Statin‐induced liver dysfunction triggering fatal myonecrosis

Abstract Sickle cell disease (SCD) has evolved into a debilitating disorder with emerging end-organ damage. One of the organs affected is the liver, causing “sickle hepatopathy,” an umbrella term for a variety of acute and chronic pathologies. Prevalence of liver dysfunction in SCD is unknown, with estimates of 10%. Dominant etiologies include gallstones, hepatic sequestration, viral hepatitis, and sickle cell intrahepatic cholestasis (SCIC). In addition, causes of liver disease outside SCD must be identified and managed. SCIC is an uncommon, severe subtype, with outcome of its acute form having vastly improved with exchange blood transfusion (EBT). In its chronic form, there is limited evidence for EBT programs as a therapeutic option. Liver transplantation may have a role in a subset of patients with minimal SCD-related other organ damage. In the transplantation setting, EBT is important to maintain a low hemoglobin S fraction peri- and posttransplantation. Liver dysfunction in SCD is likely to escalate as life span increases and patients incur incremental transfusional iron overload. Future work must concentrate on not only investigating the underlying pathogenesis, but also identifying in whom and when to intervene with the 2 treatment modalities available: EBT and liver transplantation.

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A case of a girl presenting with fever, cytopenia, liver dysfunction, hepatosplenomegaly, and hemophagocytosis in the bone marrow

Journal of Clinical Virology ◽

10.1016/j.jcv.2010.12.013 ◽

2011 ◽

Vol 51 (1) ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

R.N. Gunson ◽

R. Hague ◽

B. Gartner ◽

C. Aitken

Keyword(s):

Bone Marrow ◽

Liver Dysfunction

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Effects of Coffee Consumption against the Development of Liver Dysfunction. A 4-Year Follow-Up Study of Middle-Aged Japanese Male Office Workers.

Industrial Health ◽

10.2486/indhealth.38.99 ◽

2000 ◽

Vol 38 (1) ◽

pp. 99-102 ◽

Cited By ~ 16

Author(s):

Noriyuki NAKANISHI ◽

Koji NAKAMURA ◽

Kenji SUZUKI ◽

Kozo TATARA

Keyword(s):

Liver Dysfunction ◽

Coffee Consumption ◽

Office Workers ◽

Middle Aged ◽

Follow Up Study ◽

Japanese Male

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Prognostic value of cardio-hepatic-skeletal muscle syndrome in patients with heart failure

Scientific Reports ◽

10.1038/s41598-020-80641-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Takumi Noda ◽

Kentaro Kamiya ◽

Nobuaki Hamazaki ◽

Kohei Nozaki ◽

Takafumi Ichikawa ◽

...

Keyword(s):

Heart Failure ◽

Physical Function ◽

Grip Strength ◽

Liver Dysfunction ◽

Gait Speed ◽

International Normalized Ratio ◽

Walking Distance ◽

Leg Strength ◽

Function Test ◽

End Stage

AbstractAlthough heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. We reviewed 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-min walking distance [6MWD]). In the multiple regression analysis, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (all P < 0.001). One hundred thirty deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62–3.04). For all-cause mortality, patients with high MELD-XI scores and reduced physical functions were found to have a significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR]: 3.80, P < 0.001; leg strength, HR: 4.65, P < 0.001; gait speed, HR: 2.49, P = 0.001, and 6MWD, HR: 5.48, P < 0.001). Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF.

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Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?

Annals of Intensive Care ◽

10.1186/s13613-021-00835-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kevin Roedl ◽

Dominik Jarczak ◽

Andreas Drolz ◽

Dominic Wichmann ◽

Olaf Boenisch ◽

...

Keyword(s):

Critically Ill ◽

Liver Dysfunction ◽

Critically Ill Patients ◽

Severity Of Illness ◽

University Hospital ◽

Severe Liver ◽

Saps Ii ◽

Severe Liver Dysfunction ◽

Global Threat ◽

The University

Abstract Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.

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