Abnormal liver function tests predict transfer to intensive care unit and death in COVID‐19

A volunteer study suggested that taking paracetamol 4 g daily could result in elevated alanine aminotransferase plasma levels in a substantial proportion of healthy volunteers. The safety of this dose of paracetamol for acute postoperative pain remains controversial. This study aimed to examine the incidence of alanine aminotransferase elevations after short-term use of paracetamol 4 g daily, as part of the standard pain management protocol, for 93 consecutive patients after cardiothoracic surgery. Alanine aminotransferase levels and other liver function tests were measured preoperatively as baseline and once daily after surgery during the intensive care unit stay. Preoperative alanine aminotransferase levels of more than one time the upper limit of normal (ULN, >40 U/l) was observed in 11% (n=10) of the patients but none of these baseline alanine aminotransferase levels exceeded three times the ULN (>3×ULN). The average daily dose of paracetamol administered was 50 mg/kg (SD=16) after surgery. Postoperative alanine aminotransferase levels of >1×ULN was observed in 17% (n=16), and 4% (n=4) exceeded >3×ULN. The other liver function tests of the latter four patients, including aspartate aminotransferase (range 173 to 5590 U/l), γ-glutamyltransferase (range 56 to 103 U/l), lactate dehydrogenase (range 376 to 3518 U/l) and the International Normalised Ratio (range 2.0 to 6.6), were all abnormal. These four patients all had right ventricular failure or cardiogenic shock during the postoperative period which could explain the significant rises in alanine aminotransferase after surgery. In conclusion, the incidence of significant alanine aminotransferase elevations after using daily paracetamol as an analgesic agent for cardiac surgery, at a dose of 4 g per day, was low and mostly due to complications after surgery. Our results, albeit still very limited, provided some reassurance about the safety of paracetamol 4 g daily, as a supplementary analgesic agent for adult patients undergoing cardiac surgery.

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Reducing the number of unnecessary liver function tests requested on the Paediatric Intensive Care Unit

BMJ Quality Improvement Reports ◽

10.1136/bmjquality.u214071.w5561 ◽

2017 ◽

Vol 6 (1) ◽

pp. u214071.w5561 ◽

Cited By ~ 3

Author(s):

Lynn Sinitsky ◽

Joe Brierley

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Function ◽

Paediatric Intensive Care Unit ◽

Liver Function Tests ◽

Paediatric Intensive Care ◽

Function Tests

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Abnormal liver function tests are associated with increased mortality in both cardiothoracic and general intensive care

Critical Care ◽

10.1186/cc7621 ◽

2009 ◽

Vol 13 (Suppl 1) ◽

pp. P457 ◽

Cited By ~ 1

Author(s):

S Musa ◽

M Cowan ◽

S Thomson ◽

P Collinson ◽

G McAnulty ◽

...

Keyword(s):

Intensive Care ◽

Liver Function ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Function Tests

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‘Liver function tests’ on the intensive care unit: a prospective, observational study

Intensive Care Medicine ◽

10.1007/s00134-009-1511-7 ◽

2009 ◽

Vol 35 (8) ◽

pp. 1406-1411 ◽

Cited By ~ 37

Author(s):

S. J. Thomson ◽

M. L. Cowan ◽

I. Johnston ◽

S. Musa ◽

M. Grounds ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Function ◽

Observational Study ◽

Prospective Observational Study ◽

Liver Function Tests ◽

Function Tests

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G533 Reducing the number of unnecessary liver function tests requested on the paediatric intensive care unit

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-310863.520 ◽

2016 ◽

Vol 101 (Suppl 1) ◽

pp. A314-A315

Author(s):

L Sinitsky ◽

D Shepherd ◽

M Cooshneea ◽

J Brierley

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Function ◽

Paediatric Intensive Care Unit ◽

Liver Function Tests ◽

Paediatric Intensive Care ◽

Function Tests

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Impact of the Severity of Liver Injury in COVID-19 Patients Admitted to an Intensive Care Unit During the SARS-CoV2 Pandemic Outbreak

The Journal of Critical Care Medicine ◽

10.2478/jccm-2021-0021 ◽

2021 ◽

Vol 7 (3) ◽

pp. 211-216

Author(s):

Adina Roman ◽

Septimiu Moldovan ◽

Ario Santini ◽

Mircea Stoian ◽

Daniela Dobru

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Injury ◽

Liver Function ◽

Epidemiological Data ◽

Liver Function Tests ◽

Albumin Level ◽

World Health ◽

Female Ratio ◽

Function Tests

Abstract Introduction: The World Health Organization (WHO) identified a novel coronavirus, originating in Wuhan, China, in December 2019, as a pneumonia causing pathogen. Epidemiological data in Romania show more than 450.000 confirmed patients, with a constant number of approximately 10% admission in intensive care unit. Method: A retrospective, observational study was conducted from 1st March to 30th October 2020, comprising 657 patients, confirmed as having COVID-19, and who had been admitted to the intensive care unit of the Mures County Clinical Hospital, Tîrgu Mures, Romania, which had been designated as a support hospital during the pandemic. Patients who presented at admission or developed abnormal liver function tests in the first seven days of admission, were included in the study; patients with pre-existing liver disease, were excluded. Results: The mean (SD) age of patients included in the study was 59.41 (14.66) years with a male: female ratio of 1.51:1. Survivor status, defined as patients discharged from the intensive care unit, was significantly associated with parameters such as age, leukocyte count, albumin level, glycaemia level (p<0.05 for all parameters.) Conclusions: Liver injury expressed through liver function tests cannot solely constitute a prognostic factor for COVID-19 patients, but its presence in critically ill patients should be further investigated and included in future guideline protocols.

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Alpha 1 Anti Trypsin Levels in Asymptomatic Patients with Abnormal Liver Function Tests

Endoscopy ◽

10.1055/s-2006-956876 ◽

2006 ◽

Vol 38 (11) ◽

Author(s):

BJ Egan ◽

S Sarwar ◽

M Anwar ◽

C O'Morain ◽

B Ryan

Keyword(s):

Liver Function ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Function Tests ◽

Asymptomatic Patients

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Abnormal Liver Function Tests and Long-Term Outcomes in Patients Discharged after Acute Heart Failure

Journal of Clinical Medicine ◽

10.3390/jcm10081730 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1730

Author(s):

Hiroshi Miyama ◽

Yasuyuki Shiraishi ◽

Shun Kohsaka ◽

Ayumi Goda ◽

Yosuke Nishihata ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Adverse Outcomes ◽

Long Term Outcomes ◽

Function Tests ◽

Parameter Values

Abnormal liver function tests (LFTs) are known to be associated with impaired clinical outcomes in heart failure (HF) patients. However, this implication varies with each single LFT panel. We aim to evaluate the long-term outcomes of acute HF (AHF) patients by assessing multiple LFT panels in combination. From a prospective multicenter registry in Japan, 1158 AHF patients who were successfully discharged were analyzed (mean age, 73.9 ± 13.5 years; men, 58%). LFTs (i.e., total bilirubin, aspartate aminotransferase or alanine aminotransferase, and alkaline phosphatase) at discharge were assessed; borderline and abnormal LFTs were defined as 1 and ≥2 parameter values above the normal range, respectively. The primary endpoint was composite of all-cause death or HF readmission. At the time of discharge, 28.7% and 8.6% of patients showed borderline and abnormal LFTs, respectively. There were 196 (16.9%) deaths and 298 (25.7%) HF readmissions during a median 12.4-month follow-up period. The abnormal LFTs group had a significantly higher risk of experiencing the composite outcome (adjusted hazard ratio: 1.51, 95% confidence interval: 1.08–2.12, p = 0.017), whereas the borderline LFTs group was not associated with higher risk of adverse events when referenced to the normal LFTs group. Among AHF patients, the combined elevation of ≥2 LFT panels at discharge was associated with long-term adverse outcomes.

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