scholarly journals Liver injury in COVID-19: The current evidence

2020 ◽  
Vol 8 (5) ◽  
pp. 509-519 ◽  
Author(s):  
Saleh A Alqahtani ◽  
Jörn M Schattenberg
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Liver Function ◽  
Case Series ◽  
Current Evidence ◽  
Disease Course ◽  
Underlying Liver Disease ◽  
Hepatobiliary Complications ◽  
Novel Coronavirus ◽  
Work Up

Patients with novel coronavirus disease 2019 (COVID-19) experience various degrees of liver function abnormalities. Liver injury requires extensive work-up and continuous surveillance and can be multifactorial and heterogeneous in nature. In the context of COVID-19, clinicians will have to determine whether liver injury is related to an underlying liver disease, drugs used for the treatment of COVID-19, direct effect of the virus, or a complicated disease course. Recent studies proposed several theories on potential mechanisms of liver injury in these patients. This review summarizes current evidence related to hepatobiliary complications in COVID-19, provides an overview of the available case series and critically elucidates the proposed mechanisms and provides recommendations for clinicians.

Acute Liver Failure

2019 ◽  
pp. 264-269
Author(s):  
James Y. Findlay ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Underlying Liver Disease ◽  
Rapid Deterioration ◽  
Uncommon Condition ◽  
Acute Insult

Acute liver failure (ALF) is an uncommon condition in which an acute insult results in a rapid deterioration of liver function, encephalopathy, and coagulopathy in the absence of prior underlying liver disease. It is differentiated from rapid deterioration in the setting of underlying liver disease (acute on chronic liver failure) and from the gradual deterioration in liver function that can occur in chronic liver failure.

scholarly journals Interaction of volatile organic compounds and underlying liver disease: a new paradigm for risk

2018 ◽  
Vol 399 (11) ◽  
pp. 1237-1248 ◽  
Author(s):  
Anna L. Lang ◽  
Juliane I. Beier
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Acute Liver Injury ◽  
Industrial Chemicals ◽  
New Paradigm ◽  
Alcoholic Fatty Liver ◽  
Underlying Liver Disease ◽  
Volatile Organic ◽  
Occupational Cohort ◽  
Alcoholic Fatty Liver Disease

Abstract Occupational and environmental exposures to industrial chemicals are known to cause hepatotoxicity and liver injury, in humans and in animal models. Historically, research has focused on severe acute liver injury (e.g. fulminant liver failure) or endstage diseases (e.g. cirrhosis and HCC). However, it has become recently recognized that toxicants can cause more subtle changes to the liver. For example, toxicant-associated steatohepatitis, characterized by hepatic steatosis, and inflammation, was recently recognized in an occupational cohort exposed to vinyl chloride. At high occupational levels, toxicants are sufficient to cause liver damage and disease even in healthy subjects with no comorbidities for liver injury. However, it is still largely unknown how exposure to toxicants initiate and possibly more importantly exacerbate liver disease, when combined with other factors, such as underlying non-alcoholic fatty liver disease caused by poor diet and/or obesity. With better understanding of the mechanism(s) and risk factors that mediate the initiation and progression of toxicant-induced liver disease, rational targeted therapy can be developed to better predict risk, as well as to treat or prevent this disease. The purpose of this review is to summarize established and proposed mechanisms of volatile organic compound-induced liver injury and to highlight key signaling events known or hypothesized to mediate these effects.

scholarly journals Influence of Tigecycline on Liver Function in Adult Patients in the Intensive Care Unit

2021 ◽  
Author(s):  
Jingnan Song ◽  
Pan Chen ◽  
Zhaoxia Tang ◽  
Yifan Zheng ◽  
Xiao Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Regression Analysis ◽  
Intensive Care ◽  
Liver Disease ◽  
Liver Injury ◽  
Liver Function ◽  
Adult Patients ◽  
Apache Ii Score ◽  
Cox Regression Analysis

Abstract Background There are few studies investigating TGC-associated hepatotoxicity in ICU patients, and the pathogenesis of hepatotoxicity and identification of risk factors are limited. Objectives To analyze the influence of tigecycline (TGC) on liver function in adult patients in the Intensive Care Unit to identify potential risk factors for tigecycline-induced liver injury (TILI). Methods Patients receiving tigecycline treatment in ICU during January 2019 to October 2020 were retrospectively enrolled. The liver function parameters before and after tigecycline treatment were collected, and risk factors associated with TILI was identified by logistic regression analysis. The probability of 28-day mortality was determined in Cox regression analysis. Results A total of 242 patients were enrolled, and TILI was identified in 24 patients (9.92%), of whom 75.0% had grade 1 liver injury, and 16.67%, 4.17%, 4.17% had grade 2 to 4 liver injury, respectively. The pattern of hepatotoxicity was hepatocellular in 16 patients (66.67%), cholestatic in 4 patients (16.67%), and mixed in 4 patients (16.67%). The median time from tigecycline start to symptoms was only 5 days (IQR, 3-7 days). Multivariate analysis identified tigecycline dose ≥ 200mg/day, longer course of treatment and preexisting liver disease tend to be independently associated with TILI. In addition, APACHE II score > 15, higher dose of tigecycline and TILI were independent risk factors of 28-day mortality, while longer course of tigecycline reduced this risk despite its association with TILI. Conclusions The maintenance dose and course of tigecycline, as well as liver disease is considered as risk factors of hepatotoxicity. 28-day mortality tended to be higher in TILI patients. The relationships among tigecycline dose and course, TILI and mortality should be further investigated.

scholarly journals Characteristics and outcomes of patients with COVID-19 and liver injury: a retrospective analysis and a multicenter experience

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrei Voiosu ◽  
Adina Roman ◽  
Ruxandra Pop ◽  
Alina Boeriu ◽  
Cristiana Popp ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Liver Function ◽  
Chronic Liver Disease ◽  
Liver Function Tests ◽  
Chronic Liver ◽  
Upper Limit ◽  
Function Tests ◽  
Elevated Liver Function Tests ◽  
Negative Outcome

Abstract Background and aims: Patients with COVID-19 frequently present abnormal elevated liver function tests of unknown clinical significance. We aimed to investigate the characteristics and factors influencing outcome in patients with confirmed SARS-CoV-2 infection and liver injury on admission. Methods: This is a retrospective observational study of patients hospitalized in two COVID units in Romania. Relevant data on clinical and laboratory parameters and medication administered during the admission were analyzed to identify predictors of a negative outcome. Patients with confirmed COVID-19 and liver function tests (LFTs) above the upper limit of normal were included in the analysis. Results: From 1,207 patients, we identified 134 patients (11%) with abnormal LFTs during hospitalization. The majority of patients had mildly elevated levels and a predominantly cholestatic pattern of liver injury. Patients who received lopinavir/ritonavir were more likely to have increased ALAT levels (p<0.0001). Sixteen patients had pre-existing chronic liver disease, and they were more likely to suffer from severe COVID-19 (p=0.009) and have a negative outcome (p<0.001), but on multivariate analysis, only the severity of COVID-19 was predictive of death (OR 69.9; 95% CI 6.4-761.4). Conclusions: Mild liver injury is relatively common in COVID-19 and possibly influenced by medication. Patients with chronic liver disease are at high risk for negative outcome, but the severity of the infection is the only predictor of death.

scholarly journals Liver Injury in Patients with COVID-19 without Underlying Liver Disease

2022 ◽  
Vol 11 (2) ◽  
pp. 308
Author(s):  
Monika Pazgan-Simon ◽  
Sylwia Serafińska ◽  
Michał Kukla ◽  
Marta Kucharska ◽  
Jolanta Zuwała-Jagiełło ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Vascular Endothelial Cells ◽  
Signs And Symptoms ◽  
Liver Function Tests ◽  
Underlying Mechanism ◽  
Underlying Liver Disease ◽  
Pattern Of Injury ◽  
Laboratory Test Results ◽  
Type Pattern

SARS-CoV-2 shows a high affinity for the ACE-2 receptor, present on the epithelial cells of the upper and lower respiratory tract, within the intestine, kidneys, heart, testes, biliary epithelium, and—where it is particularly challenging—on vascular endothelial cells. Liver involvement is a rare manifestation of COVID-19. Material and Methods: We reviewed 450 patients admitted due to the fact of SARS-CoV-2 infection (COVID-19) including 88 with liver injury. Based on medical history and previous laboratory test results, we excluded cases of underlying liver disease. The analysis involved a clinical course of COVID-19 in patients without underlying liver disease as well as the type and course of liver injury. Results: Signs and symptoms of liver injury were present in 20% of patients, mostly presenting as a mixed-type pattern of injury with less common cases of standalone hepatocellular (parenchymal) or cholestatic injury. The liver injury symptoms resolved at the end of inpatient treatment in 20% of cases. Sixteen patients died with no cases where liver injury would be deemed a cause of death. Conclusions: (1) Liver injury secondary to COVID-19 was mild, and in in 20%, the signs and symptoms of liver injury resolved by the end of hospitalization. (2) It seems that liver injury in patients with COVID-19 was not associated with a higher risk of mortality. (3) The underlying mechanism of liver injury as well as its sequelae are not fully known. Therefore, caution and further monitoring are advised, especially in patients whose liver function tests have not returned to normal values.

S-adenosylmethionine and proliferation: new pathways, new targets

2008 ◽  
Vol 36 (5) ◽  
pp. 848-852 ◽  
Author(s):  
Nuria Martínez-López ◽  
Marta Varela-Rey ◽  
Usue Ariz ◽  
Nieves Embade ◽  
Mercedes Vazquez-Chantada ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Underlying Liver Disease ◽  
New Findings ◽  
Wide Range ◽  
The Common ◽  
Low Levels ◽  
Amp Activated Protein Kinase ◽  
Hepatocyte Growth ◽  
Growth Abnormalities

SAMe (S-adenosylmethionine) is the main methyl donor group in the cell. MAT (methionine adenosyltransferase) is the unique enzyme responsible for the synthesis of SAMe from methionine and ATP, and SAMe is the common point between the three principal metabolic pathways: polyamines, transmethylation and transsulfuration that converge into the methionine cycle. SAMe is now also considered a key regulator of metabolism, proliferation, differentiation, apoptosis and cell death. Recent results show a new signalling pathway implicated in the proliferation of the hepatocyte, where AMPK (AMP-activated protein kinase) and HuR, modulated by SAMe, take place in HGF (hepatocyte growth factor)-mediated cell growth. Abnormalities in methionine metabolism occur in several animal models of alcoholic liver injury, and it is also altered in patients with liver disease. Both high and low levels of SAMe predispose to liver injury. In this regard, knockout mouse models have been developed for the enzymes responsible for SAMe synthesis and catabolism, MAT1A and GNMT (glycine N-methyltransferase) respectively. These knockout mice develop steatosis and HCC (hepatocellular carcinoma), and both models closely replicate the pathologies of human disease, which makes them extremely useful to elucidate the mechanism underlying liver disease. These new findings open a wide range of possibilities to discover novel targets for clinical applications.

scholarly journals Assessment of hepatitis and fibrosis using Gd-EOB-DTPA MRI in dogs

2020 ◽  
Vol 7 (1) ◽  
pp. e000371
Author(s):  
Toshiyuki Tanaka ◽  
Hidetaka Nishida ◽  
Keiichiro Mie ◽  
Hiroki Yamazaki ◽  
Lee-Shuan Lin ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Contrast Enhancement ◽  
Case Series ◽  
Hepatocellular Adenoma ◽  
Normal Liver ◽  
Histopathological Diagnosis ◽  
Retrospective Case ◽  
Relative Contrast ◽  
Nodular Hyperplasia

BackgroundGadoxetate sodium (Gd-EOB-DTPA) is taken into hepatocytes and excreted into the bile. Hepatocytes with reduced function or dysfunction due to hepatocellular carcinoma (HCC), hepatitis or hepatic fibrosis show impaired Gd-EOB-DTPA uptake. The purpose of the present retrospective case series was to assess the relationship between liver function and contrast enhancement using Gd-EOB-DTPA MRI.MethodsSixteen dogs with a histopathological diagnosis of liver disease, including six with HCC, three with nodular hyperplasia, two with hepatocellular adenoma, two with liver fibrosis and three with hepatitis were included in the study along with three dogs with suspected liver disease but no histopathological diagnosis of liver disease. Relative signal intensities (RSI) of the common bile duct and gall bladder were calculated, and their relationship with the following serum biochemical parameters was assessed: total bilirubin, alanine transaminase, alkaline phosphatase and albumin (Alb). To assess anatomical liver function, relative contrast enhancement indices (RCEI) of the liver were calculated, and differences were assessed between normal and diseased liver.ResultsRSI showed no significant differences between dogs without and with a histopathological diagnosis of liver disease (P=0.88) although they were significantly correlated with Alb (ρ=0.57, P=0.02) in dogs with a histopathological diagnosis of liver disease. RCEI was significantly higher in normal liver tissue than that in livers with hepatitis/fibrosis (P=0.048) and HCC (P=0.03) but not nodular hyperplasia/hepatocellular adenoma (P=0.51).ConclusionsGd-EOB-DTPA MRI may be potentially useful in the assessment of anatomical liver function in dogs with liver disease.

scholarly journals Current Evidence of the Pharmacological Treatments for Novel Coronavirus Disease 2019 (COVID-19) A Scoping Review

2020 ◽  
Author(s):  
Noyuri Yamaji ◽  
Sachiko Ohde ◽  
Kimi Estela Kobayashi-Cuya ◽  
Shota Saito ◽  
Osamu Takahashi
Keyword(s):  
Scoping Review ◽  
Experimental Studies ◽  
Case Series ◽  
Severe Infection ◽  
Current Evidence ◽  
Cochrane Library ◽  
The Novel ◽  
Pharmacological Treatments ◽  
Ongoing Research ◽  
Novel Coronavirus

Background: As of May 2 2020, 3,267,184 confirmed cases of COVID-19 and 229,971 COVID-19-caused deaths have been reported worldwide. Currently, there is limited clarity on the pharmacological treatments available for the novel coronavirus. We systematically identified the current evidence and ongoing research on the pharmacological treatments for COVID-19. Methods: We conducted a scoping review using PRISMA-ScR. Observational studies, including cohort studies and case series, as well as experimental studies, including randomized controlled trials (RCTs) and non-RCTs were searched electronically on April 7, 2020 and by hand on May 1, 2020. PubMed, EMBASE, and Cochrane library databases were searched along with seven trial registries. The inclusion criteria were patients with confirmed COVID-19 who received pharmacological therapies, including hydroxychloroquine and chloroquine, lopinavir/ritonavir, remdesivir, tocilizumab, and favipiravir. Results: We identified 222 studies on pharmacological treatment of the novel coronavirus. We included 11 of these studies in this review, including the ones on hydroxychloroquine and chloroquine (one cohort), lopinavir/ritonavir (one RCT, three cohorts, and two case series), remdesivir (one RCT and one case series), tocilizumab (one case series), and favipiravir (one RCT). In the three RCTs carried out in China, both lopinavir/ritonavir and remdesivir did not show any significant earlier clinical improvement in case of severe infection [Hazard ratio (HR): 1.31, p=0.09 and HR: 1.24, p=0.24, respectively], The clinical recovery rate on day seven was not significantly different between the favipiravir and arbidol groups (p=0.14) for moderate patients, although the duration of pyrexia and cough in the favipiravir group was significantly shorter as compared to the arbidol group (p<0.01). There are 135 ongoing RCTs, including 72 for hydroxychloroquine and chloroquine, 29 for lopinavir/ritonavir, 14 for remdesivir, 16 for tocilizumab, and 4 for favipiravir. Conclusion: The clinical effectiveness and safety of these drugs for the treatment of COVID-19 remains unclear owing to the lack of large, high-quality RCTs. However, in the event of emerging infectious diseases, we need to repeatedly and systematically update the best available evidence to avoid misleading information.

scholarly journals Liver Disease - A Concern in SARS-COV2 Infection

2020 ◽  
Author(s):  
Prosenjit Mondal ◽  
Surbhi Dogra
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Severe Acute Respiratory Syndrome ◽  
Liver Function ◽  
Poor Prognosis ◽  
Clinical Characteristics ◽  
Hepatic Injury ◽  
Clinical Symptoms ◽  
Cardiac Diseases ◽  
Global Pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of coronavirus disease (COVID-19) that has resulted in a global pandemic. The clinical symptoms of the disease vary from mild illness to acute respiratory issues. Older age, diabetes, cardiac diseases predict poor prognosis in COVID-19 patients. Various reports mention the incidence of liver injury with transient elevations in the levels of aminotransferases (liver function enzymes). The clinical characteristics, etiology and underlying pathophysiological mechanisms associated with liver damage in SARS-CoV2 infected patients need to be explored. This review highlights the severity of the hepatic injury in COVID-19.

scholarly journals COVID-19 infection during pregnancy: fetus as a patient deserves more attention

2020 ◽  
Vol 48 (5) ◽  
pp. 438-440 ◽  
Author(s):  
Vedran Stefanovic
Keyword(s):  
Magnesium Sulfate ◽  
Perinatal Death ◽  
Case Series ◽  
Neonatal Morbidity ◽  
Current Evidence ◽  
Delivery Mode ◽  
Perinatal Complications ◽  
Antenatal Steroids ◽  
Antenatal Steroid ◽  
Novel Coronavirus

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic is causing concern also for the management and outcome of COVID-19-positive pregnant women and their offspring, as reported cases are rare. Current evidence suggests the association of COVID-19 infection in pregnancy with both severe maternal morbidity requiring intensive care and perinatal complications (preterm birth with consequent neonatal morbidity and even perinatal death). Most of the reported cases focused specifically on the maternal outcomes and possible vertical transmission, but less attention has been paid to fetus as a patient in such pregnancies. The use of antenatal steroids and fetal neuroprotection with magnesium sulfate is clearly underreported. Several recently issued guidelines suggest lowering the upper gestational age for antenatal steroid administration and also advocate extreme caution or even restraining from the use of magnesium sulfate. Also, the rate of cesarean deliveries among COVID-19 women is unacceptably high. Here we provide arguments for NOT changing the existing guidelines and caution against cesarean delivery that was the prevalent delivery mode in the reported cases and case series.

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