Chronic liver disease not a significant comorbid condition for COVID-19

AbstractTo explore the role of chronic liver disease (CLD) in COVID-19. A total of 1439 consecutively hospitalized patients with COVID-19 from one large medical center in the United States from March 16, 2020 to April 23, 2020 were retrospectively identified. Clinical characteristics and outcomes were compared between patients with and without CLD. Postmortem examination of liver in 8 critically ill COVID-19 patients was performed. There was no significant difference in the incidence of CLD between critical and non-critical groups (4.1% vs 2.9%, p = 0.259), or COVID-19 related liver injury between patients with and without CLD (65.7% vs 49.7%, p = 0.065). Postmortem examination of liver demonstrated mild liver injury associated central vein outflow obstruction and minimal to moderate portal lymphocytic infiltrate without evidence of CLD. Patients with CLD were not associated with a higher risk of liver injury or critical/fatal outcomes. CLD was not a significant comorbid condition for COVID-19.

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Chronic liver disease not a significant comorbid condition for COVID-19

10.21203/rs.3.rs-208825/v1 ◽

2021 ◽

Author(s):

Jiahao Lin ◽

Bingting Bao ◽

Nigar Anjuman Khurram ◽

Kasey Halsey ◽

Ji Whae Choi ◽

...

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Chronic Liver Disease ◽

The United States ◽

Postmortem Examination ◽

Chronic Liver ◽

Critical Groups ◽

Comorbid Condition ◽

Central Vein ◽

Significant Difference

Abstract Purpose: To explore the role of chronic liver disease (CLD) in COVID-19.Methods: A total of 1,439 consecutively hospitalized patients with COVID-19 from one large medical center in the United States from March 16, 2020 to April 23, 2020 were retrospectively identified. Clinical characteristics and outcomes were compared between patients with and without CLD. Postmortem examination of liver in 8 critically ill COVID-19 patients was performed.Results: There was no significant difference in the incidence of CLD between critical and non-critical groups (4.1% vs 2.9%, p=0.259), or COVID-19 related liver injury between patients with and without CLD (65.7% vs 49.7%, p=0.065). Postmortem examination of liver demonstrated mild liver injury associated central vein outflow obstruction and minimal to moderate portal lymphocytic infiltrate without evidence of CLD.Conclusion: Patients with CLD were not associated with a higher risk of liver injury or critical/fatal outcomes. CLD was not a significant comorbid condition for COVID-19.

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Kratom-Induced Cholestatic Liver Injury and Its Conservative Management

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619836138 ◽

2019 ◽

Vol 7 ◽

pp. 232470961983613 ◽

Cited By ~ 4

Author(s):

Christopher T. Fernandes ◽

Umair Iqbal ◽

Sean P. Tighe ◽

Aijaz Ahmed

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Chronic Liver Disease ◽

The United States ◽

Chronic Liver ◽

Herbal Supplement ◽

Herbal Supplements ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Analgesic Effects

Drug-induced liver injury (DILI) is a common cause of hepatotoxicity associated with prescription-based and over-the-counter exposure to medications and herbal supplements. Use of unapproved and inadequately tested herbal supplements can cause DILI. Therefore, thorough history-taking on exposure to herbal supplements must be an integral part of clinical evaluation of DILI. Kratom is an herbal supplement or remedy that has been known for its analgesic effects and has also been used for self-treatment of opiate withdrawals. A 52-year-old man was seen for evaluation of yellow discoloration of the eyes and skin. He reported taking kratom for right shoulder strain for at least a couple of months. On workup, his total bilirubin was noted to be 23.2 mg/dL, which peaked at 28.9 mg/dL. He was noted to have mild elevation of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Extensive laboratory tests were ordered and known causes of chronic liver disease ruled out. Magnetic resonance imaging of the abdomen was unremarkable without stigmata of portal hypertension or signs of chronic liver disease. He demonstrated no evidence of coagulopathy or hepatic encephalopathy during his illness. He underwent liver biopsy, which demonstrated histologic evidence of acute cholestatic hepatitis highly suspicious of DILI. He was advised to avoid kratom or other herbal supplements in future and prescribed ursodeoxycholic acid with significant improvement in his liver chemistries. Kratom is associated with significant liver enzymes derangements leading to DILI. Kratom is not approved for use in the United States and should be avoided.

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Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211023410 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110234

Author(s):

Mario Romero-Cristóbal ◽

Ana Clemente-Sánchez ◽

Patricia Piñeiro ◽

Jamil Cedeño ◽

Laura Rayón ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Injury ◽

Chronic Liver Disease ◽

Critically Ill ◽

Cox Regression ◽

Chronic Liver ◽

Cox Regression Analysis ◽

Risk Of Death ◽

The Impact

Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. Methods: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan–Meier and Cox regression analysis. Results: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis ( p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11–1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99–1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin. Conclusion: Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

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Drug-Induced Liver Injury in Patients With Preexisting Chronic Liver Disease in Drug Development: How to Identify and Manage?

Gastroenterology ◽

10.1053/j.gastro.2016.10.010 ◽

2016 ◽

Vol 151 (6) ◽

pp. 1046-1051 ◽

Cited By ~ 23

Author(s):

Naga Chalasani ◽

Arie Regev

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Drug Development ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Drug Induced ◽

Drug Induced Liver Injury

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Shared Symptoms and Putative Biological Mechanisms in Chronic Liver Disease

Biological Research For Nursing ◽

10.1177/1099800414541541 ◽

2014 ◽

Vol 17 (2) ◽

pp. 222-229 ◽

Cited By ~ 3

Author(s):

Victoria Menzies ◽

Nancy Jallo ◽

Patricia Kinser ◽

Jo Lynne W. Robins ◽

Kyungeh An ◽

...

Keyword(s):

Quality Of Life ◽

Liver Disease ◽

Chronic Liver Disease ◽

Symptom Management ◽

Patient Population ◽

The United States ◽

Chronic Liver ◽

Biological Mechanisms ◽

Management Interventions

Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver–gut–brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.

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TOLAK UKUR FUNGSI HATI BERDASARKAN DERAJAT FIBROSIS PENYAKIT HATI KRONIS (Liver Function Parameters based on Degree of Liver Fibrosis in Chronic Liver Disease)

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v21i1.1260 ◽

2018 ◽

Vol 21 (1) ◽

pp. 57

Author(s):

Rahmafitria Rahmafitria ◽

Mutmainnah Mutmainnah ◽

Ibrahim Abdul Samad

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Function ◽

Chronic Liver Disease ◽

Total Bilirubin ◽

Chronic Liver ◽

Low Degree ◽

Significant Difference ◽

The Mean ◽

High Degree

Evaluating the degree of liver fibrosis degree is invasive as well as uncomfortable, therefore, non invasive examinations such as liverfunction tests and elastography (Fibro Scan) as a predictor‘s device of liver fibrosis degree are necessary. The aim of this study was toknow the differences of liver function parameters based on the fibrosis degree in patients with chronic liver disease. This study was a crosssectional design using data from chronic liver disease patients treated at the Dr. Wahidin Sudirohusodo Hospital. The elasticity of the liverwas measured using a fibro scan device during June 2010–July 2011. The analysis was carried out by ANOVA test on various parametersof liver function particularly on the fibrosis degree in chronic liver disease. In this study PT, albumin, total bilirubin and platelet countshowed a significant difference of 0.019, 0.009, 0.017 and 0.000 respectively. The mean values of PT and total bilirubin were significantlyhigher in the high degree of fibrosis compared to those with medium and low degree of fibrosis in the chronic liver disease patients. Basedon this study, the mean albumin levels and platelet count were significantly lower in the high degree of fibrosis compared with the mediumand low degree of fibrosis, however, no significant differences in AST, ALT, APTT and GGT were found.

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Increased hepatic fibrosis and JNK2-dependent liver injury in mice exhibiting hepatocyte-specific deletion of cFLIP

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00525.2011 ◽

2012 ◽

Vol 303 (4) ◽

pp. G498-G506 ◽

Cited By ~ 18

Author(s):

Jörn M. Schattenberg ◽

Michael Nagel ◽

Yong Ook Kim ◽

Tobias Kohl ◽

Marcus A. Wörns ◽

...

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Chronic Liver Disease ◽

Hepatic Fibrosis ◽

Chronic Liver ◽

Hepatocellular Injury ◽

Inhibitory Protein ◽

Hepatocellular Apoptosis ◽

Specific Deletion

Chronic liver disease promotes hepatocellular injury involving apoptosis and triggers compensatory regeneration that leads to the activation of quiescent stellate cells in the liver. The deposition of extracellular matrix from activated myofibroblasts promotes hepatic fibrosis and the progression to cirrhosis with deleterious effects on liver physiology. The role of apoptosis signaling pathways in the development of fibrosis remains undefined. The aim of the current study was to determine the involvement of the caspase-8 homologue cellular FLICE-inhibitory protein (cFLIP) during the initiation and progression of fibrosis. Liver injury and fibrosis from carbon tetrachloride (CCl4) and thioacetamide (TAA) were examined in mice exhibiting a hepatocyte-specific deletion of cFLIP ( flip −/−). Acute liver injury from CCl4 and TAA were enhanced in flip −/− mice. This was accompanied by increased activation of caspase-3 and -9, pronounced phosphorylation of JNK, and decreased phosphorylation of Erk. Deletion of the cJun NH2-terminal kinase 2 (JNK2) in flip −/− mice protected from injury. Hepatic fibrosis was increased at baseline in 12-wk-old flip −/− mice, and progression of fibrosis from TAA was accelerated compared with the wild type. In conclusion, deletion of cFLIP in hepatocytes leads to increased fibrosis and accelerated fibrosis progression. This is accompanied by increased injury involving the activation of caspases and JNK2. Thus predisposition to liver injury involving increased hepatocellular apoptosis is a critical mediator of accelerated fibrogenesis, and prevention of liver injury will be a most important measure for patients with chronic liver disease.

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