID-19. However, due to the lack of relevant research, most of them are still limited to the theoretical stage, further study of COVID-19 and CLD needs to be improved in the future.
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104
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Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis. Can J Gastroenterol Hepatol 2022; 2022:7235860. [PMID: 35369116 PMCID: PMC8966744 DOI: 10.1155/2022/7235860] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/18/2022] [Indexed: 02/07/2023] Open
Abstract
Methods We identified relevant cohort studies that assessed the relationship between liver fibrosis scores (e.g., FIB-4, NAFLD fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI)) and associated prognosis outcomes by searching the PubMed, EMBASE, and medRxiv databases. The potential dose-response effect was performed using a stage robust error meta-regression. Results Sixteen studies with 8,736 hospitalized patients with COVID-19 were included. One-point score in FIB-4 increase was significantly associated with increased mechanical ventilation (RR: 2.23, 95% CI: 1.37-3.65, P=0.001), severe COVID-19 (RR: 1.82, 95% CI: 1.53-2.16, P < 0.001), and death (RR: 1.47, 95% CI: 1.31-1.65, P < 0.001), rather than hospitalization (RR: 1.35, 95% CI: 0.72-2.56, P=0.35). Furthermore, there is a significant positive linear relationship between FIB-4 and severe COVID-19 (P nonlinearity=0.12) and mortality (P nonlinearity=0.18). Regarding other liver scores, one unit elevation in APRI increased the risk of death by 178% (RR: 2.78, 95% CI: 1.10-6.99, P=0.03). Higher NFS (≥-1.5) and Forns index were associated with increased risk of severe COVID-19 and COVID-19-associated death. Conclusion Our dose-response meta-analysis suggests high liver fibrosis scores are associated with worse prognosis in patients with COVID-19. For patients with COVID-19 at admission, especially for those with coexisting chronic liver diseases, assessment of liver fibrosis scores might be useful for identifying high risk of developing severe COVID-19 cases and worse outcomes.
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105
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Ekpanyapong S, Bunchorntavakul C, Reddy KR. COVID-19 and the Liver: Lessons Learnt from the EAST and the WEST, A Year Later. J Viral Hepat 2022; 29:4-20. [PMID: 34352133 PMCID: PMC8446947 DOI: 10.1111/jvh.13590] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023]
Abstract
Globally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) has been a major cause for significant morbidity and mortality. Since the start of the pandemic, several hepato-biliary manifestations in coronavirus disease 2019 (COVID-19) have been described and unique considerations raised. The review aims to summarize the pathogenesis and hepato-biliary manifestations in COVID-19 and discuss the similarities, contrasting features and disease-specific management across a range of hepato-biliary diseases from the EAST and the WEST. Published studies and regional society guidelines from the EAST and the WEST were comprehensively reviewed and summarized. A wide range of hepato-biliary manifestations, including the infrequent and chronic manifestation of cholangiopathy, has been observed in COVID-19. The pathogenesis of liver injury is multifactorial and with scant evidence for a direct SARS-CoV-2 infection of the liver. Patients with non-alcoholic fatty liver disease, cirrhosis, and liver cancer are potentially at increased risk for severe COVID-19, and there are unique considerations in chronic hepatitis B or C, hepatocellular carcinoma, and in those immunosuppressed such as autoimmune hepatitis or liver transplant recipients. With the surges in SARS-CoV-2 infection, liver transplant activity has variably been impacted. Preliminarily, SARS-CoV-2 vaccines appear to be safe in those with chronic liver disease and in transplant recipients, while emerging data suggest the need for a third dose in immunosuppressed patients. In conclusion, patients with chronic liver disease, particularly cirrhosis, and liver transplant recipients, are vulnerable to severe COVID-19. Over the past year, several unique considerations have been highlighted across a spectrum of hepato-biliary diseases. Vaccination is strongly recommended for those with chronic liver disease and liver transplant recipients.
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Affiliation(s)
- Sirina Ekpanyapong
- Division of Gastroenterology and HepatologyDepartment of MedicineRajavithi HospitalBangkokThailand
| | | | - K. Rajender Reddy
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Wade H, Duan Q, Su Q. Interaction between Sars-CoV-2 structural proteins and host cellular receptors: From basic mechanisms to clinical perspectives. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2022; 132:243-277. [PMID: 36088078 PMCID: PMC9182089 DOI: 10.1016/bs.apcsb.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) has caused a global pandemic that has affected the lives of billions of individuals. Sars-CoV-2 primarily infects human cells by binding of the viral spike protein to angiotensin-converting enzyme 2 (ACE2). In addition, novel means of viral entry are currently being investigated, including Neuropillin 1, toll-like receptors (TLRs), cluster of differentiation 147 (CD147), and integrin α5β1. Enriched expression of these proteins across metabolic regulatory organs/tissues, including the circulatory system, liver, pancreas, and intestine contributes to major clinical complications among COVID-19 patients, particularly the development of hypertension, myocardial injury, arrhythmia, acute coronary syndrome and increased coagulation in the circulatory system during and post-infection. Pre-existing metabolic disease, such as cardiovascular disease, obesity, diabetes, and non-alcoholic fatty liver disease, is associated with increased risk of hospitalization, persistent post-infection complications and worse outcomes in patients with COVID-19. This review overviews the biological features of Sars-CoV-2, highlights recent findings that delineate the pathological mechanisms of COVID-19 and the consequent clinical diseases.
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107
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Korath ADJ, Janda J, Untersmayr E, Sokolowska M, Feleszko W, Agache I, Adel Seida A, Hartmann K, Jensen‐Jarolim E, Pali‐Schöll I. One Health: EAACI Position Paper on coronaviruses at the human-animal interface, with a specific focus on comparative and zoonotic aspects of SARS-CoV-2. Allergy 2022; 77:55-71. [PMID: 34180546 PMCID: PMC8441637 DOI: 10.1111/all.14991] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022]
Abstract
The latest outbreak of a coronavirus disease in 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evolved into a worldwide pandemic with massive effects on health, quality of life, and economy. Given the short period of time since the outbreak, there are several knowledge gaps on the comparative and zoonotic aspects of this new virus. Within the One Health concept, the current EAACI position paper dwells into the current knowledge on SARS-CoV-2's receptors, symptoms, transmission routes for human and animals living in close vicinity to each other, usefulness of animal models to study this disease and management options to avoid intra- and interspecies transmission. Similar pandemics might appear unexpectedly and more frequently in the near future due to climate change, consumption of exotic foods and drinks, globe-trotter travel possibilities, the growing world population, the decreasing production space, declining room for wildlife and free-ranging animals, and the changed lifestyle including living very close to animals. Therefore, both the society and the health authorities need to be aware and well prepared for similar future situations, and research needs to focus on prevention and fast development of treatment options (medications, vaccines).
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Affiliation(s)
- Anna D. J. Korath
- Comparative MedicineInteruniversity Messerli Research InstituteUniversity of Veterinary Medicine and Medical University ViennaViennaAustria
| | - Jozef Janda
- Faculty of ScienceCharles UniversityPragueCzech Republic
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy ResearchCenter of Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF),University of ZurichZurichSwitzerland
| | - Wojciech Feleszko
- Department of Paediatric Allergy and PulmonologyThe Medical University of WarsawWarsawPoland
| | | | - Ahmed Adel Seida
- Department of Microbiology and ImmunologyFaculty of Veterinary MedicineCairo UniversityCairoEgypt
| | - Katrin Hartmann
- Medizinische KleintierklinikZentrum für Klinische TiermedizinLMUMunichGermany
| | - Erika Jensen‐Jarolim
- Comparative MedicineInteruniversity Messerli Research InstituteUniversity of Veterinary Medicine and Medical University ViennaViennaAustria
- Institute of Pathophysiology and Allergy ResearchCenter of Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Isabella Pali‐Schöll
- Comparative MedicineInteruniversity Messerli Research InstituteUniversity of Veterinary Medicine and Medical University ViennaViennaAustria
- Institute of Pathophysiology and Allergy ResearchCenter of Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
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108
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Madan K, Rastogi R, Bhargava R, Dagar V, Singla V, Sahu A, Singh P, Garg P, Aggarwal B, Singh RK. Is Fatty Liver Associated with Increased Mortality and Morbidity in Coronavirus Disease 2019 (COVID-19) Pneumonia? J Clin Exp Hepatol 2022; 12:1320-1327. [PMID: 35469129 PMCID: PMC9020647 DOI: 10.1016/j.jceh.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fatty liver has been shown to be associated with severe COVID-19 disease without any impact on mortality. This is based on heterogenous criteria for defining both fatty liver as well as the severity parameters. This study aimed to study the impact of fatty liver on the mortality and severity of disease in patients with COVID-19 pneumonia. METHODS In a case control study design, patients with COVID-19 pneumonia (COVID-19 computed tomography severity index [CTSI] on high-resolution computed tomography chest of ≥1) with fatty liver (defined as liver to spleen attenuation index ≤5 on noncontrast computed tomography cuts of upper abdomen) were compared with those without fatty liver. The primary outcome measure was in-hospital mortality, and the secondary outcome measures were CTSI score, need for intensive care unit (ICU) care, need for ventilatory support, duration of ICU stay, and duration of hospital stay. RESULTS Of 446 patients with COVID-19 pneumonia, 289 (64.7%)admitted to Max Hospital, Saket, India, between January 1, 2021, and October 30, 2021, had fatty liver. Fifty-nine of 446 patients died during the index admission. In-hospital mortality was not different between patients with fatty liver (38 [13.24%]) or without fatty liver (21 [13.81%]). COVID-19 CTSI score was found to be significantly higher among patients who had fatty liver (13.40 [5.16] vs 11.81 [5.50]; P = 0.003). There was no difference in the requirement of ICU (94 [32%] vs 62 [39.49%]; P = 0.752), requirement of ventilatory support (27 [9.34%] vs 14 [8.91%]; P = 0.385), duration of ICU stay (8.29 [6.87] vs 7.07 [5.71] days; P = 0.208), and duration of hospital stay (10.10 [7.14] vs 10.69 [8.13] days; P = 0.430) between the groups with fatty liver or no fatty liver. Similarly, no difference was found in primary or secondary outcomes measure between the group with severe fatty liver vs mild/moderate or no fatty liver. High total leucocyte count and Fibrosis-4 (FIB-4) index were independently associated with mortality. CONCLUSIONS Fatty liver may not be associated with increased mortality or clinical morbidity in patients who have COVID-19 pneumonia.
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Affiliation(s)
- Kaushal Madan
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
- Address for correspondence: Dr Kaushal Madan, Principal Director and Head, Clinical Hepatology, Centre for Gastroenterology, Hepatology & Endoscopy, Max Institute of Liver and GI Sciences, Max Hospitals, Saket, New Delhi 110017, India.
| | - Ruchi Rastogi
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
| | - Richa Bhargava
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Vineeta Dagar
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
| | - Vikas Singla
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Amit Sahu
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
| | - Pankaj Singh
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Pallavi Garg
- Max Centre for Gastroenterology, Hepatology & Endoscopy, Max Hospitals, Saket, New Delhi 110017, India
| | - Bharat Aggarwal
- Department of Radiodiagnosis, Max Hospitals, Saket, New Delhi 110017, India
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Philips CA, Rela M, Soin AS, Gupta S, Surendran S, Augustine P. Critical Update on the Diagnosis and Management of COVID-19 in Advanced Cirrhosis and Liver Transplant Recipients. J Clin Transl Hepatol 2021; 9:947-959. [PMID: 34966658 PMCID: PMC8666374 DOI: 10.14218/jcth.2021.00228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has impacted health care worldwide, with specific patient populations, such as those with diabetes, cardiovascular disease, and chronic lung disease, at higher risk of infection and others at higher risk of disease progression. Patients with decompensated cirrhosis fall into the latter category and are a unique group that require specific treatment and management decisions because they can develop acute-on-chronic liver failure. In liver transplant recipients, the atypical immunity profile due to immunosuppression protects against downstream inflammatory responses triggered by COVID-19. This exhaustive review discusses the outcomes associated with COVID-19 in patients with advanced cirrhosis and in liver transplant recipients. We focus on the immunopathogenesis of COVID-19, its correlation with the pathogenesis of advanced liver disease, and the effect of immunosuppression in liver transplant recipients to provide insight into the outcomes of this unique patient population.
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Affiliation(s)
- Cyriac Abby Philips
- Department of Clinical and Translational Hepatology and The Monarch Liver Laboratory, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Mohamed Rela
- Institute of Liver Disease and Liver Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Arvinder Singh Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India
| | - Subhash Gupta
- Max Centre for Liver and Biliary Sciences, Max Saket Hospital, New Delhi, India
| | - Sudhindran Surendran
- Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Philip Augustine
- Gastroenterology and Advanced GI Endoscopy, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
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Kalal CR, Joshi H, Kumar V, Gopal D, Rathod D, Shukla A, Gianchandani T, Bhatt C. Clinical Significance of Liver Function Abnormality in Patients with COVID-19: A Single-center Experience from Western India. J Clin Transl Hepatol 2021; 9:878-888. [PMID: 34966651 PMCID: PMC8666361 DOI: 10.14218/jcth.2020.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/18/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS The impact of coronavirus disease-2019 (COVID-19) on liver function remains to be fully elucidated. This study was designed to investigate such and determine the clinical significance in determining mortality risk. METHODS A retrospective study was conducted in patients with COVID-19 from March 2020 to July 2020. Clinical details were retrieved from electronic medical records to obtain clinical characteristics, medical history, laboratory tests, therapeutic intervention, and outcome data. RESULTS A total of 184 patients with COVID-19 were included (median age: 45.5 years), comprised of 62.5% men. In total, 22 (12.0%) patients had severe infection and 162 (88.0%) had mild to moderate infection. Overall, 95 (51.6%) showed abnormal liver function test (LFT) and 17 (9.2%) showed normal LFT at admission. The median age, hospital stay, and LFT were significantly higher in severe vs. non-severe infection (p<0.001). Out of 12 deaths, the majority were due to severe infection (n=11). Deaths were also due to acute respiratory distress syndrome (n=5), cardiac reasons (n=3), and sepsis with multiorgan failure (n=3). The median age, hospital stay and number of intensive care unit admissions were higher in patients having abnormal LFT compared to normal LFT. Incidence of elevated aspartate aminotransferase (42.8% and 40.4%), alanine transaminase (43.7% and 41.6%), and hypoalbuminemia (71.4% and72.7%) at admission and discharge were more common in severe infection. The mean survival was significantly lower in severe infection compared to those with non-severe disease (17.2 vs. 52.3 days; p<0.001). CONCLUSIONS Incidence of abnormal liver function was higher in patients with severe COVID-19 and was associated with prolonged hospital stay; mortality was associated with severity of COVID-19. For ruling out the risk of liver injury, it is crucial to vigilantly monitor the liver function parameters in patients with COVID-19 admitted to hospital.
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Affiliation(s)
- Chetan R. Kalal
- Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
- Correspondence to: Chetan R. Kalal, Hepatology, Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra 400004, India. Tel: +91-8506873687, E-mail:
| | - Harshad Joshi
- Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Vivek Kumar
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Divya Gopal
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Darshana Rathod
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ashish Shukla
- Department of Critical Care, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Tarang Gianchandani
- Department of Administration, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Chetan Bhatt
- Department of Gastroenterology, Hepatology and Liver Transplant, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
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Kayaaslan B, Guner R. COVID-19 and the liver: A brief and core review. World J Hepatol 2021; 13:2013-2023. [PMID: 35070005 PMCID: PMC8727220 DOI: 10.4254/wjh.v13.i12.2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/23/2021] [Accepted: 11/27/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 has a wide range of clinical spectrum from asymptomatic infection to severe infection resulting in death within a short time. Currently, it is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) does not only cause a respiratory tract infection but a more complicated disease that can lead to multiple system involvement including the liver. Herein, we evaluate the epidemiology, the impact of liver injury/ dysfunction on disease prognosis, the pathophysiological mechanisms and management of liver injury. More than one-fourth of the patients have abnormal liver function tests, mostly a mild-to-moderate liver dysfunction. Liver injury is significantly associated with a poor clinical outcome. Direct cytotoxic effect of SARS-CoV-2, the immune response ("cytokine storm"), the complications related to the disease, and drugs used in the treatments are the pathophysiological mechanisms responsible for liver injury. However, the exact mechanism is not yet clearly explained. The binding of SARS-CoV-2 to the angiotensin-converting enzyme 2 receptors and entering the hepatocyte and cholangiocytes can cause cytotoxic effects on the liver. Excessive immune response has an important role in disease progression and causes acute respiratory distress syndrome and multi-organ failures accompanied by liver injury. Treatment drugs, particularly lopinavir/ritonavir, remdesivir and antibiotics are a frequent reason for liver injury. The possible reasons should be meticulously investigated and resolved.
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Affiliation(s)
- Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara 06800, Turkey.
| | - Rahmet Guner
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara 06800, Turkey
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Ahmed MH, Ahmed HAAM, Nosair NAEA, Hassan AM, Sherief DE, Mahros AM. Fecal Calprotectin as a Predictor of COVID-19 Severity. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1055/s-0041-1736646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AbstractCoronavirus disease 2019 (COVID-19) is highly transmittable through contact with respiratory droplets. The virus is also shed in fecal matter. Some patients may present with effects in more than one system; however, there are no defined biomarkers that can accurately predict the course or progression of the disease. The present study aimed to estimate the severity of the disease, to correlate the severity of the disease with biochemical predictors, to identify valuable biomarkers indicative of gastrointestinal disease, and to determine the cutoff values. A cross-sectional study was conducted on COVID-19 patients admitted to the Kafrelsheikh University Hospital (isolation unit) between July 10, 2020, and October 30, 2020. The diagnosis of COVID-19 was confirmed via reverse transcription-polymerase chain reaction (RT-PCR), which was employed for the detection of the viral RNA. We conclude that lymphopenia, elevated C-reactive protein (CRP) level, and liver enzymes were among the most important laboratory findings in COVID-19 patients. Statistically significant differences in platelet count, neutrophil count, D-dimer level, and fecal calprotectin levels were observed among patients presenting with chest symptoms only and patients with both chest and gastrointestinal symptoms (p = 0.004; < 0.001; 0.010; 0.003; and < 0.001, respectively). C-reactive protein, D-dimer, and fecal calprotectin levels positively correlated with disease severity. The cutoff value for fecal calprotectin that can predict gastrointestinal involvement in COVID-19 was 165.0, with a sensitivity of 88.1% and a specificity of 76.5%.
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Affiliation(s)
- Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | | | - Nahla Abd el-Aziz Nosair
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Asmaa Mbarak Hassan
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Dalia ElSayed Sherief
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Aya Mohammed Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Sabetkish N, Rahmani A. The overall impact of COVID-19 on healthcare during the pandemic: A multidisciplinary point of view. Health Sci Rep 2021; 4:e386. [PMID: 34622020 PMCID: PMC8485600 DOI: 10.1002/hsr2.386] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS The Coronavirus disease 2019 (COVID-19) pandemic globally changed the priorities of medical and surgical procedures. It has caused many healthcare systems to stop performing their routine screenings. Altering medical clinics to COVID-19 referral centers, lockdowns, and the public fear to refer to medical centers caused a significant reduction in the referral rate; especially in the elderly. This short review article highlights the transform in clinical practice during the post-COVID era and the need for future medical revolutions. METHODS A comprehensive literature search was separately performed by both authors. The articles published between 2019 and August 2021 were included in this study and selected according to a quality appraisal method. RESULTS We have summarized the possible corresponding changes in the diagnosis and treatment of all fields of medical care including internal medicine, surgical, and minor subcategories after the COVID-19 pandemic. We have also discussed the potential impacts of the pandemic on all these different categories and subcategories of medicine, including the outpatient setting and clinical work. We do believe that the lack of routine check-ups has led to an increase in the stage of disease in patients with a previously diagnosed problem. On the other hand, the dramatic change in the lifestyle of the population including restricted mobility and increased consumption of unhealthy food has caused metabolic syndrome and other new diseases that have not been diagnosed and properly managed. CONCLUSION Our findings revealed the urgent need for public health awareness. It indicated the need to carry out both psychological and screening approaches in the post-COVID era to not miss patients with a chronic disease and new cases who were undiagnosed during the COVID pandemic.
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Affiliation(s)
- Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical CenterTehran University of Medical SciencesTehranIran
- ImmunologyAsthma and Allergy Research Institute, Tehran University of Medical SciencesTehranIran
| | - Alireza Rahmani
- Research Center for Prevention of Cardiovascular DiseaseInstitute of Endocrinology & Metabolism, Iran University of Medical SciencesTehranIran
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Gato S, Lucena-Valera A, Muñoz-Hernández R, Sousa JM, Romero-Gómez M, Ampuero J. Impact of COVID-19 on liver disease: From the experimental to the clinic perspective. World J Virol 2021; 10:301-311. [PMID: 34909404 PMCID: PMC8641041 DOI: 10.5501/wjv.v10.i6.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/18/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has caused a global pandemic unprecedented in over a century. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a predominantly respiratory infection, various degrees of liver function abnormalities have been reported. Pre-existing liver disease in patients with SARS-CoV-2 infection has not been comprehensively evaluated in most studies, but it can critically compromise survival and trigger hepatic decompensation. The collapse of the healthcare services has negatively impacted the diagnosis, monitoring, and treatment of liver diseases in non-COVID-19 patients. In this review, we aim to discuss the impact of COVID-19 on liver disease from the experimental to the clinic perspective.
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Affiliation(s)
- Sheila Gato
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
| | - Ana Lucena-Valera
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
| | - Rocío Muñoz-Hernández
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
- University of Seville, Sevilla 41013, Spain
| | - José Manuel Sousa
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
| | - Manuel Romero-Gómez
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
- University of Seville, Sevilla 41013, Spain
| | - Javier Ampuero
- SeLiver Group, Instituto de Biomedicina de Sevilla, Sevilla 41013, Spain
- Digestive Department, Hospital Universitario Virgen del Rocio, Sevilla 41013, Spain
- University of Seville, Sevilla 41013, Spain
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Afify S, Eysa B, Hamid FA, Abo-Elazm OM, Edris MA, Maher R, Abdelhalim A, Abdel Ghaffar MM, Omran DA, Shousha HI. Survival and outcomes for co-infection of chronic hepatitis C with and without cirrhosis and COVID-19: A multicenter retrospective study. World J Gastroenterol 2021; 27:7362-7375. [PMID: 34876795 PMCID: PMC8611210 DOI: 10.3748/wjg.v27.i42.7362] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/12/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic liver disease, particularly cirrhosis, is associated with worse outcomes in patients infected with coronavirus disease 2019 (COVID-19).
AIM To assess outcomes of COVID-19 infection among patients with pre-existing hepatitis C with or without liver cirrhosis.
METHODS This multicenter, retrospective cohort study included all cases of confirmed co-infection of severe acute respiratory syndrome coronavirus 2 and chronic hepatitis C with or without liver cirrhosis who were admitted to six hospitals (Al-Sahel Hospital, Al-Matareya Hospital, Al-Ahrar Hospital, Ahmed Maher Teaching Hospital, Al-Gomhoreya Hospital, and the National Hepatology and Tropical Medicine Research Institute) affiliated with the General Organization for Teaching Hospitals and Institutes in Egypt. Patients were recruited from May 1, 2020, to July 31, 2020. Demographic, laboratory, imaging features, and outcomes were collected. Multivariate regression analysis was performed to detect factors affecting mortality.
RESULTS This retrospective cohort study included 125 patients with chronic hepatitis C and COVID-19 co-infection, of which 64 (51.20%) had liver cirrhosis and 40 (32.00%) died. Fever, cough, dyspnea, and fatigue were the most frequent symptoms in patients with liver cirrhosis. Cough, sore throat, fatigue, myalgia, and diarrhea were significantly more common in patients with liver cirrhosis than in non-cirrhotic patients. There was no difference between patients with and without cirrhosis regarding comorbidities. Fifteen patients (23.40%) with liver cirrhosis presented with hepatic encephalopathy. Patients with liver cirrhosis were more likely than non-cirrhotic patients to have combined ground-glass opacities and consolidations in CT chest scans: 28 (43.75%) vs 4 (6.55%), respectively (P value < 0.001). These patients also were more likely to have severe COVID-19 infection, compared to patients without liver cirrhosis: 29 (45.31%) vs 11 (18.04%), respectively (P value < 0.003). Mortality was higher in patients with liver cirrhosis, compared to those with no cirrhosis: 33 (51.56%) vs 9 (14.75%), respectively (P value < 0.001). All patients in Child-Pugh class A recovered and were discharged. Cirrhotic mortality occurred among decompensated patients only. A multivariate regression analysis revealed the following independent factors affecting mortality: Male gender (OR 7.17, 95%CI: 2.19–23.51; P value = 0.001), diabetes mellitus (OR 4.03, 95%CI: 1.49–10.91; P value = 0.006), and liver cirrhosis (OR 1.103, 95%CI: 1.037–1.282; P value < 0.0001). We found no differences in liver function, COVID-19 disease severity, or outcomes between patients who previously received direct-acting antiviral therapy (and achieved sustained virological response) and patients who did not receive this therapy.
CONCLUSION Patients with liver cirrhosis are susceptible to higher severity and mortality if infected with COVID-19. Male gender, diabetes mellitus, and liver cirrhosis are independent factors associated with increased mortality risk.
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Affiliation(s)
- Shimaa Afify
- Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo 20222, Egypt
| | - Basem Eysa
- Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo 20222, Egypt
| | - Fatma Abdel Hamid
- Department of Endemic Medicine, Faculty of Medicine, Fayoum University, El-Fayoum 13524, Egypt
| | - Omnia M Abo-Elazm
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo 20222, Egypt
| | - Mohamed A Edris
- Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo 20222, Egypt
| | - Rabab Maher
- Department of Gastroenterology, Students Hospital, Cairo University, Giza 12111, Egypt
| | - Ahmed Abdelhalim
- Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo 20222, Egypt
| | | | - Dalia A Omran
- Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Hend Ibrahim Shousha
- Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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116
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Nayak B, Lal G, Kumar S, Das CJ, Saraya A, Shalimar. Host Response to SARS-CoV2 and Emerging Variants in Pre-Existing Liver and Gastrointestinal Diseases. Front Cell Infect Microbiol 2021; 11:753249. [PMID: 34760721 PMCID: PMC8573081 DOI: 10.3389/fcimb.2021.753249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background Novel coronavirus SARS-CoV2 is evolving continuously with emergence of several variants of increasing transmission capabilities and pandemic potential. Generation of variants occurs through accumulation of mutations due to the RNA nature of viral genome, which is further enhanced by variable selection pressures of this ongoing pandemic. COVID-19 presentations of SARS-CoV2 are mainly pulmonary manifestations with or without mild gastrointestinal (GI) and hepatic symptoms. However, the virus has evolved beyond pulmonary manifestations to multisystem disorder due to systemic inflammation and cytokine storm. Definitive cause of acute or late onset of inflammation, infection in various organs, and host response to emerging variants lacks clarity and needs elucidation. Several studies have reported underlying diseases including diabetes, hypertension, obesity, cardio- and cerebrovascular disorders, and immunocompromised conditions as significant risk factors for severe form of COVID-19. Pre-existing liver and GI diseases are also highly predominant in the population, which can alter COVID-19 outcome due to altered immune status and host response. We aim to review the emerging variants of SARS-CoV2 and host response in patients with pre-existing liver and GI diseases. Methods In this review, we have elucidated the emergence and characteristic features of new SARS-CoV2 variants, mechanisms of infection and host immune response, GI and hepatic manifestation with radiologic features of COVID-19, and outcomes in pre-existing liver and GI diseases. Key Findings Emerging variants of concern (VOC) have shown increased transmissibility and virulence with severe COVID-19 presentation and mortality. There is a drastic swift of variants from the first wave to the next wave of infections with predominated major VOC including alpha (B.1.1.7, UK), beta (B.1.351, South Africa), gamma (B.1.1.28.1, Brazil), and delta (B1.1.617, India) variants. The mutations in the spike protein of VOC are implicated for increased receptor binding (N501Y, P681R) and immune escape (L452R, E484K/Q, T478K/R) to host response. Pre-existing liver and GI diseases not only have altered tissue expression and distribution of viral entry ACE2 receptor but also host protease TMPRSS2, which is required for both spike protein binding and cleavage to initiate infection. Altered immune status due to pre-existing conditions results in delayed virus clearance or prolonged viremia. Even though GI and hepatic manifestations of SARS-CoV2 are less severe, the detection of virus in patient’s stool indicates GI tropism, replication, and shedding from the GI tract. COVID-19-induced liver injury, acute hepatic decompensation, and incidences of acute-on-chronic liver failure may change the disease outcomes. Conclusions The changes in the spike protein of emerging variants, immunomodulation by viral proteins, and altered expression of host viral entry receptor in pre-existing diseases are the key determinants of host response to SARS-CoV2 and its disease outcome.
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Affiliation(s)
- Baibaswata Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Geetanjali Lal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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117
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Dawood RM, Salum GM, El-Meguid MA. The Impact of COVID-19 on Liver Injury: COVID-19 and Liver Injury. Am J Med Sci 2021; 363:94-103. [PMID: 34752738 PMCID: PMC8571104 DOI: 10.1016/j.amjms.2021.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/14/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
The current coronavirus disease outbreak of 2019 (COVID-19) has led to a global pandemic. The principal cause of mortality in COVID-19 is represented lung injury with the development of acute respiratory distress syndrome (ARDS). In patients with COVID-19 infection, liver injury or liver dysfunction has been reported. It may be associated with the general severity of the disease and serve as a prognostic factor for ARDS development. In COVID-19, the spectrum of liver damage may range from direct SARS-CoV-2 viral proteins, inflammatory processes, hypoxemia, the antiviral drugs induced hepatic injury and the presence of the preexisting liver disease. We highlight in this review important topics such as the epidemiological features, potential causes of liver injury, and the strategies for management and prevention of hepatic injury in COVID-19 patients.
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Affiliation(s)
- Reham M Dawood
- Department of Microbial Biotechnology, Genetic Engineering Division, National Research Centre, Giza, Egypt.
| | - Ghada Maher Salum
- Department of Microbial Biotechnology, Genetic Engineering Division, National Research Centre, Giza, Egypt
| | - Mai Abd El-Meguid
- Department of Microbial Biotechnology, Genetic Engineering Division, National Research Centre, Giza, Egypt
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118
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Ruiz I, Huard G, Fournier C, Bissonnette J, Castel H, Giard JM, Villeneuve JP, Fenyves D, Marleau D, Willems B, Corsilli D, Correal F, Ferreira V, Martel D, Mathieu A, Vincent C, Bilodeau M. A real-world experience of SARS-CoV-2 infection in a tertiary referral centre of Montréal: Unexpected low prevalence and low mortality. CANADIAN LIVER JOURNAL 2021; 4:391-400. [DOI: 10.3138/canlivj-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with chronic liver disease (CLD) and liver transplant (LT) recipients remains a concern. The aim of this study was to report the impact of coronavirus disease 2019 (COVID-19) infection among patients at the tertiary health care centre Centre hospitalier de l’Université de Montréal (CHUM) during the first wave of the SARS-CoV-2 pandemic. METHODS: This real-world, retrospective cohort included all patients admitted to our liver unit and/or seen as an outpatient with CLD with or without cirrhosis and/or LT recipients who tested positive to SARS-CoV-2 infection. Cases were considered positive as defined by the detection of SARS-CoV-2 by reverse-transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. RESULTS: Between April 1 and July 31, 2020, 5,637 were admitted to our liver unit and/or seen as outpatient. Among them, 42 were positive for SARS-CoV-2. Twenty-two patients had CLD without cirrhosis while 16 patients had cirrhosis at the time of the infection (13, 2, and 1 with Child–Pugh A, B, and C scores, respectively). Four were LT recipients. Overall, 15 of 42 patients (35.7%) were hospitalized; among them, 7 of 42 (16.7%) required respiratory support and 4 of 42 (9.5%) were transferred to the intensive care unit. Only 4 of 42 (9.5%) patients died: 2 with CLD without cirrhosis and 2 with CLD with cirrhosis. Overall survival was 90.5%. CONCLUSION: This real-world study demonstrates an unexpectedly low prevalence and low mortality in the context of SARS-CoV-2 infection among patients with CLD with or without cirrhosis and LT recipients.
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Affiliation(s)
- Isaac Ruiz
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Geneviève Huard
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Claire Fournier
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Julien Bissonnette
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Hélène Castel
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jeanne-Marie Giard
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jean-Pierre Villeneuve
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daphna Fenyves
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Denis Marleau
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Bernard Willems
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daniel Corsilli
- Intensive Care Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Florence Correal
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Victor Ferreira
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Dominic Martel
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alexandre Mathieu
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Catherine Vincent
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Marc Bilodeau
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
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Sirinawasatien A, Chantarojanasiri T, Ekpanyapong S, Tivatunsakul N, Luvira V. Coronavirus disease 2019 gastrointestinal and liver manifestations in adults: A review. JGH Open 2021; 5:1257-1265. [PMID: 34816011 PMCID: PMC8593773 DOI: 10.1002/jgh3.12671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an important health problem that has a serious adverse impact on the global economy and healthcare systems. The virus is not only involved in the respiratory system, but also causes other systemic effects as well as several gastrointestinal and liver issues. Evidence has shown direct viral invasion into the gastrointestinal tissue and supporting vascular network, causing various manifestations such as diarrhea, nausea, gastrointestinal bleeding, and abnormal liver function tests. The degree of gastrointestinal injury, especially in terms of liver involvement, is correlated with disease severity. There is no specific treatment for gastrointestinal involvement, and the symptoms can be managed with supportive therapy. Moreover, increased liver decompensation and mortality can be found in COVID-19-infected patients with coexisting liver disease. As the virus can be identified in gastrointestinal contents, endoscopic procedures during the pandemic should be carefully selected and proper protection strategies should be encouraged to prevent viral transmission.
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Affiliation(s)
- Apichet Sirinawasatien
- Division of Gastroenterology, Department of Medicine, Rajavithi Hospital, College of MedicineRungsit UniversityBangkokThailand
| | - Tanyaporn Chantarojanasiri
- Division of Gastroenterology, Department of Medicine, Rajavithi Hospital, College of MedicineRungsit UniversityBangkokThailand
| | - Sirina Ekpanyapong
- Division of Gastroenterology, Department of Medicine, Rajavithi Hospital, College of MedicineRungsit UniversityBangkokThailand
| | - Naris Tivatunsakul
- Division of Gastroenterology, Department of MedicineBanpong HospitalRatchaburiThailand
| | - Viravarn Luvira
- Department of Clinical Tropical Medicine, Faulty of Tropical MedicineMahidol UniversityBangkokThailand
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Sami R, Hajian MR, Amra B, Soltaninejad F, Mansourian M, Mirfendereski S, Sadegh R, Khademi N, Jalali S, Shokri-Mashhadi N. Risk Factors for the Mortality in Hospitalized Patients with COVID-19: A Brief Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:487-492. [PMID: 34840389 PMCID: PMC8611225 DOI: 10.30476/ijms.2021.47835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 01/12/2023]
Abstract
The cumulative rate of death of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has necessitated better recognizing the risk factors of the disease and the COVID-19-induced mortality. This cross-sectional study aimed to determine the potential risk factors that predict COVID-19-related mortality concentrating on the initial recorded laboratory tests. We extracted admission's medical records of a total of 136 deaths related to COVID-19 and 272 discharged adult inpatients (≥18 years old) related to four referral centers from February 24th to April 12th, 2020, in Isfahan, Iran, to figure out the relationship between the laboratory findings and mortality beyond demographic and clinical findings. We applied the independent sample t test and a chichi square test with SPSS software to compare the differences between the survivor and non-survivor patients. A P value of less than 0.05 was considered significant. Our results showed that greater length of hospitalization (P≤0.001), pre-existing chronic obstructive pulmonary disease (P≤0.001), high pulse rate, hypoxia (P≤0.001), and high computed tomography scan score (P<0.001), in addition to high values of some laboratory parameters, increase the risk of mortality. Moreover, high neutrophil/lymphocyte ratio (OR, 1.890; 95% CI, 1.074-3.325, P=0.027), increased creatinine levels (OR, 15.488; 95% CI, 0.801-299.479, P=0.07), and elevated potassium levels (OR, 13.400; 95% CI, 1.084-165.618, P=0.043) independently predicted in-hospital death related to COVID-19 infection. These results emphasized the potential role of impaired laboratory parameters for the prognosis of fatal outcomes in adult inpatients.
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Affiliation(s)
- Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad-Reza Hajian
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Amra
- Bamdad Respiratory and Sleep Research Center, Department of Internal Medicine, Pulmonary and Sleep Ward, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sam Mirfendereski
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Sadegh
- Department of Community and Prevention Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nilufar Khademi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soheila Jalali
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Shokri-Mashhadi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Moreira JLDS, Barbosa SMB, Gonçalves Júnior J. Pathophysiology and molecular mechanisms of liver injury in severe forms of COVID-19: An integrative review. Clin Res Hepatol Gastroenterol 2021; 45:101752. [PMID: 34303828 PMCID: PMC8299216 DOI: 10.1016/j.clinre.2021.101752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS SARS-CoV-2 has primary pulmonary impairment, but other organs such as the liver can also be affected. This implies a worsening of patient's prognosis and an increase in morbidity and mortality. The metabolic pathways and molecular factors involved in the genesis of this injury are still unknown. Therefore, we aimed to carry out an integrative review about the pathophysiology and possible molecular mechanisms of liver injury by COVID-19. METHODS We carried out an integrative literature review in the following databases: PubMed, Scopus, and Embase from December 2020 to March 2021 using the following descriptors: # 1 "COVID-19" (MeSH) AND / OR # 2 "Liver injury" (MeSH) AND / OR # 3 "Pathophysiology" (MesH). RESULTS The data were extracted and divided into two main themes, for heuristic purposes: "Hepatotropism and SARS-CoV-2", and "Pathophysiological hypotheses for liver injury associated with SARS-CoV-2". CONCLUSIONS The virus seems to promote liver damage through five mechanisms: direct injury, humoral and cellular inflammatory response, hypoxemia caused by a decrease in the effective circulating volume, reinfection through the portal system, and use of drugs in the treatment. The literature also points out that the expression of the angiotensin-converting enzyme II and transmembrane serine protease 2 receptors is expressive in cholangiocyte and is present in hepatocytes, which is a risk factor for the virus to enter these cells. Finally, patients with previous liver disease appear to be more susceptible to liver injury by COVID-19.
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Affiliation(s)
| | | | - Jucier Gonçalves Júnior
- Departament of Internal Medicine - Division of Rheumathology, Universidade de São Paulo (USP), São Paulo, Brazil.
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122
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Idalsoaga F, Ayares G, Arab JP, Díaz LA. COVID-19 and Indirect Liver Injury: A Narrative Synthesis of the Evidence. J Clin Transl Hepatol 2021; 9:760-768. [PMID: 34722191 PMCID: PMC8516829 DOI: 10.14218/jcth.2020.00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/16/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is frequently affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection. The most common manifestations are mildly elevated alanine aminotransferase and aspartate aminotransferase, with a prevalence of 16-53% among patients. Cases with severe coronavirus disease 2019 (COVID-19) seem to have higher rates of acute liver dysfunction, and the presence of abnormal liver tests at admission signifies a higher risk of severe disease during hospitalization. Patients with chronic liver diseases also have a higher risk of severe disease and mortality (mainly seen in patients with metabolic-associated fatty liver disease). Several pathways of damage have been proposed in the liver involvement of COVID-19 patients; although, the end-cause is most likely multifactorial. Abnormal liver tests have been attributed to the expression of angiotensin-converting enzyme 2 receptors in SARS-CoV-2 infection. This enzyme is expressed widely in cholangiocytes and less in hepatocytes. Other factors attributed to liver damage include drug-induced liver injury, uncontrolled release of proinflammatory molecules ("cytokine storm"), pneumonia-associated hypoxia, and direct damage by the infection. Hepatic steatosis, vascular thrombosis, fibrosis, and inflammatory features (including Kupffer cell hyperplasia) are the most common liver histopathological findings in deceased COVID-19 patients, suggesting important indirect mechanisms of liver damage. In this translational medicine-based narrative review, we summarize the current data on the possible indirect mechanisms involved in liver damage due to COVID-19, the histopathological findings, and the impact of these mechanisms in patients with chronic liver disease.
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Affiliation(s)
- Francisco Idalsoaga
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gustavo Ayares
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Envejecimiento y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Correspondence to: Luis Antonio Díaz, Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, Santiago 8330024, Chile. ORCID: https://orcid.org/0000-0002-8540-4930. Tel/Fax:+56-2-2354-3820, E-mail:
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123
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Middleton P, Hsu C, Lythgoe MP. Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000739. [PMID: 34675033 PMCID: PMC8532143 DOI: 10.1136/bmjgast-2021-000739] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed. OBJECTIVES To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection. DESIGN/METHOD PubMed and EMBASE databases were searched for studies included up to 3 February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Quality In Prognostic Score (QUIPS) risk-of-bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane RevMan V.5.4 software using a random effects model. RESULTS 63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality OR of 2.48 (95% CI: 2.02 to 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI: 1.36 to 2.42). CONCLUSION Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination.
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Affiliation(s)
- Paul Middleton
- Institute of Clinical Sciences, Imperial College London, London, UK
| | | | - Mark P Lythgoe
- Department of Surgery & Cancer, Imperial College London, London, UK
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124
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Vitrone M, Mele F, Durante-Mangoni E, Zampino R. Drugs and liver injury: a not to be overlooked binomial in COVID-19. J Chemother 2021; 34:207-220. [PMID: 34644236 DOI: 10.1080/1120009x.2021.1988203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SARS-CoV-2 infection (COVID-19) results predominantly in pulmonary involvement but a direct, virus-induced liver damage may also occur, whose mechanisms are being actively investigated. Accordingly, it appears of utmost importance to monitor liver function and carefully evaluate hepatic safety of the various drugs administered during COVID-19. In this respect, many drugs, biological agents and novel molecules, whose efficacy in COVID-19 is under scrutiny, have also been shown to potentially cause or worsen liver damage. In this article, we review safety data of established as well as promising agents for COVID-19.
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Affiliation(s)
- M Vitrone
- Department of Advanced Medical & Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - F Mele
- Department of Advanced Medical & Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - E Durante-Mangoni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - R Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy.,Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
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125
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Abd-Elsalam S, Soliman S, Esmail ES, Khalaf M, Mostafa EF, Medhat MA, Ahmed OA, El Ghafar MSA, Alboraie M, Hassany SM. Do Zinc Supplements Enhance the Clinical Efficacy of Hydroxychloroquine?: a Randomized, Multicenter Trial. Biol Trace Elem Res 2021; 199:3642-3646. [PMID: 33247380 PMCID: PMC7695238 DOI: 10.1007/s12011-020-02512-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
No specific treatment for COVID-19 infection is available up till now, and there is a great urge for effective treatment to reduce morbidity and mortality during this pandemic. We aimed to evaluate the effect of combining chloroquine/hydroxychloroquine (CQ/HCQ) and zinc in the treatment of COVID-19 patients. This was a randomized clinical trial conducted at three major University hospitals in Egypt. One hundred ninety-one patients with a confirmed diagnosis of COVID-19 infection were randomized into two groups: group I (96) patients received both HCQ and zinc, and group II (95) received HCQ only. The primary endpoints were the recovery within 28 days, the need for mechanical ventilation, and death. The two groups were matched for age and gender. They had no significant difference regarding any of the baseline laboratory parameters or clinical severity grading. Clinical recovery after 28 days was achieved by 79.2% in the zinc group and 77.9% in zinc-free treatment group, without any significant difference (p = 0.969). The need for mechanical ventilation and the overall mortality rates did not show any significant difference between the 2 groups either (p = 0.537 and 0.986, respectively). The age of the patient and the need for mechanical ventilation were the only risk factors associated with the patients' mortality by the univariate regression analysis (p = 0.001 and < 0.001, respectively). Zinc supplements did not enhance the clinical efficacy of HCQ. More randomized studies are needed to evaluate the value of adding zinc to other therapies for COVID 19. ClinicalTrials.gov Identifier: NCT04447534.
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Affiliation(s)
- Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, El-Giash Street, Tanta, 31527, Egypt.
| | - Shaimaa Soliman
- Public health and Community Medicine, Menoufia University, Menoufia, Egypt
| | - Eslam Saber Esmail
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, El-Giash Street, Tanta, 31527, Egypt
| | - Mai Khalaf
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, El-Giash Street, Tanta, 31527, Egypt
| | - Ehab F Mostafa
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed A Medhat
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Mohamed Samir Abd El Ghafar
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Sahar M Hassany
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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126
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Su YJ, Chang CW, Chen MJ, Lai YC. Impact of COVID-19 on liver. World J Clin Cases 2021. [PMID: 34621856 DOI: 10.12998/wjcc.v9.i27.7998.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The incidence of liver injury after coronavirus disease 2019 (COVID-19) infection ranged from 15%-53%. The mechanism includes direct viral cytopathic effect, cytokinesis, and treatment drug-induced liver injury. The symptoms include nausea, vomiting, diarrhea, and loss of appetite. The laboratory results include increased liver enzyme levels, decreased monocyte count, and longer prothrombin time. The most common imaging findings are hepatomegaly on ultrasound, ground-glass opacity on chest computed tomography (CT), and liver hypodensity and pericholecystic fat stranding on abdominal CT. Patients may also have different presentations and poor outcomes of different liver diseases concomitant with COVID-19 infection. Liver function test (LFT) results should be monitored, and all factors known to cause or predispose liver injury should be investigated while managing the patients. The risks of transfer to an intensive care unit, need for mechanical ventilator support, and acute kidney injury is higher in COVID-19 patients with than without abnormal LFTs. Increased mortality and length of hospital stay are both observed.
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Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
| | - Chen-Wang Chang
- MacKay Junior College of Medicine, Nursing and Management, Taipei City 25245, Taiwan
| | - Ming-Jen Chen
- MacKay Junior College of Medicine, Nursing and Management, Taipei City 25245, Taiwan
| | - Yen-Chun Lai
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei City 110301, Taiwan
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127
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Su YJ, Chang CW, Chen MJ, Lai YC. Impact of COVID-19 on liver. World J Clin Cases 2021; 9:7998-8007. [PMID: 34621856 PMCID: PMC8462210 DOI: 10.12998/wjcc.v9.i27.7998] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/22/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of liver injury after coronavirus disease 2019 (COVID-19) infection ranged from 15%-53%. The mechanism includes direct viral cytopathic effect, cytokinesis, and treatment drug-induced liver injury. The symptoms include nausea, vomiting, diarrhea, and loss of appetite. The laboratory results include increased liver enzyme levels, decreased monocyte count, and longer prothrombin time. The most common imaging findings are hepatomegaly on ultrasound, ground-glass opacity on chest computed tomography (CT), and liver hypodensity and pericholecystic fat stranding on abdominal CT. Patients may also have different presentations and poor outcomes of different liver diseases concomitant with COVID-19 infection. Liver function test (LFT) results should be monitored, and all factors known to cause or predispose liver injury should be investigated while managing the patients. The risks of transfer to an intensive care unit, need for mechanical ventilator support, and acute kidney injury is higher in COVID-19 patients with than without abnormal LFTs. Increased mortality and length of hospital stay are both observed.
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Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
- Poison Center, Department of Emergency Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
- Yuanpei University of Medical Technology, HsinChu 30015, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei City 25245, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Chen-Wang Chang
- MacKay Junior College of Medicine, Nursing and Management, Taipei City 25245, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Ming-Jen Chen
- MacKay Junior College of Medicine, Nursing and Management, Taipei City 25245, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
| | - Yen-Chun Lai
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei City 110301, Taiwan
- Heroic Faith Medical Science Company, Taipei 11493, Taiwan
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128
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Cococcia S, Lenti MV, Santacroce G, Achilli G, Borrelli de Andreis F, Di Sabatino A. Liver-spleen axis dysfunction in COVID-19. World J Gastroenterol 2021; 27:5919-5931. [PMID: 34629809 PMCID: PMC8475007 DOI: 10.3748/wjg.v27.i35.5919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/01/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly through the respiratory route. Besides interstitial pneumonia, a number of other clinical manifestations were noticed in COVID-19 patients. In particular, liver and spleen dysfunctions have been described both as complications of COVID-19 and as potential predisposing factors for severe COVID-19. Liver damage is rather common in COVID-19 patients, and it is most likely multifactorial, caused by the direct insult of SARS-CoV-2 to the liver by the cytokine storm triggered by the virus, by the use of hepatotoxic drugs, and as a consequence of hypoxia. Although generally mild, liver impairment has been found to be associated with a higher rate of intensive care unit admission. A higher mortality rate was reported among chronic liver disease patients. Instead, spleen impairment in patients with COVID-19 has been poorly described. The main anatomical changes are the architectural derangement of the B cell compartment, white pulp atrophy, and reduction or absence of lymphoid follicles, while, from a functional point of view, the IgM memory B cell pool is markedly depleted. The outcome of COVID-19 in asplenic or hyposplenic patients is yet to be defined. In this review, we will summarise the current knowledge regarding the impact of SARS-CoV-2 on the liver and spleen function, as well as the outcome of patients with a pre-existent liver disease or defective spleen function.
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Affiliation(s)
- Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
- Department of Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
| | - Giovanni Santacroce
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
| | - Giovanna Achilli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
| | | | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
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129
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Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients. J Clin Med 2021; 10:jcm10184222. [PMID: 34575333 PMCID: PMC8470265 DOI: 10.3390/jcm10184222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Derangement of liver blood tests (LBT) is frequent in patients with Coronavirus disease 2019 (COVID-19). We aimed to evaluate (a) the prevalence of deranged LBT as well as their association with (b) clinical severity at admission and (c) 30-day outcomes among the hospitalized patients with COVID-19. METHODS Consecutive patients with COVID-19 hospitalized in the regional referral center over the 12-month period were included. Clinical severity of COVID-19 at hospital admission and 30-day outcomes (need for intensive care, mechanical ventilation, or death) were analyzed. RESULTS Derangement of LBT occurred in 2854/3812 (74.9%) of patients, most frequently due to elevation of AST (61.6%), GGT (46.1%) and ALT (33.4%). Elevated AST, ALT, GGT and low albumin were associated with more severe disease at admission. However, in multivariate Cox regression analysis, when adjusted for age, sex, obesity and presence of chronic liver disease, only AST remained associated with the risk of dying (HR 1.5081 and 2.1315, for elevations 1-3 × ULN and >3 × ULN, respectively) independently of comorbidity burden and COVID-19 severity at admission. Patients with more severe liver injury more frequently experienced defined adverse outcomes. CONCLUSIONS Deranged LBTs are common among patients hospitalized with COVID-19 and might be used as predictors of adverse clinical outcomes.
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130
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Mani I, Alexopoulou A. Recent challenges facing patients with preexisting chronic liver disease in the era of the COVID-19 pandemic. Ann Gastroenterol 2021; 34:625-633. [PMID: 34475732 PMCID: PMC8375661 DOI: 10.20524/aog.2021.0628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19 pandemic has resulted in a growing number of beds in common hospital wards and intensive care units being occupied by COVID-19 patients and the majority of medical and nursing staff being dedicated to their care. The present review summarizes the impact of COVID-19 on patients with underlying chronic liver diseases (CLD). Deferrals of all non-urgent activities in healthcare facilities, including a decrease in liver-clinic visits for patients with CLD, inadequate hepatocellular carcinoma (HCC) surveillance, and postponement of liver transplant activities are the most important consequences. Delays in viral hepatitis elimination programs were also reported, leading to future development of advanced CLD and HCC. Patients with chronic hepatitis B (CHB) and C without cirrhosis are not at risk for a more severe COVID-19 infection course. However, CHB status must be known in patients who are going to receive immunosuppression for preventing disease flare. In addition, checking for drug-drug interactions and potential hepatotoxicity reactions from agents administered to treat both SARS-CoV-2 and CLD are required. Patients with nonalcoholic fatty liver disease appeared to be at a high risk for severe COVID-19, even after adjustment for comorbidities. Patients with cirrhosis may develop decompensation, acute-on-chronic liver failure, or severe COVID-19. The mortality rate is worse in patients with high model for end-stage liver disease score, regardless of the etiology of cirrhosis.
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Affiliation(s)
- Iliana Mani
- 2 Department of Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece (Iliana Mani, Alexandra Alexopoulou)
| | - Alexandra Alexopoulou
- 2 Department of Medicine, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece (Iliana Mani, Alexandra Alexopoulou)
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131
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Correlation of SARS-CoV-2 Infection with Hepatitis and Liver Disorders. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2021. [DOI: 10.52547/jommid.9.3.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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132
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Thuluvath PJ, Alukal JJ, Ravindran N, Satapathy SK. What GI Physicians Need to Know During COVID-19 Pandemic. Dig Dis Sci 2021; 66:2865-2875. [PMID: 33015748 PMCID: PMC7533169 DOI: 10.1007/s10620-020-06625-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
The worldwide pandemic of COVID-19, caused by the virus SARS-CoV-2, continues to cause significant morbidity and mortality in both low- and high-income countries. Although COVID-19 is predominantly a respiratory illness, other systems including gastrointestinal (GI) system and liver may be involved because of the ubiquitous nature of ACE-2 receptors in various cell lines that SARS-CoV-2 utilizes to enter host cells. It appears that GI symptoms and liver enzyme abnormalities are common in COVID-19. The involvement of the GI tract and liver correlates with the severity of disease. A minority (10-20%) of patients with COVID-19 may also present initially with only GI complaints. The most common GI symptoms are anorexia, loss of smell, nausea, vomiting, and diarrhea. Viral RNA can be detected in stool in up to 50% of patients, sometimes even after pharyngeal clearance, but it is unclear whether fecal-oral transmission occurs. Liver enzymes are elevated, usually mild (2-3 times), in a substantial proportion of patients. There are many confounding factors that could cause liver enzyme abnormalities including medications, sepsis, and hypoxia. Although infection rates in those with preexisting liver disease are similar to that of general population, once infected, patients with liver disease are more likely to have a more severe disease and a higher mortality. There is a paucity of objective data on the optimal preventive or management strategies, but few recommendations for GI physicians based on circumstantial evidence are discussed.
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Affiliation(s)
- Paul J Thuluvath
- Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA.
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Joseph J Alukal
- Department of Internal Medicine, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, NY, USA
| | - Nishal Ravindran
- Department of Internal Medicine, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, NY, USA
| | - Sanjaya K Satapathy
- Department of Internal Medicine, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, NY, USA
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133
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Demirtas CO, Keklikkiran C, Ergenc I, Erturk Sengel B, Eskidemir G, Cinel I, Odabasi Z, Korten V, Yilmaz Y. Liver stiffness is associated with disease severity and worse clinical scenarios in coronavirus disease 2019: A prospective transient elastography study. Int J Clin Pract 2021; 75:e14363. [PMID: 33993597 PMCID: PMC8237050 DOI: 10.1111/ijcp.14363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pre-existing chronic liver disease is currently considered a poor prognostic factor for coronavirus disease 2019 (COVID-19). The present study aimed to investigate the association of liver stiffness measurement (LSM) with disease severity and clinical course of COVID-19. METHODS We prospectively recruited consecutive hospitalised adult patients with COVID-19 in a 3-month period. Demographic, laboratory, clinical and vibration-controlled transient elastography (VCTE) features were recorded at entry, and all patients were prospectively followed-up. Severe liver fibrosis was defined as an LSM value higher than 9.6 kPA. Multivariate logistic regression analysis was performed to reveal factors associated with disease severity and outcomes. RESULTS Out of 98 eligible patients with COVID-19, 12 (12.2%) had severe liver fibrosis. Patients with severe liver fibrosis had higher baseline disease severity (P = .022), more commonly required oxygen treatment at entry (P = .010), and had intensive-care unit (ICU) requirements during the 6 (1-39)-day median follow-up time (P = .017). The presence of severe liver fibrosis was independently associated with disease severity (odds ratio (OR): 7.685, 95% confidence interval (CI): 1.435-41.162, P = .017) and ICU requirement (OR: 46.656, 95% CI: 2.144-1015.090, P = .014). LSM was correlated with alanine aminotransferase levels (P = .005, r: 0.283), but not with other markers of acute hepatic injury or inflammation. CONCLUSION Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well-established clinical and laboratory factors. Further multicentre prospective studies are warranted to validate our results.
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Affiliation(s)
- Coskun Ozer Demirtas
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
| | - Caglayan Keklikkiran
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
| | - Ilkay Ergenc
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
| | - Buket Erturk Sengel
- Department of Infectious DiseasesSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Gunes Eskidemir
- Department of Critical Care MedicineSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Ismail Cinel
- Department of Critical Care MedicineSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Zekaver Odabasi
- Department of Infectious DiseasesSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Volkan Korten
- Department of Infectious DiseasesSchool of MedicineMarmara UniversityIstanbulTurkey
| | - Yusuf Yilmaz
- Department of GastroenterologySchool of MedicineMarmara UniversityIstanbulTurkey
- Institute of GastroenterologyMarmara UniversityIstanbulTurkey
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134
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Phipps MM, Verna EC. Coronavirus Disease 2019 and Liver Transplantation: Lessons from the First Year of the Pandemic. Liver Transpl 2021; 27:1312-1325. [PMID: 34096188 PMCID: PMC8242435 DOI: 10.1002/lt.26194] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023]
Abstract
Over the last year, the novel coronavirus disease 2019 (COVID-19) has continued to spread across the globe, causing significant morbidity and mortality among transplantation candidates and recipients. Patients with end-stage liver disease awaiting liver transplantation and patients with a history of liver transplantation represent vulnerable populations, especially given the high rates of associated medical comorbidities in these groups and their immunosuppressed status. In addition, concerns surrounding COVID-19 risk in this patient population have affected rates of transplantation and general transplantation practices. Here, we explore what we have learned about the impact of COVID-19 on liver transplantation candidates and recipients as well as the many key knowledge gaps that remain.
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Affiliation(s)
- Meaghan M. Phipps
- Division of Digestive and Liver DiseasesDepartment of MedicineColumbia UniversityNew YorkNY
| | - Elizabeth C. Verna
- Division of Digestive and Liver DiseasesDepartment of MedicineColumbia UniversityNew YorkNY
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135
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An overview of SARS-COV-2-related hepatic injury. HEPATOLOGY FORUM 2021; 2:122-127. [PMID: 35784909 PMCID: PMC9138946 DOI: 10.14744/hf.2021.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/24/2021] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), is highly contagious and has a variety of clinical manifestations, including liver injury. There have been a few reports indicating acute-on chronic liver failure among COVID-19 patients, however, patients with COVID-19-related liver injury are generally asymptomatic and present with a mild to moderate elevation in serum hepatic enzymes. Severe COVID-19 patients have high rates of liver injury with poorer outcomes. The pattern of abnormalities in liver biochemical indicators may be hepatocellular, cholestatic, or mixed. Although the pathogenesis of hepatic injury is not yet completely understood, causes of liver damage include systemic inflammatory response syndrome, ischemia-reperfusion injury, side effects of medications, and underlying chronic liver disease. While viral RNA has been detected in hepatocytes, it remains unknown if the coronavirus has the capacity to cause cytopathic effects in hepatic tissue. Additionally, it is important to remember that the current upheaval to daily life and access to healthcare caused by the COVID-19 pandemic has had a significant and negative effect on other patients with chronic liver disease. The objective of this review was to summarize the current literature on COVID-19-related hepatic injury with an examination of clinical features, potential pathogenesis, and histopathological findings of this entity.
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136
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Aguila EJT, Cua IHY, Singh R. Effects of coronavirus disease 2019 on the digestive system and its nutritional implications. Curr Opin Clin Nutr Metab Care 2021; 24:440-445. [PMID: 34334686 DOI: 10.1097/mco.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW There has been a deluge of scientific data since coronavirus disease 2019 (COVID-19) was first reported. The effects of COVID-19 on the digestive system are now increasingly well understood. This article aims to review the current data on the effects of COVID-19 on the digestive system with particular emphasis on preexisting digestive diseases and its implications on nutrition practices. RECENT FINDINGS Evidence has shown that Severe acute respiratory syndrome coronavirus 2 virus affects the gastrointestinal (GI) tract, pancreas and hepatobiliary system resulting in different GI manifestations. Several preexisting digestive diseases have been investigated. These studies have revealed that these special patient population groups are generally not at an increased risk to contract COVID-19, but are susceptible to develop increasing severity of disease. Aside from medical therapy, optimizing nutritional care has a beneficial role in this group of patients. SUMMARY GI manifestations of COVID-19 in addition to preexisting digestive diseases have an impact on patient's nutrition. Digestion, absorption and transport of nutrients may be impaired. To date, there are no existing guidelines on the nutritional management of patients for this particular at-risk group. Most nutrition practices are based only on observations and clinical experience. Basic prepandemic nutrition care principles are primarily followed but often individualized based on clinical judgment.
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Affiliation(s)
- Enrik John T Aguila
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | - Ian Homer Y Cua
- Institute of Digestive and Liver Diseases, St. Luke's Medical Center Global City, Taguig City, Philippines
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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137
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Chen VL, Hawa F, Berinstein JA, Reddy CA, Kassab I, Platt KD, Hsu CY, Steiner CA, Louissaint J, Gunaratnam NT, Sharma P. Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19. Dig Dis Sci 2021; 66:3192-3198. [PMID: 32980956 PMCID: PMC7520076 DOI: 10.1007/s10620-020-06618-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. AIMS To characterize the impact of HS on disease severity and liver injury in COVID-19. METHODS We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. RESULTS In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. CONCLUSIONS HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.
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Affiliation(s)
- Vincent L. Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Fadi Hawa
- Department of Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI USA
| | - Jeffrey A. Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Chanakyaram A. Reddy
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Ihab Kassab
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Kevin D. Platt
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Chia-Yang Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Calen A. Steiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Jeremy Louissaint
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | | | - Pratima Sharma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
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138
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Philips CA, Kakkar K, Joseph M, Yerol PK, Ahamed R, Rajesh S, Augustine P. Critically Ill COVID-19 Patient with Chronic Liver Disease - Insights into a Comprehensive Liver Intensive Care. J Clin Transl Hepatol 2021; 9:576-586. [PMID: 34447688 PMCID: PMC8369022 DOI: 10.14218/jcth.2020.00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/07/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
The novel coronavirus-related coronavirus disease 2019 (COVID-19) pandemic has been relentless in disrupting and overwhelming healthcare the world over. Clinical outcomes of COVID-19 in patients with chronic comorbidities, especially in those with metabolic syndrome, are well documented. Chronic liver disease and cirrhosis patients are a special sub-group, among whom the management of COVID-19 is challenging. Understanding the pathophysiology of COVID-19 in patients with cirrhosis and portal hypertension improves our identification of at-risk patients for disease progression that will further help compartmentalize generalized and specialized treatment options in this special patient group. In this exhaustive review, we critically review the impact of COVID-19 on the liver and in chronic liver disease and cirrhosis patients. We further discuss common features associated with the pathophysiology of COVID-19 and cirrhosis, based on the renin-angiotensin system and deliberate current literature on guidelines for the treatment of COVID-19 and extrapolate the same to the cirrhosis population to provide a concise and stepwise, evidence-based management for cirrhosis patients with severe and critical COVID-19. There are no specific management guidelines for cirrhosis patients with COVID-19 and current recommendations for treatment are as per guidelines for general population. Nevertheless, specific issues like avoiding corticosteroids in decompensated patients with variceal bleeding, suspected sepsis, high grade hepatic encephalopathy and acute kidney injury, use of early mechanical ventilation strategies in those with severe ascites and hepatopulmonary syndrome, avoidance of remdesivir in advanced liver disease, and application of liver-specific severity scores for prognostication and identification of futility need to be highlighted.
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Affiliation(s)
- Cyriac Abby Philips
- Department of Clinical Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Chunangamvely, Aluva, Ernakulam, Kerala, India
- Correspondence to: Cyriac Abby Philips, Department of Clinical Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Chunangamvely, Aluva, Ernakulam, Kerala 683112, India. ORCID: https://orcid.org/0000-0002-9587-336X. Tel: +91-484-2905000, Fax: +91-484-7184000, E-mail:
| | - Kamna Kakkar
- Department of Pulmonary and Critical Care Medicine, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Moby Joseph
- Great Western Hospitals, NHS Foundation Trust, Swindon, United Kingdom
| | - Praveen Kumar Yerol
- Department of Gastroenterology, State Government Medicine College and Hospital, Thrissur, Kerala, India
| | - Rizwan Ahamed
- Gastroenterology and Advanced G.I Endoscopy, Center of Excellence in GI Sciences, Rajagiri Hospital, Chunangamvely, Aluva, Ernakulam, Kerala, India
| | - Sasidharan Rajesh
- Interventional Hepatobiliary Radiology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Chunangamvely, Aluva, Ernakulam, Kerala, India
| | - Philip Augustine
- Gastroenterology and Advanced G.I Endoscopy, Center of Excellence in GI Sciences, Rajagiri Hospital, Chunangamvely, Aluva, Ernakulam, Kerala, India
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139
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Madhu D, Sharma S, Agarwal A, Saraya A. Special Considerations in the Management of Autoimmune Hepatitis in COVID-19 Hotspots: A Review. J Clin Transl Hepatol 2021; 9:568-575. [PMID: 34447687 PMCID: PMC8369025 DOI: 10.14218/jcth.2021.00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
The ongoing coronavirus disease-2019 (COVID-19) pandemic has necessitated special considerations in the management of diseases. The way presence of pre-existing diseases or treatment for it predisposes to, alters course of, and changes the management of COVID-19, is of relevance and is being extensively studied. Autoimmune hepatitis (AIH) is unique in that it is an autoimmune disease mandating treatment with immunosuppressive drugs, as well as a liver disease with potential for varying degrees of underlying fibrosis. The use of immunosuppressive drugs could alter the risk of acquiring COVID-19, the clinical course and severity of COVID-19 and the degree of underlying liver fibrosis could alter the clinical outcomes of patients with COVID-19. In this review, we try to summarize key areas relevant in understanding and improving the clinical care of patients with AIH in the current pandemic. Special considerations required in the management of patients with AIH in COVID-19 hotspots have been outlined based on the current evidence.
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Affiliation(s)
- Deepak Madhu
- Department of Gastroenterology, Aster MIMS Calicut, Kerala, India
- Department of Gastroenterology, Caritas Hospital, Kottayam, Kerala, India
| | - Sanchit Sharma
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Agarwal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
- Correspondence to: Anoop Saraya, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar; New Delhi 110029, India. ORCID: https://orcid.org/0000-0002-3921-6752. Tel: +91-9868397203, E-mail:
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140
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Anirvan P, Singh SP, Giammarino A, Satapathy SK. Association of non-alcoholic fatty liver disease and COVID-19: A literature review of current evidence. World J Hepatol 2021; 13:916-925. [PMID: 34552698 PMCID: PMC8422920 DOI: 10.4254/wjh.v13.i8.916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/21/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has swept through nations, crippled economies and caused millions of deaths worldwide. Many people diagnosed with COVID-19 infections are often found to develop liver injury, which, in a small portion of patients, progresses to severe liver disease. Liver injury in the form of elevated transaminases, hyperbilirubinemia and alterations in serum albumin has been observed to be higher in patients with severe forms of the disease. Those who already have insult to the liver from chronic disease, such as nonalcoholic fatty liver disease (NAFLD) may be at the greatest disadvantage. The severity of COVID-19 also seems to be driven by the presence of NAFLD and other co-morbidities. About 25% of the global population has NAFLD. With such a widespread prevalence of NAFLD, understanding the disease progression of COVID-19 and the occurrence of liver injury in this vulnerable population assumes great significance. In this review, we present an overview of COVID-19 infection in patients with NAFLD.
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Affiliation(s)
- Prajna Anirvan
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack 753007, Odisha, India
| | - Shivaram P Singh
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack 753007, Odisha, India
| | - Alexa Giammarino
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra, Manhasset, NY 11030, United States
| | - Sanjaya K Satapathy
- Division of Hepatology at Sandra Atlas Bass Center for Liver Diseases and Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra, Manhasset, NY 11030, United States
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141
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Nobel YR, Phipps M, Verna EC. COVID-19 and Effect on Liver Transplant. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2021; 19:483-499. [PMID: 34421290 PMCID: PMC8364825 DOI: 10.1007/s11938-021-00355-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The Coronavirus disease-2019 (COVID-19) pandemic has significantly impacted all aspects of liver transplantation. We reviewed the literature regarding COVID-19 clinical outcomes, treatment, and vaccination of liver transplant candidates and recipients. RECENT FINDINGS Patients with chronic liver disease, especially with cirrhosis, have higher morbidity and mortality from COVID-19 than patients without liver disease. Increased mortality has not been consistently seen in liver transplant recipients, in whom severe disease is more strongly associated advanced age and medical comorbidities, rather than with transplant-specific factors. While several targeted COVID-19 therapies have reported hepatotoxicity, these therapies may be safe and effective in patients with liver disease and liver transplant recipients. Questions remain regarding whether SARS-CoV-2 can be transmitted via the donor liver and whether transplant is safe in patients and/or donors with recent or active COVID-19. SUMMARY COVID-19 has significantly affected the care of liver transplant candidates and recipients. Guidelines for the safe practice of liver transplantation are rapidly evolving, and current recommendations are discussed.
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Affiliation(s)
- Yael R. Nobel
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY USA
| | - Meaghan Phipps
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY USA
| | - Elizabeth C. Verna
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY USA
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142
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Saviano A, Wrensch F, Ghany MG, Baumert TF. Liver Disease and Coronavirus Disease 2019: From Pathogenesis to Clinical Care. Hepatology 2021; 74:1088-1100. [PMID: 33332624 PMCID: PMC8209116 DOI: 10.1002/hep.31684] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that emerged in late 2019, is posing an unprecedented challenge to global health. Coronavirus disease 2019 (COVID-19), the clinical disease caused by SARS-CoV-2, has a variable presentation ranging from asymptomatic infection to life-threatening acute respiratory distress syndrome and multiorgan failure. Liver involvement is common during COVID-19 and exhibits a spectrum of clinical manifestations from asymptomatic elevations of liver function tests to hepatic decompensation. The presence of abnormal liver tests has been associated with a more severe presentation of COVID-19 disease and overall mortality. Although SARS-CoV-2 RNA has been detected in the liver of patients with COVID-19, it remains unclear whether SARS-CoV-2 productively infects and replicates in liver cells and has a direct liver-pathogenic effect. The cause of liver injury in COVID-19 can be attributed to multiple factors, including virus-induced systemic inflammation, hypoxia, hepatic congestion, and drug-induced liver disease. Among patients with cirrhosis, COVID-19 has been associated with hepatic decompensation and liver-related mortality. Additionally, COVID-19's impact on health care resources can adversely affect delivery of care and outcomes of patients with chronic liver disease. Understanding the underlying mechanisms of liver injury during COVID-19 will be important in the management of patients with COVID-19, especially those with advanced liver disease. This review summarizes our current knowledge of SARS-CoV-2 virus-host interactions in the liver as well the clinical impact of liver disease in COVID-19.
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Affiliation(s)
- Antonio Saviano
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
- Institut Hospitalo‐UniversitairePôle Hépato‐digestifNouvel Hôpital CivilStrasbourgFrance
| | - Florian Wrensch
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
| | - Marc G. Ghany
- Liver Diseases BranchNational Institute of DiabetesDigestive and Kidney DiseasesNational Institutes of HealthBethesdaMD
| | - Thomas F. Baumert
- Inserm, U1110Institut de Recherche sur les Maladies Virales et HépatiquesUniversité de StrasbourgStrasbourgFrance
- Institut Hospitalo‐UniversitairePôle Hépato‐digestifNouvel Hôpital CivilStrasbourgFrance
- Institut Universitaire de FranceParisFrance
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143
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Mohamed DZ, Ghoneim MES, Abu-Risha SES, Abdelsalam RA, Farag MA. Gastrointestinal and hepatic diseases during the COVID-19 pandemic: Manifestations, mechanism and management. World J Gastroenterol 2021; 27:4504-4535. [PMID: 34366621 PMCID: PMC8326263 DOI: 10.3748/wjg.v27.i28.4504] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered the causative pathogen of coronavirus disease 2019 (COVID-19) and has become an international danger to human health. Although respiratory transmission and symptoms are still the essential manifestations of COVID-19, the digestive system could be an unconventional or supplementary route for COVID-19 to be transmitted and manifested, most likely due to the presence of angiotensin-converting enzyme 2 (ACE2) in the gastrointestinal tract. In addition, SARS-CoV-2 can trigger hepatic injury via direct binding to the ACE2 receptor in cholangiocytes, antibody-dependent enhancement of infection, systemic inflammatory response syndrome, inflammatory cytokine storms, ischemia/reperfusion injury, and adverse events of treatment drugs. Gastrointestinal symptoms, including anorexia, nausea, vomiting, and diarrhea, which are unusual in patients with COVID-19, and some digestive signs may occur without other respiratory symptoms. Furthermore, SARS-CoV-2 can be found in infected patients' stool, demonstrating the likelihood of transmission through the fecal-oral route. In addition, liver function should be monitored during COVID-19, particularly in more severe cases. This review summarizes the evidence for extra-pulmonary manifestations, mechanisms, and management of COVID-19, particularly those related to the gastrointestinal tract and liver.
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Affiliation(s)
- Dina Zakaria Mohamed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta 31511, Egypt
| | - Mai El-Sayed Ghoneim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Sadat City, Menoufia 32632, Egypt
| | - Sally El-Sayed Abu-Risha
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta 31511, Egypt
| | - Ramy Ahmed Abdelsalam
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
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144
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Zhou F, Xia J, Yuan HX, Sun Y, Zhang Y. Liver injury in COVID-19: Known and unknown. World J Clin Cases 2021; 9:4980-4989. [PMID: 34307548 PMCID: PMC8283595 DOI: 10.12998/wjcc.v9.i19.4980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/13/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
Since the first report of the coronavirus disease 2019 (COVID-19) in December 2019 in Wuhan, China, the outbreak of the disease is currently continuously evolving. Previous studies have shown varying degrees of liver damage in patients with COVID-19. However, the exact causes of liver injury and the relationship between COVID-19 and liver injury is unclear. This article describes liver injury induced by COVID-19, analyzes its causes, and discusses the treatment and prognosis of liver damage in patients with COVID-19.
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Affiliation(s)
- Feng Zhou
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Jian Xia
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Hai-Xia Yuan
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ying Sun
- Department of Endocrinology, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
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145
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Sharma S, Elhence A, Vaishnav M, Kumar R, Shalimar. COVID-19 in patients with cirrhosis: understanding adverse impact. Gut 2021; 70:1409. [PMID: 32826307 DOI: 10.1136/gutjnl-2020-322561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Sanchit Sharma
- Gastroenterology and Human Nutrition, AIIMS, New Delhi, India
| | | | - Manas Vaishnav
- Gastroenterology and Human Nutrition, AIIMS, New Delhi, India
| | | | - Shalimar
- Gastroenterology and Human Nutrition, AIIMS, New Delhi, India
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146
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McGrowder DA, Miller F, Anderson Cross M, Anderson-Jackson L, Bryan S, Dilworth L. Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis. Diseases 2021; 9:diseases9030050. [PMID: 34287285 PMCID: PMC8293258 DOI: 10.3390/diseases9030050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Globally, millions of persons have contracted the coronavirus disease 2019 (COVID-19) over the past several months, resulting in significant mortality. Health care systems are negatively impacted including the care of individuals with cancers and other chronic diseases such as chronic active hepatitis, cirrhosis and hepatocellular carcinoma. There are various probable pathogenic mechanisms that have been presented to account for liver injury in COVID-19 patients such as hepatotoxicity cause by therapeutic drugs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the bile duct cells and hepatocytes, hypoxia and systemic inflammatory response. Liver biochemistry tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) are deranged in COVID-19 patients with liver injury. Hepatocellular damage results in the elevation of serum AST and ALT levels in early onset disease while a cholestatic pattern that develops as the disease progress causes higher levels of ALP, GGT, direct and total bilirubin. These liver biochemistry tests are prognostic markers of disease severity and should be carefully monitored in COVID-19 patients. We conducted a systematic review of abnormal liver biochemistry tests in COVID-19 and the possible pathogenesis involved. Significant findings regarding the severity, hepatocellular pattern, incidence and related clinical outcomes in COVID-19 patients are highlighted.
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Affiliation(s)
- Donovan A. McGrowder
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (L.A.-J.); (L.D.)
- Correspondence:
| | - Fabian Miller
- Department of Physical Education, Faculty of Education, The Mico University College, 1A Marescaux Road, Kingston 5, Jamaica;
- Department of Biotechnology, Faculty of Science and Technology, The University of the West Indies, Kingston 7, Jamaica
| | - Melisa Anderson Cross
- School of Allied Health and Wellness, College of Health Sciences, University of Technology, Kingston 7, Jamaica;
| | - Lennox Anderson-Jackson
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (L.A.-J.); (L.D.)
| | - Sophia Bryan
- Department of Basic Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica;
| | - Lowell Dilworth
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (L.A.-J.); (L.D.)
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147
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Sharma P, Kumar A, Anikhindi S, Bansal N, Singla V, Shivam K, Arora A. Effect of COVID-19 on Pre-existing Liver disease: What Hepatologist Should Know? J Clin Exp Hepatol 2021; 11:484-493. [PMID: 33398223 PMCID: PMC7774459 DOI: 10.1016/j.jceh.2020.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
COVID-19 is characterized by predominant respiratory and gastrointestinal symptoms. Liver enzymes derangement is seen in 15-55% of the patients. Advanced age, hypertension, diabetes, obesity, malignancy, and cardiovascular disease predispose them to severe disease and the need for hospitalization. Data on pre-existing liver disease in patients with COVID-19 is limited, and most studies had only 3-8% of these patients. Patients with metabolic dysfunction-associated fatty liver (MAFLD) had shown a 4-6 fold increase in severity of COVID-19, and its severity and mortality increased in patients with higher fibrosis scores. Patients with chronic liver disease had shown that cirrhosis is an independent predictor of severity of COVID-19 with increased hospitalization and mortality. Increase in Child Turcotte Pugh (CTP) score and model for end-stage liver disease (MELD) score increases the mortality in these patients. Few case reports had shown SARS-CoV-2 as an acute event in the decompensation of underlying chronic liver disease. Immunosuppression should be reduced prophylactically in patients with autoimmune liver disease and post-transplantation with no COVID-19. Hydroxychloroquine and remdesivir is found to be safe in limited studies in a patient with cirrhosis and COVID-19. For hepatologists, cirrhosis with COVID-19 is a pertinent issue as the present pandemic will have severe disease in patients with chronic liver disease leading to more hospitalization and decompensation.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ACE2, Angiotensin-Converting Enzyme 2
- AIH, Autoimmune Hepatitis
- ALP, Alkaline Phosphatase
- AST/ALT, Aspartate and Alanine Aminotransferase
- CHF, Congestive Heart Failure
- CKD, Chronic Kidney Disease
- CLD, Chronic Liver Disease
- CLIF-OC, Chronic Liver Failure Organ Cirrhosis
- CLIF-OF, Chronic Liver Failure Organ Failure
- COVID-19
- CRP, C Reactive Protein
- CTP, Child Turcotte Pugh
- Cirrhosis
- DILI, Drug-Induced Liver Injury
- EASL, European Association for the Study of Liver
- HBC, Hepatitis C
- HBV, Hepatitis B
- HCC, Hepatocellular Carcinoma
- HCQ, Hydoxycholoroquine
- LT, Liver Transplantation
- Liver disease
- MAFLD, Metabolic Associated Fatty Liver Disease
- MELD, Model for End-stage Liver Disease
- NAFLD, Nonalcoholic Fatty Liver Disease
- PPE, Personal Protection Kit
- RR, Relative Risk
- RTPCR, Reverse Transcription-Polymerase Chain Reaction
- Severity
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Affiliation(s)
- Praveen Sharma
- Department of Gastroenterology Sir Ganga Ram Hospital New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology Sir Ganga Ram Hospital New Delhi, India
| | | | - Naresh Bansal
- Department of Gastroenterology Sir Ganga Ram Hospital New Delhi, India
| | - Vikas Singla
- Department of Gastroenterology Sir Ganga Ram Hospital New Delhi, India
| | - Khare Shivam
- Department of Gastroenterology Sir Ganga Ram Hospital New Delhi, India
| | - Anil Arora
- Department of Gastroenterology Sir Ganga Ram Hospital New Delhi, India
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148
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Mohamed AA, Tantawi OI, Fathalla LA, El-Hassib DMA, El-Toukhy NETR, Salah W, Elkadeem M, Ezzat O, Abd-Elsalam S. Covid-19: Urgent Call to Action. Antiinflamm Antiallergy Agents Med Chem 2021; 20:118-122. [PMID: 33267767 DOI: 10.2174/1871523019666201202092859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/24/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023]
Abstract
Novel Corona Virus 2019 (COVID-19) is a new virus spread rapidly all over the world. It has specific respiratory or gastrointestinal tract symptoms. Its reported complications include respiratory distress, systemic inflammatory response syndrome, and septic shock. Due to heavy cytokines released by the virus; corticosteroids (40-120 mg / day) were given to severe cases to reduce pneumonia. It's a difficult task to control the spread of SARS-CoV-2, and to invent proper vaccines and treatments. In this review, the existing understanding of fatal, pandemic human coronavirus SARS-Cov2 (COVID-19), with special reference to its diagnosis, origin, transmission, and different approaches to develop its therapeutics, will be discussed.
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Affiliation(s)
- Amal A Mohamed
- Department of Biochemistry, National Hepatology Tropical Medicine Research Institute, Cairo, Egypt
| | - Omnia I Tantawi
- Faculty of Biotechnology, Misr University for Science and Technology (MUST), Cairo, Egypt
| | - Lamiaa A Fathalla
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Dalia M Abd El-Hassib
- Clinical and Chemical Pathology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Naglaa El-Toukhy R El-Toukhy
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine-Benha University, Benha, Egypt
| | - Wafaa Salah
- Department of Internal medicine, National Institute of Diabetes and Endocrinology, Cairo, Egypt
| | - Mahmoud Elkadeem
- Department of Biochemistry, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Omnia Ezzat
- Department of Biochemistry, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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149
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Cai Y, Ye LP, Song YQ, Mao XL, Wang L, Jiang YZ, Que WT, Li SW. Liver injury in COVID-19: Detection, pathogenesis, and treatment. World J Gastroenterol 2021; 27:3022-3036. [PMID: 34168405 PMCID: PMC8192279 DOI: 10.3748/wjg.v27.i22.3022] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
In the early December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 was first reported in Wuhan, China, followed by an outbreak that spread around the world. Numerous studies have shown that liver injury is common in patients with coronavirus disease 2019 (COVID-19), and may aggravate the severity of the disease. However, the exact cause and specific mechanism of COVID-associated liver injury needs to be elucidated further. In this review, we present an analysis of the clinical features, potential mechanisms, and treatment strategies for liver injury associated with COVID-19. We hope that this review would benefit clinicians in devising better strategies for management of such patients.
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Affiliation(s)
- Yue Cai
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Li-Ping Ye
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Ya-Qi Song
- School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Xin-Li Mao
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Li Wang
- College of Basic Medicine, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
| | - Yan-Zhi Jiang
- Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - Wei-Tao Que
- Department of Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - Shao-Wei Li
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
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150
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Lv Y, Zhao X, Wang Y, Zhu J, Ma C, Feng X, Ma Y, Zheng Y, Yang L, Han G, Xie H. Abnormal Liver Function Tests Were Associated With Adverse Clinical Outcomes: An Observational Cohort Study of 2,912 Patients With COVID-19. Front Med (Lausanne) 2021; 8:639855. [PMID: 34179034 PMCID: PMC8219933 DOI: 10.3389/fmed.2021.639855] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background and Aim: The impact of liver function test (LFTs) abnormality on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains controversial. The aim of this study was to assess the impact of abnormal LFTs on clinical outcomes in a large cohort of hospitalized patients with COVID-19. Methods: We retrospectively collected data on 2,912 consecutive patients with COVID-19 who were admitted to a makeshift hospital in China between 5 February and 23 March 2020. The association between LFTs abnormalities (baseline and peak values) and clinical outcomes was measured by using Cox regression models. Results: On admission 1,414 patients (48.6%) had abnormal LFTs, with alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) elevation in 662 (22.7%), 221 (7.6%), 52 (1.8%), 135 (4.6%), and 536 (18.5%) patients, respectively, and hypoalbuminemia in 737 (25.3%) patients. During a median 13 (IQR: 8-19) days of hospitalization, 61 patients (2.1%) died, 106 patients (3.6%) admitted to intensive care unit (ICU), and 75 patients (2.6%) required mechanical ventilation. After adjustment for confounders, baseline abnormal LFTs were independently associated with increased risks of mortality (adjusted HR 3.66, 95%CI 1.64-8.19, p = 0.002), ICU admission (adjusted HR 3.12 95%CI 1.86-5.23, p < 0.001), and mechanical ventilation (adjusted HR 3.00, 95%CI 1.63-5.52, p < 0.001), which was homogeneous across the severity of COVID-19 infection. Among the parameters of LTFs, the associations with the outcomes were more pronounced for AST and albumin abnormality. In contrast, ALT elevation was not significantly associated with those outcomes. Similar results were observed for peak values of LFTs during hospitalization. Conclusions: Abnormality of AST, albumin, TBIL, ALP, and GGT but not ALT were independently associated with adverse outcomes.
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Affiliation(s)
- Yong Lv
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Xiaodi Zhao
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Yan Wang
- Endoscopy Center, 986 Air Force Hospital, Xi'an, China
| | - Jingpu Zhu
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, China
| | - Chengfei Ma
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, China
| | - Xiaodong Feng
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, China
| | - Yao Ma
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, China
| | - Yipeng Zheng
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, China
| | - Liyu Yang
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Huahong Xie
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
- Huoshen Shan Hospital, Wuhan, China
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