Clinical characteristics and outcomes of COVID-19 patients with hypoxic hepatitis

Wu, Yanyan; Ma, Zhuang; Guo, Xiaozhong; Li, Hongyu; Tang, Yufu; Meng, Hao; Yu, Hao; Peng, Chengfei; Chu, Guiyang; Wang, Xinwei; Teng, Yue; Zhang, Quanyu; Zhu, Tianyi; Wang, Bing; Tong, Zhenhua; Zhao, Haitao; Lü, Hui; Qi, Xingshun

doi:10.1016/j.clinre.2021.101665

Cited by 5 publications

(6 citation statements)

References 9 publications

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“…In animal models of influenza, even in the absence of viral replication within the liver, the production of inflammatory cytokines resulted in hepatic oxidative stress which leads to hepatocellular injury [20] . Patients with severe disease may also have liver injury secondary to an ischaemic insult, which is classically seen to improve quickly with reperfusion of the organ [22–25] . Only a small proportion of these patients progress to fulminant liver failure, which had not been observed in our cohort [25] .…”

Section: Discussionmentioning

confidence: 65%

“…[20] Patients with severe disease may also have liver injury secondary to an ischaemic insult, which is classically seen to improve quickly with reperfusion of the organ. [22][23][24][25] Only a small proportion of these patients progress to fulminant liver failure, which had not been observed in our cohort. [25] Regardless of the mechanism of injury, data from this study and others suggests that liver injury which occurs as a consequence of moderate to severe COVID-19 disease may be reversible.…”

Section: Discussionmentioning

confidence: 89%

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Elevated liver enzymes in hospitalized patients with COVID-19 in Singapore

et al. 2021

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Liver dysfunction in patients with COVID-19 (coronavirus disease 2019) has been described. However, it is not clear if the presence of abnormal liver function tests at presentation was related to underlying undiagnosed liver disease, or a result of the viral infection.We retrospectively examined the first 554 consecutive polymerase chain reaction positive SARS-CoV-2 patients admitted from February 2020 to April 2020 to our academic medical centre. We reviewed their clinical data, chest radiography and laboratory studies obtained within 24 hour of admission.Despite similar hemodynamic parameters, we found significant aspartate transaminase elevation (64 ± 141 vs 35 ± 23 U/L, P < .001) in those with pneumonia compared to those without. Elevated liver enzymes were seen in 102 patients (18.4%). They presented with higher temperatures (38.5 ± 0.9 vs 37.5 ± 0.8 degC, P = .011), higher total white cell counts (6.95 ± 2.29 vs 6.39 ± 2.19 x10 9 /L, P = .021), serum ferritin (240 ± 274 vs 165 ± 198 ng/ml, P = .002) and lactate dehydrogenase (632 ± 912 vs 389 ± 107 U/ L, P < .001). These patients were more likely to require intensive care (6.9% vs 2.7% P = .036) and mechanical ventilation (5.9% vs 2.2%, P = .046). Migrant workers from dormitories had a higher rate of baseline liver function test abnormalities (88/425 vs 14/129, P = .01), which were more likely to persist at the time of discharge.Despite relatively mild COVID-19 disease, there was a significant prevalence of liver dysfunction, particularly amongst migrant workers. Elevated liver enzymes were associated with more severe disease, despite similar haemodynamic characteristics. Future studies should explore whether pre-existing liver disease may predispose to more severe COVID-19 disease.Abbreviations: ALP = alkaline phosphatase, ALT = alanine transaminase, AST = aspartate transaminase, COVID-19 = coronavirus disease 2019, LDH = lactate dehydrogenase, LFT = liver function test, NAFLD = non-alcoholic fatty liver disease, ULN = upper limit of normal.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 89%

Elevated liver enzymes in hospitalized patients with COVID-19 in Singapore

et al. 2021

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“…We collected the data of 3041 COVID-19 patients consecutively admitted to the Wuhan Huoshenshan Hospital from February 2020 to April 2020. 14 – 17 Among them, 17 patients were excluded, because the severity of COVID-19 at admission was not clearly defined. Age, sex, and presence of malignancy were not limited.…”

Section: Methodsmentioning

confidence: 99%

Impact of proton pump inhibitors on the in-hospital outcome of COVID-19 patients: a retrospective study

Yao

et al. 2022

Therap Adv Gastroenterol

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Background: Coronavirus disease 2019 (COVID-19) has triggered a global public health crisis. Proton pump inhibitors (PPIs) are one of the most commonly prescribed drugs. However, the effect of PPIs on the clinical outcomes of COVID-19 patients remains unclear. Methods: All COVID-19 patients admitted to the Wuhan Huoshenshan Hospital from February 2020 to April 2020 were retrospectively collected. Patients were divided into PPIs and non-PPIs groups. Logistic regression analyses were performed to explore the effects of PPIs on the outcomes of COVID-19 patients, including transfer to intensive care unit, mechanical ventilation, and death. Subgroup analyses were performed according to the presence of upper gastrointestinal symptoms potentially associated with acid and the routes, types, median total dosage, and duration of PPIs. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Of the 3024 COVID-19 patients included, 694 and 2330 were in PPIs and non-PPIs groups, respectively. Univariate logistic regression analysis showed that PPIs significantly increased the risk of reaching the composite endpoint in COVID-19 patients (OR = 10.23, 95% CI = 6.90–15.16, p < 0.001). After adjusting for age, sex, comorbidities, other medications, and severe/critical COVID-19, PPIs were independently associated with an increased risk of reaching the composite endpoint (OR = 7.00, 95% CI = 4.57–10.71, p < 0.001). This association remained significant in patients with upper gastrointestinal symptoms and those who received an intravenous omeprazole alone, but not those who received oral lansoprazole or rabeprazole alone. It was not influenced by dosage or duration of PPIs. Conclusion: The use of intravenous PPIs alone during hospitalization may be associated with worse clinical outcome in COVID-19 patients.

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“…Current studies suggest that HH is uncommon in patients with COVID-19, but has a very high mortality rate. For instance, Wu et al [ 62 ] identified 8 adult cases with HH among 3041 COVID-19 patients, and only 1 (12.5%) patient was discharged, and 7 (87.5%) died. Despite the lack of related reports on HH in pediatric patients, it is also a warning signal that we should be more concerned about the possibility of HH in children.…”

Section: Indirect Pathophysiological Mechanismsmentioning

confidence: 99%

COVID-19 and liver dysfunction in children: Current views and new hypotheses

Yun¹,

Feng²,

Zhang³

2023

World J Hepatol

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Coronavirus disease 2019 (COVID-19) poses an extremely serious global impact on public healthcare for individuals of all ages, including children. Increasing evidence has shown that liver abnormalities are commonly found in children with COVID-19, and age-related features in innate and adaptive response have been demonstrated. However, there are few reports and studies on COVID-19 related liver injury in children, and the data are scattered. So that many contradictions have arose. This situation is not only due to the serious ethical issues in studying pediatric patients with COVID-19, but also because of the short duration and wide coverage of the COVID-19 epidemic, the severity and complexity of clinical cases varied, as did the inclusion criteria for case reporting and patient outcomes. Therefore, we totaled the incidences, characteristics and pathomechanism of liver injury in children since the COVID-19 outbreak. The etiology of COVID-19-related liver injury is divided into three categories: (1) The direct mechanism involves severe acute respiratory syndrome coronavirus 2 binding to angiotensin-converting enzyme 2 in the liver or bile duct to exert direct toxicity; (2) the indirect mechanisms include an inflammatory immune response and hypoxia; and (3) COVID-19-related treatments, such as mechanical ventilation and antiviral drugs, may cause liver injury. In summary, this minireview provides fundamental insights into COVID-19 and liver dysfunction in children.

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Clinical characteristics and outcomes of COVID-19 patients with hypoxic hepatitis

Cited by 5 publications

References 9 publications

Elevated liver enzymes in hospitalized patients with COVID-19 in Singapore

Elevated liver enzymes in hospitalized patients with COVID-19 in Singapore

Impact of proton pump inhibitors on the in-hospital outcome of COVID-19 patients: a retrospective study

COVID-19 and liver dysfunction in children: Current views and new hypotheses

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