scholarly journals Coronavirus Disease-19 and Liver Injury

2020 ◽  
Vol 8 (T1) ◽  
pp. 154-157
Author(s):  
Gontar Alamsyah Siregar ◽  
Ginanda Putra Siregar ◽  
Darmadi Darmadi ◽  
Riska Habriel Ruslie
Keyword(s):  
Liver Injury ◽  
Liver Enzymes ◽  
Gamma Glutamyl Transferase ◽  
Converting Enzyme ◽  
Drug Induced ◽  
Angiotensin Converting Enzyme 2 ◽  
Cytopathic Effects ◽  
Elevated Liver Enzymes ◽  
Apoptotic Activity ◽  
Glutamyl Transferase

Coronavirus Disease (COVID)-19 is a pandemic since March 11, 2020. The total case is more than a half million worldwide. Liver injury is quite common in COVID-19 patients. Direct viral infection is possible due to the presence of angiotensin converting enzyme 2 in cholangiocytes and hepatocytes. Other proposed mechanisms are virus-induced cytopathic effects, inflammation process, hypoxia and shock, increased apoptotic activity, increased positive end expiratory effect, and drug-induced. The manifestation of liver injury is mild and transient with elevated liver enzymes, bilirubin, and gamma-glutamyl transferase levels. Deterioration of liver function can occur in subjects with COVID-19 and underlying liver injury. The management is principally supportive. Hepatoprotective drugs may be administered in severe cases.

scholarly journals COVID-19 associated variations in liver function parameters: a retrospective study

2020 ◽  
pp. postgradmedj-2020-138930
Author(s):  
Ram Krishan Saini ◽  
Neha Saini ◽  
Sant Ram ◽  
Shiv Lal Soni ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Liver Injury ◽  
Liver Function ◽  
Liver Enzyme ◽  
Inflammatory Markers ◽  
Liver Enzymes ◽  
Tertiary Care ◽  
Abnormal Liver Function ◽  
Gamma Glutamyl Transferase ◽  
Number Of Patients ◽  
Glutamyl Transferase

BackgroundCharacteristics of laboratory findings of COVID-19 patients are of great significance for diagnosis and treatment. Studies that have analysed the variations in hepatic profile in correlation with the inflammatory markers in SARS-CoV-2 are limited.MethodsWe retrospectively analysed liver function tests and inflammatory markers of 170 admitted patients with confirmed COVID-19 in the tertiary care centre, Post Graduate Institute of Medical Education and Research (PGIMER), India, using Roche Cobas Autoanalyzer.ResultsNumber of patients with normal liver enzyme levels were 63 (41.5%), while with raised levels of any of the liver enzymes were 89 (58.5%), out of which 43 (48.31%) had liver injury which manifested as increased severity in terms of intensive care unit (ICU) requirement (p=0.0005). Significantly raised levels of liver enzymes and liver injury were observed with age (p<0.0001) and in males (p=0.004). Significantly decreased levels of albumin and total proteins and increased levels of total bilirubin (p<0.0001) were seen in patients with abnormal liver enzyme levels and liver injury as compared to patients with normal levels. Significant increase in the levels of alanine transaminase and gamma-glutamyl transferase was seen on the 7th day, CRP and ferritin (p<0.0001) peaks were observed on 2nd and 3rd day respectively. A significant positive correlation was found between the levels of these inflammatory markers and liver function parameters.ConclusionsMore than half of patients admitted to the hospital with SARS-CoV-2 infection had an abnormal liver function which was found to be associated with raised levels of inflammatory markers. Significantly higher proportions of patients with abnormal liver function were elderly and males and were at higher risk of progressing to severe disease.

Blood mercury and liver enzymes: A pan-India retrospective correlation study

2020 ◽  
Vol 36 (12) ◽  
pp. 1019-1023
Author(s):  
Krishnakumar Sivapandi ◽  
Amruta Velumani ◽  
Kallathikumar Kallathiyan ◽  
Sandhya Iyer ◽  
Prachi Sinkar
Keyword(s):  
Inductively Coupled Plasma ◽  
Liver Enzymes ◽  
National Laboratory ◽  
Linear Regression Analysis ◽  
Correlation Study ◽  
Gamma Glutamyl Transferase ◽  
Toxic Heavy Metal ◽  
Elevated Liver Enzymes ◽  
The Difference ◽  
Glutamyl Transferase

Mercury (Hg) is a toxic heavy metal, and the reported effects of exposure on liver function continue to be inconsistent. The objective of our study was to identify correlations between high blood Hg levels and liver enzymes in a pan-India population including adults ≥19 years of age. This retrospective study analyzed the data from 95,398 individuals tested for blood Hg levels and liver enzymes in our national laboratory. Testing for blood Hg was done by inductively coupled plasma-mass spectrometry, while testing for liver enzymes—aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT), and gamma-glutamyl transferase—was done by automated photometry systems. Data from all the individuals inclusive of 52,497 males and 42,901 females were studied. The frequency of high blood Hg levels (>5 µg/L) was found to be 0.6%, and the difference between males and females was not found to be significant. Further correlation by linear regression analysis found no relationship between high blood Hg levels and liver enzymes among females. However, among males, there was a significant correlation between high blood Hg levels, and increased AST as well as ALT. Our report suggested that for males but not females, Hg exposure may be one of the differentials for elevated liver enzymes.

scholarly journals Elevated Liver Enzymes and Incident Type Two Diabetes Mellitus Risk in Yemeni Patients     

2021 ◽  
Author(s):  
Lotfi S. Bin Dahman ◽  
Mariam A. Humam ◽  
Nabil S. Musiaan ◽  
Ahmed M. Daakik ◽  
Mohammed A. Balfas
Keyword(s):  
Blood Glucose ◽  
Total Cholesterol ◽  
Liver Enzymes ◽  
Fasting Blood Glucose ◽  
Density Lipoprotein ◽  
Predictive Biomarkers ◽  
Gamma Glutamyl Transferase ◽  
Incident Type ◽  
Elevated Liver Enzymes ◽  
Glutamyl Transferase

Abstract This case-control study was aimed to assess the association between liver enzymes and incident T2D in Yemeni patients. The present study comprising 142 T2D patients and 142 healthy control subjects were recruited from the diabetic outpatient clinic of Ibn-Sina Hospital in Mukalla during the period from 1st January to 30th May 2020. Serum fasting blood glucose (FBG), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) were analyzed using the Cobas Integra Plus 400 autoanalyzer. Anthropometric and blood pressure measurements were taken from each participant. T2D patients had significantly higher FBG (P= <0.0001), total cholesterol (P= <0.0001), LDL-C (P= <0.0001), and GGT (P= <0.0001) while, HDL-C was significantly lower in T2D patients (P= 0.021). Serum ALT and GGT levels were significantly associated with increased incident T2D risk (P= 0.006 for ALT and 0.022 for GGT), and the odds ratios at 95% CI comparing the highest versus lower tertiles of ALT and GGT were 2.75(2.01-3.48) and 1.17(1.83-6.42) respectively. In conclusion, higher levels of ALT and GGT are positively associated with increased blood glucose levels and are used as predictive biomarkers for developing a higher risk of diabetes. Thus, routine screening of ALT and GGT in T2D patients is recommended for the early detection of liver disorders.

scholarly journals Anastrozole-induced liver injury after a prolonged latency: a very rare complication of a commonly prescribed medication

2019 ◽  
Vol 12 (11) ◽  
pp. e231741 ◽  
Author(s):  
Chencheng Xie ◽  
Hafez Mohammad Ammar Abdullah ◽  
Mohamed Abdallah ◽  
Erin Quist ◽  
Mumtaz Niazi
Keyword(s):  
Liver Injury ◽  
Liver Enzymes ◽  
Rare Complication ◽  
Assessment Method ◽  
Drug Induced ◽  
Serious Adverse Events ◽  
Drug Induced Liver Injury ◽  
Elevated Liver Enzymes ◽  
Safe Side ◽  
Prolonged Latency

Anastrozole is an aromatase inhibitor that has been used more frequently over the last decade especially for oestrogen receptor-positive breast cancer. It has a relatively safe side effect profile. However, occasionally it has been associated with serious adverse events. Here, we present the case of a 58-year-old woman who presented with significantly elevated liver enzymes 4 years after starting anastrozole. She was not taking any other medications and an extensive workup did not reveal any other cause for her liver injury. The patient’s liver enzymes normalised after discounting the anastrozole. She scored 4 on the updated Roussel Uclaf Causality Assessment Method grading system which was possible for drug-induced liver injury. A review of the literature revealed six prior cases of anastrozole-related liver injury. Anastrozole should be considered as a possible culprit in patients who develop an unexplained acute liver injury.

Hepatic Involvement in Aicardi-Goutières Syndrome

2021 ◽  
Author(s):  
Francesco Gavazzi ◽  
Zachary M. Cross ◽  
Sarah Woidill ◽  
Joseph M. McMann ◽  
Elizabeth B. Rand ◽  
...  
Keyword(s):  
Liver Enzymes ◽  
Fold Increase ◽  
Rank Test ◽  
Gamma Glutamyl Transferase ◽  
Type I ◽  
Hepatic Involvement ◽  
Markers Of Inflammation ◽  
Log Rank Test ◽  
Elevated Liver Enzymes ◽  
Glutamyl Transferase

AbstractAicardi-Goutières syndrome (AGS) is a monogenic type-I interferonopathy that results in neurologic injury. The systemic impact of sustained interferon activation is less well characterized. Liver inflammation is known to be associated with the neonatal form of AGS, but the incidence of AGS-related hepatitis across lifespan is unknown.We compared natural history data including liver enzyme levels with markers of inflammation, (liver-specific autoantibodies and interferon signaling gene expression[ISG] scores). Liver enzymes were classified as normal or elevated by the fold increase over the upper limit of normal (ULN). The highest increases were designated as hepatitis, defined as aspartate-aminotransferase or alanine-aminotransferase threefold ULN, or gamma-glutamyl transferase 2.5-fold ULN. A larger cohort was used to further characterize the longitudinal incidence of liver abnormalities and the association with age and genotype.Across the AGS cohort (n = 102), elevated liver enzymes were identified in 76 individuals (74.5%) with abnormalities at a level consistent with hepatitis in 29 individuals (28.4%). SAMHD1 mutations were less likely to be associated with hepatitis (log-rank test; p = 0.011). Hepatitis was associated with early-onset disease and microcephaly (log-rank test; microcephaly p = 0.0401, age onset p = 0.0355). While most subjects (n = 20/33) were found to have liver-specific autoantibodies, there was no association between the presence of autoantibodies or ISG scores with hepatitis-level enzyme elevations.In conclusion, all genotypes of AGS are associated with transient elevations of liver enzymes and the presence of liver-associated autoantibodies. This adds to our growing understanding of the systemic pathology AGS.

scholarly journals Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

2020 ◽  
Vol 7 (1) ◽  
pp. e000549
Author(s):  
Robin Daniel Abeles ◽  
Matthew Foxton ◽  
Shahid Khan ◽  
Robert Goldin ◽  
Belinda Smith ◽  
...  
Keyword(s):  
Liver Injury ◽  
Causality Assessment ◽  
Case Reports ◽  
Kidney Injury ◽  
Assessment Method ◽  
Gamma Glutamyl Transferase ◽  
Drug Induced ◽  
Comprehensive Review ◽  
Glutamyl Transferase ◽  
Androgenic Steroids

BackgroundAnabolic androgenic steroids (AAS) usage is widespread and increasing. AAS drug-induced liver injury (DILI) is recognised but its clinical course and management is poorly described. We report 2 cases of AAS DILI with associated renal dysfunction, managed successfully with oral corticosteroids.MethodsA comprehensive review identified 50 further cases to characterise the clinical and biochemical course. Causality grading was calculated using the updated Roussel Uclaf Causality Assessment Method (RUCAM) score. Data are presented as median values.ResultsThe most common AAS taken was methyldrostanolone. Patients commonly present with jaundice and pruritus but may exhibit other constitutional symptoms. Patients presented 56 days after starting, and bilirubin peaked 28 days after stopping, AAS. Causality assessment was ‘unlikely’ in 1 (2%), ‘possible’ in 31 (60%) and ‘probable’ in 20 (38%). Peak values were: bilirubin 705 μmol/L, alanine transaminase 125 U/L, aspartate transaminase 71 U/L, alkaline phosphatase 262 U/L, gamma-glutamyl transferase 52 U/L, international normalised ratio 1.1. Liver biopsies showed ‘bland’ canalicular cholestasis. 43% of patients developed kidney injury (peak creatinine 225 μmol/L). Therapies included antipruritics, ursodeoxycholic acid and corticosteroids. No patients died or required liver transplantation.ConclusionsPhysicians are likely to encounter AAS DILI. Causality assessment using the updated RUCAM should be performed but defining indications and proving efficacy for therapies remains challenging.

scholarly journals Recurrence and Severe Worsening of Hepatotoxicity After Reintroduction of Atorvastatin in Combination With Ezetimibe

2017 ◽  
Vol 10 ◽  
pp. 117954761773137 ◽  
Author(s):  
Silje Bergland Ellingsen ◽  
Elisabet Nordmo ◽  
Knut Tore Lappegård
Keyword(s):  
Liver Injury ◽  
Liver Enzymes ◽  
Current Data ◽  
Class Effect ◽  
Drug Induced ◽  
Good Tolerance ◽  
Drug Induced Liver Injury ◽  
Severe Hepatotoxicity ◽  
Elevated Liver Enzymes ◽  
History Of

Severe hepatotoxicity is a rare but well-known adverse reaction to statins. However, despite the widespread use of statins, only a few cases describing statin reexposure or switch to another statin after liver injury have been published. The literature on hepatotoxicity with ezetimibe alone or in combination with statins is also scarce. We report a case where a patient with a history of elevated liver enzymes while using atorvastatin, but prior and subsequent good tolerance to simvastatin and pravastatin, developed drug-induced liver injury on reexposure to a combination of atorvastatin and ezetimibe. The hepatotoxicity in our patient was most likely caused by reexposure to atorvastatin, although we cannot exclude ezetimibe as a contributing factor. This case highlights the risk of hepatotoxicity recurrence on rechallenge with the same statin. The tolerance to other statins in this case also strengthens the suspicion that statin-induced liver injury may not be a class effect, although the current data are too scarce to draw any definite conclusions.

scholarly journals A possible increase in liver enzymes due to amlodipine: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2091782
Author(s):  
Ginny Varghese ◽  
Lama Madi ◽  
Muna Ghannam ◽  
Rafaat Saad
Keyword(s):  
Liver Injury ◽  
Liver Enzymes ◽  
Case Reports ◽  
Assessment Method ◽  
Probability Scale ◽  
Antihypertensive Medications ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Elevated Liver Enzymes ◽  
Liver Transaminases

Amlodipine is a commonly prescribed antihypertensive drug, well tolerated and has rarely been attributed as a cause for elevated liver enzymes. Here, we present a 47-year-old male patient known to be hypertensive and admitted to our rehabilitation facility after an acute stroke. During his stay, amlodipine was started in addition to other antihypertensive medications to control his blood pressure. His liver transaminases after 4 days (notably alanine aminotransferase) were found to be markedly elevated. After reviewing the medications and investigating probable causes, amlodipine was suspended. After 5 days of suspending amlodipine, the transaminases started to trend downward. The Naranjo Adverse Drug Reaction Probability Scale and the Roussel Uclaf Causality Assessment Method were performed to assess causality in this suspected idiosyncratic drug-induced liver injury case. Both the scores denoted a probable amlodipine-induced liver injury. Previous case reports related to amlodipine-induced liver injury are mentioned and presented in the table below. In conclusion, amlodipine, though not well known to be hepatotoxic, can induce liver enzyme elevations in an idiosyncratic manner.

scholarly journals Drug-Induced Liver Injury: A Unique Presentation of Single-Dose Administration of Propylthiouracil

2020 ◽  
Vol 8 ◽  
pp. 232470962095132
Author(s):  
Simcha Weissman ◽  
Nishan G. Rajaratnam ◽  
Nabeel Qureshi ◽  
Faisal Inayat ◽  
Sameh Elias
Keyword(s):  
Single Dose ◽  
Liver Injury ◽  
Liver Enzymes ◽  
Antithyroid Drug ◽  
Thyroid Storm ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Elevated Liver Enzymes ◽  
Pharmacologic Agents

Antithyroid drug-induced severe liver injury is an uncommon but serious complication. We hereby delineate the case of a 38-year-old female who presented to the emergency department for an impending thyroid storm. After initiation of a single dose of propylthiouracil, her liver enzymes went into the thousands. She was subsequently admitted to the intensive care unit. Propylthiouracil was discontinued and corticosteroids were initiated with the resolution of her elevated liver enzymes. On follow-up, her liver function was at its baseline and thyroid hormone levels were under control. We hope this report will encourage clinicians to cast a broad differential diagnosis in patients presenting with liver injury in the acute setting. Furthermore, it is imperative to raise awareness regarding the ever-increasing list of pharmacologic agents that can perpetuate drug-induced hepatotoxicity.

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