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

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.

scholarly journals Aminotransferase Levels in Relation to Short-Term use of Acetaminophen Four Grams Daily in Postoperative Cardiothoracic Patients in the Intensive Care Unit

2011 ◽  
Vol 39 (6) ◽  
pp. 1056-1063 ◽  
Author(s):  
S. J. G. M. Ahlers ◽  
L. van Gulik ◽  
E. P. A. van Dongen ◽  
P. Bruins ◽  
D. Tibboel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Liver Function ◽  
Alanine Aminotransferase ◽  
Liver Function Tests ◽  
Analgesic Agent ◽  
Short Term ◽  
Function Tests ◽  
Volunteer Study

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.

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

2020 ◽  
Vol 40 (10) ◽  
pp. 2394-2406 ◽  
Author(s):  
Salvatore Piano ◽  
Andrea Dalbeni ◽  
Elia Vettore ◽  
Devis Benfaremo ◽  
Massimo Mattioli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Function ◽  
Liver Function Tests ◽  
Abnormal Liver Function ◽  
Function Tests

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

2009 ◽  
Vol 35 (8) ◽  
pp. 1406-1411 ◽  
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

scholarly journals Methimazole induced hepatotoxicity: A rare adverse reaction

2019 ◽  
Vol 6 (3) ◽  
pp. 1
Author(s):  
Kevin C. Kohm ◽  
Lauren Pioppo ◽  
Jack Xu ◽  
Preston Keiffer ◽  
Eric Pagan ◽  
...  
Keyword(s):  
Liver Injury ◽  
Liver Function ◽  
Side Effect ◽  
Hepatic Injury ◽  
Total Bilirubin ◽  
Liver Function Tests ◽  
Side Effect Profile ◽  
Function Tests ◽  
Painless Jaundice ◽  
Graves Orbitopathy

Methimazole (MMI) is a commonly used medication in the treatment of hyperthyroidism. The side effect profile is extensive and includes the rare but serious side effect of drug associated liver injury. We report the case of a 51-year-old female who presented with painless jaundice several weeks after initiating MMI therapy for treatment of hyperthyroidism complicated by Graves’ orbitopathy. Liver function tests on presentation showed alanine aminotransferase (ALT) 1366 IU/L, aspartate aminotransferase (AST) 853 IU/L, total bilirubin 26.2 mg/dl, alkaline phosphatase 954 IU/L. Workup of structural, infectious, and autoimmune causes of hepatic injury was negative. The patient was therefore found to have MMI associated liver injury. MMI was discontinued and the patient was started on ursodiol, resulting in resolution of her jaundice and improvement of her liver function tests.

Propafenone-Induced Liver Injury

1992 ◽  
Vol 26 (7-8) ◽  
pp. 926-928 ◽  
Author(s):  
Sarah A. Spinier ◽  
Cheryl A. Elder ◽  
K. Elizabeth Kindwall
Keyword(s):  
Atrial Fibrillation ◽  
Liver Injury ◽  
Liver Function ◽  
Care Center ◽  
Tertiary Care ◽  
Liver Function Tests ◽  
Tertiary Care Center ◽  
Upper Limit ◽  
Function Tests ◽  
Recurrent Atrial Fibrillation

OBJECTIVE: To describe propafenone-induced liver injury. DESIGN: Retrospective case report. SETTING: Referred care in a large tertiary care center. Laboratory tests were performed at the auxiliary site and the tertiary care center. PATIENT: A 71-year-old woman with atrial fibrillation developed elevations of greater than two times the upper limit of normal in alkaline phosphatase (ALK), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyltransferase (GGT) after initiation of propafenone therapy. INTERVENTIONS: Studies included serial measurements of ALK, ALT, AST, and GGT. RESULTS: The patient developed elevations of greater than two times the upper limit of normal in ALK, ALT, and AST, one month after initiating propafenone therapy. The propafenone dose was decreased from 900 to 675 mg/d and, ten days later, the ALK, ALT, and AST were decreased slightly, but still above the upper limit of normal. One month later, serum transaminases had returned to baseline, but propafenone therapy was discontinued because of recurrent atrial fibrillation, persistent elevation in ALK, and elevation in GGT. Two months after discontinuing propafenone, serum aminotransaminase and ALK concentrations had normalized and GGT had decreased and remained only slightly elevated. CONCLUSIONS: The occurrence of liver injury secondary to propafenone therapy is rare. Reported cases appear to be secondary to hepatocellular injury, cholestasis, or a combination of the two. In this case, the pattern demonstrated by elevations in liver enzymes may be classified as acute cholestatic liver injury. Because the reported incidence is 0.1–0.2 percent and there are no known fatalities secondary to propafenone liver injury, routine monitoring of liver function tests in all patients receiving propafenone cannot be recommended at this time. Baseline liver function tests prior to initiating propafenone therapy with follow-up laboratory studies one month later are recommended in patients with known liver dysfunction. If elevations are noted, a reduction in dose may result in lower liver enzyme concentrations, although discontinuation of therapy may be required in some cases.

scholarly journals Impact of COVID-19 on liver function: results from an internal medicine unit in Northern Italy

2020 ◽  
Vol 15 (8) ◽  
pp. 1399-1407 ◽  
Author(s):  
Marco Vincenzo Lenti ◽  
◽  
Federica Borrelli de Andreis ◽  
Ivan Pellegrino ◽  
Catherine Klersy ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care ◽  
Liver Function ◽  
Laboratory Data ◽  
Liver Function Tests ◽  
Gamma Glutamyl Transpeptidase ◽  
Function Tests ◽  
Altered Liver ◽  
The Impact ◽  
Internal Medicine Unit

Abstract Little is known regarding coronavirus disease 2019 (COVID-19) clinical spectrum in non-Asian populations. We herein describe the impact of COVID-19 on liver function in 100 COVID-19 consecutive patients (median age 70 years, range 25–97; 79 males) who were admitted to our internal medicine unit in March 2020. We retrospectively assessed liver function tests, taking into account demographic characteristics and clinical outcome. A patient was considered as having liver injury when alanine aminotransferase (ALT) was > 50 mU/ml, gamma-glutamyl transpeptidase (GGT) > 50 mU/ml, or total bilirubin > 1.1 mg/dl. Spearman correlation coefficient for laboratory data and bivariable analysis for mortality and/or need for intensive care were assessed. A minority of patients (18.6%) were obese, and most patients were non- or moderate-drinkers (88.5%). Liver function tests were altered in 62.4% of patients, and improved during follow-up. None of the seven patients with known chronic liver disease had liver decompensation. Only one patient developed acute liver failure. In patients with altered liver function tests, PaO2/FiO2 < 200 was associated with greater mortality and need for intensive care (HR 2.34, 95% CI 1.07–5.11, p = 0.033). To conclude, a high prevalence of altered liver function tests was noticed in Italian patients with COVID-19, and this was associated with worse outcomes when developing severe acute respiratory distress syndrome.

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.

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