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Lucena Valera A, Aller Dela Fuente R, Sánchez Torrijos Y, Romero Gómez M, Ampuero Herrojo J. FIB-4 score as predictor of COVID-19-related severity in hospitalized patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38767045 DOI: 10.17235/reed.2024.9811/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
AIM To determine the impact of liver fibrosis on the prognosis of COVID and the liver injury associated with the infection. METHODS Retrospective multicenter study including 575 patients requiring admission for COVID-19 between January and June 2020. FIB-4 was calculated within 6 months prior to infection and at 6 months post-infection. RESULTS Baseline FIB-4 was increased in patients who died (1.91±0.95 vs. 1.43±0.85; p<0.001). In addition, the 17.1% (32/187) of patients with baseline FIB-4<1.45 died versus 52.9% (9/17) if FIB-4>3.25 (p<0.001). In the adjusted multivariate analysis, baseline FIB-4 (OR 1.61 (95%CI 1.19-2.18); p=0.002) was independently associated with mortality. Parameters associated with liver injury, including AST (28±10 vs. 45±56IU/L; p<0.001) and ALT (20±12 vs. 38±48IU/L; p<0.001) were significantly higher at admission compared to baseline. Also, FIB-4 was increased from baseline to the time of admission (1.53±0.88 vs. 2.55±1.91; p<0.001), and up to 6.9% (10/145) of patients with FIB-4<1.45 at admission died versus 47.5% if FIB-4>3.25 (58/122) (p<0.001). In the adjusted multivariate analysis, FIB-4 at admission (OR 1.14 (95%CI 1.03-1.27); p=0.015) was independently associated with mortality. Also, AST (42±38 vs. 22±17IU/L; p<0.001) and ALT (40±50 vs. 20±19 IU/L; p<0.001) were significantly reduced at 6 months after the resolution of infection. Accordingly, FIB-4 decreased significantly (2.12±1.25 vs. 1.32±0.57; p<0.001) six months after the infection. CONCLUSION Increased FIB-4, either at baseline or at the time of admission, was related to the severity and mortality related to SARS-CoV-2 infection. However, the liver damage expressed by elevated transaminases and FIB-4 was reversible in most of patients.
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Romero-Gómez M, Aller R, Ampuero J, Fernández Rodríguez C, Augustín S, Latorre R, Rivera-Esteban J, Martínez Urroz B, Gutiérrez García ML, López SA, Albillos A, Hernández M, Graupera I, Benlloch S, Olveira A, Crespo J, Calleja JL. AEEH «Consensus about detection and referral of hidden prevalent liver diseases». GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:236-247. [PMID: 35569541 DOI: 10.1016/j.gastrohep.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Manuel Romero-Gómez
- Servicio de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (HUVR/CSIC/US), Universidad de Sevilla, Sevilla, España.
| | - Rocío Aller
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, España
| | - Javier Ampuero
- Servicio de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina (HUVR/CSIC/US), Universidad de Sevilla, Sevilla, España
| | | | - Salvador Augustín
- Servei de Hepatología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Raquel Latorre
- Servicio de Aparato Digestivo, Hospital Universitario Son Llàtzer, Palma de Mallorca, Islas Baleares, España
| | | | | | | | - Sonia Alonso López
- Servicio de Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Agustín Albillos
- Servicio de Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Marta Hernández
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Universidad Autónoma de Madrid, Majadahonda, Madrid, España
| | - Isabel Graupera
- Servicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, España
| | - Salvador Benlloch
- Servicio de Aparato Digestivo, Hospital Arnau de Vilanova, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Antonio Olveira
- Servicio de Aparato Digestivo, Hospital La Paz, Madrid, España
| | - Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla. IDIVAL, Santander, Cantabria, España
| | - José Luis Calleja
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Universidad Autónoma de Madrid, Majadahonda, Madrid, España
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Valsamaki A, Xanthoudaki M, Oikonomou KG, Vlachostergios PJ, Papadogoulas A, Katsiafylloudis P, Voulgaridi I, Skoura AL, Komnos A, Papamichalis P. Prevention, diagnostic evaluation, management and prognostic implications of liver disease in critically ill patients with COVID-19. World J Clin Cases 2023; 11:514-527. [PMID: 36793637 PMCID: PMC9923862 DOI: 10.12998/wjcc.v11.i3.514] [Citation(s) in RCA: 1] [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: 10/12/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/23/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, broke out in December 2019 in Wuhan city of China and spread rapidly worldwide. Therefore, by March 2020, the World Health Organization declared the disease a global pandemic. Apart from the respiratory system, various other organs of the human body are also seriously affected by the virus. Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%. Elevated levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings. Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury. This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19, the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients. Moreover, it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.
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Affiliation(s)
- Asimina Valsamaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece
| | - Maria Xanthoudaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece
| | | | - Panagiotis J Vlachostergios
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | | | | | - Ioanna Voulgaridi
- Department of Microbiology, General Hospital of Larissa, Larissa 41221, Greece
| | | | - Apostolos Komnos
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Greece
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Impact of COVID-19 on Non-Pulmonary Critical Illness: Prevalence, Clinical Manifestations, Management, and Outcomes. Clin Chest Med 2022; 44:249-262. [PMID: 37085218 PMCID: PMC9682059 DOI: 10.1016/j.ccm.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although respiratory manifestations are the most common driver of hospitalization, SARS-CoV-2 infection has a wide range of manifestations, including multisystem organ failure in severe cases. This review discusses the prevalence, pathophysiology, clinical manifestations, treatment, and outcomes of nonpulmonary organ dysfunction from SARS-CoV2, including renal, liver, cardiac, neurologic, and coagulation system dysfunction. At this time, management largely focuses on supportive care practices that are applicable regardless of the cause of organ injury.
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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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Sadeghi A, Alatab S, Alijani N. A case of COVID 19 with concomitant infection with hepatitis A. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:174-175. [PMID: 34663073 DOI: 10.17235/reed.2021.8372/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Symptoms of COVID-19 range from mild to severe with pulmonary manifestations being predominate, however, liver injury is not rare. There might be a reciprocal influence between COVID-19 and hepatic disease. While high levels of liver enzyme is associated with an increased prevalence of severe complications, search for other etiologies of hepatic disease should be not be ignored. We report a case of COVID-19 presented with acute fulminant hepatitis A (HAV) without previous history.
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Affiliation(s)
- Anahita Sadeghi
- Digestive Disease Research Center, Tehran University of Medical Sciences
| | - Sudabeh Alatab
- Digestive Disease Research Center, Tehran University of Medical Sciences, Iran
| | - Neda Alijani
- Infectious Diseases, Shariati Hospital. Tehran University of Medical Sciences
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Alventosa Mateu C, Urquijo Ponce JJ, Puchades Gimeno F, Benlloch Pérez S, Sanz Herrero F, Latorre Sánchez M, García Deltoro M, Gimeno Cardona C, Ocete Mochón MD, Diago Madrid M. Abnormal liver biochemistry constitutes an independent prognostic factor of a less favorable clinical course in patients with COVID-19. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:825-832. [PMID: 34157846 DOI: 10.17235/reed.2021.7842/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Abnormal liver biochemistry (ALB) is correlated with increased clinical involvement or severity in COVID-19, but its prognostic implications have not been studied extensively. Our aim is to determine whether ALB is a risk factor for an unfavorable clinical outcome and involvement. MATERIALS AND METHODS Retrospective, single-center study of confirmed COVID-19 cases. Patients with pharmacological hepatotoxicity or liver diseases were excluded. ALB was defined as the elevation of total bilirubin, AST, ALT, alkaline phosphatase and/or GGT above the upper limit of normal. An assessment was first made of the correlation between ALB and the need for hospitalization. This was followed by an assessment of the correlation of hospitalized patients with demographic variables, comorbidities and treatment for COVID-19 and with clinical involvement and outcome. Statistical analysis was performed using age-adjusted multiple logistic regression with a p-value of <0.05 RESULTS: Of 1,277 confirmed cases, 346 required hospitalization, and 302 were included. The prevalence of ALB was higher in hospitalized patients compared to non-hospitalized patients (60.9% vs. 10.3%, p ˂0.001). Among the hospitalized patients, there was no correlation between ALB and demographic variables, comorbidities or treatment for COVID-19, except for low molecular weight heparin. We found a significant correlation between ALB and moderate/severe COVID-19 involvement and between unfavorable clinical outcomes and elevated total bilirubin. The period of greatest clinical worsening and deterioration of liver biochemistry parameters occurred during the first seven days. There was a significant correlation between ALB and a longer hospital stay and admission to the Intensive Care Unit, but this did not imply higher mortality. CONCLUSIONS ALB is correlated with greater clinical involvement and worse clinical outcomes in hospitalized patients with COVID-19.
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Montón Rodríguez C, Navarro Cortés P, Lluch Garcia P, Mínguez Pérez M. Autoimmune hepatitis triggered by COVID-19. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:64-65. [PMID: 34015933 DOI: 10.17235/reed.2021.8045/2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present the case of a 60-year-old woman with no drug allergies or toxic habits, with hypothyroidism and receiving treatment with levothyroxine.
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Affiliation(s)
| | - Pablo Navarro Cortés
- Aparato Digestivo, Universidad de Valencia. Hospital Clínico Universitario de Valencia
| | - Paloma Lluch Garcia
- Medicina Digestiva, Universidad de Valencia. Hospital Clínico Universitario de Valencia
| | - Miguel Mínguez Pérez
- Medicina Digestiva, Universidad de Valencia. Hospital Clínico Universitario de Valencia, España
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Fernández Carrillo C, Perelló C, Llop Herrera E, García-Samaniego J, Romero M, Mostaza JM, Ibáñez L, Bañares Cañizares R, Bighelli F, Usón Perón C, Fernández Vázquez I, Hernández Castro O, Albillos A, Lalueza A, Malo de Molina R, Muñez E, Jiménez Tejero E, Calleja Panero JL. Mild ast elevation as an early sign of COVID-19 severity in a multicenter Madrid cohort. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:780-786. [PMID: 33947196 DOI: 10.17235/reed.2021.8007/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Liver enzyme elevation has been reported for SARS-CoV-2 disease (COVID-19) in heterogeneous cohorts, mainly from China. Comprehensive reports from other countries are needed. We dissect the pattern, evolution and predictive value of such abnormalities in a cohort from Madrid, Spain. METHODS Retrospective study with prospective 14-day follow-up of 373 patients with confirmed COVID-19 in five Madrid hospitals, including 50 outpatients. COVID-19 severe course was defined as need of mechanical ventilation. RESULTS A total of 33.1% hospitalised patients showed baseline AST elevation and 28.5% showed ALT elevation, contrasting with 12% and 8% of outpatients (P≤0.001). Baseline AST, ALT and GGT levels correlated with LDH and C-reactive protein levels (CRP) (r≤0.598, P<0.005). AST elevation was associated with other severity markers such as male sex, lymphopenia and pneumonia on X-ray (P<0.05 all). ALP and Bilirubin levels were rarely increased. Patients with elevated baseline AST displayed progressive normalization of this enzyme and increase in ALT and GGT levels. Patients with normal baseline AST showed a flattened evolution pattern with levels in range. Patients with a severe course of COVID-19 showed more frequently elevated baseline AST than those with a milder evolution (54.2% vs. 25.4%, P<0.001). Age, AST and CRP were independent risk factors for a severe course of COVID-19. CONCLUSION Mild liver enzyme elevation is associated with COVID-19 severity. Baseline AST is an independent predictor of severe COVID-19 course, while it tends to normalize over time. ALT and GGT show late elevation.
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Affiliation(s)
- Carlos Fernández Carrillo
- Liver Unit, Gastroenterology, IDIPHIM, CIBERehd, Hospital Universitario Puerta de Hierro-Majadahonda, España
| | - Christie Perelló
- Liver Unit, Gastroenterology, IDIPHIM, Hospital Universitario Puerta de Hierro-Majadahonda
| | - Elba Llop Herrera
- Liver Unit, Gastroenterology, IDIPHIM, CIBERehd, Hospital Universitario Puerta de Hierro Majadahonda
| | | | | | | | - Luis Ibáñez
- Liver Unit, Gastroenterology, IiSGM, Hospital Gregorio Marañón
| | - Rafael Bañares Cañizares
- Gastroenterology, IiSGM, CIBERehd, Hospital Universitario Ramón y Cajal, Universidad Complutense
| | | | - Clara Usón Perón
- Liver Unit, Gastroenterology, IiSGM, Hospital Universitario La Paz
| | | | | | - Agustín Albillos
- Gastroenterology and Hepatology, UAH, CIBERehd, Hospital Universitario Ramón y Cajal
| | - Antonio Lalueza
- Internal Medicine, Hospital Universitario 12 de Octubre, i+12
| | - Rosa Malo de Molina
- Pneumology Service, IDIPHISA, Hospital Universitario Puerta de Hierro-Majadahonda
| | - Elena Muñez
- Internal Medicine, Infectious Diseases, IDIPHISA, Hospital Universitario Puerta de Hierro-Majadahonda
| | | | - José Luis Calleja Panero
- Liver Unit, Gastroenterology,IDIPHISA,UAM,CIBErehd, Hospital Universitario Puerta de Hierro-Majadahonda
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Ampuero J, Romero Gómez M. COVID-19 and the liver: the chicken or the egg dilemma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:555. [PMID: 33569963 DOI: 10.17235/reed.2021.7861/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
After the publication of our meta-analysis, in which we demonstrated that aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin were related to a poor prognosis in patients suffering COVID-19, some authors raised the question about whether these findings are directly linked, or they are epiphenomena.
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Affiliation(s)
- Javier Ampuero
- UGC de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, España
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Cienfuegos JA, Pérez-Cuadrado E. COVID-19 and the digestive system: implications for transforming care delivery. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:83-84. [PMID: 33461301 DOI: 10.17235/reed.2021.7774/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The pandemic caused by SARS-CoV-2 has posed an unprecedented challenge to health systems, leading in many countries to the collapse of health care and a lack of preventive measures both for the most vulnerable sections of the population and among healthcare professionals.
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