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

Yun, Yangfang; Feng, Zhiyuan; Zhang, Jingjing

doi:10.4254/wjh.v15.i3.353

Cited by 2 publications

(2 citation statements)

References 77 publications

(88 reference statements)

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“…Due to the absence of a control group in our study, we cannot neglect a potential effect of concurrent SARS-CoV-2-induced hepatotoxicity on the incidence of transaminitis. SARS-CoV-2 has been hypothesized to cause liver injury via direct cytotoxic effects on hepatocytes, as well as through pathological inflammation arising from hypoxia and a dysregulated immune response [ 29 ]. The improving trajectory of transaminitis seen in two-thirds of our patients prior to completion of RDV therapy further suggests a viral driver of liver enzyme elevation.…”

Section: Discussionmentioning

confidence: 99%

Adverse effects of remdesivir for the treatment of acute COVID-19 in the pediatric population: a retrospective observational study

Schulz,

Huynh,

Heger

et al. 2024

Mol Cell Pediatr

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Background Although the severity of coronavirus disease 2019 (COVID-19) tends to be lower in children, it can still lead to severe illness, particularly among those with chronic medical conditions. While remdesivir (RDV) is one of the few approved antiviral treatments for COVID-19 in children in many countries, the available data on the safety of RDV in this population is limited. Methods To address this knowledge gap, a multicenter study involving 65 patients retrospectively analyzed the clinical data from individuals aged <18 who were hospitalized due to severe COVID-19 (defined as SpO2 < 94% or requiring supplemental oxygen) and received at least one dose of RDV. Additionally, the study encompassed 22 patients with mild-moderate COVID-19 who were considered at high risk of developing severe disease. Results Nineteen children (29%) experienced mild-to-moderate adverse events (AEs) attributed to RDV, including transaminitis in 20% of children, bradycardia in 8%, and hypotension in 5%. AEs did not require discontinuation of RDV, except in one patient who developed premature ventricular contractions. The rate of AEs did not differ between patients with severe COVID-19 and those with mild-moderate COVID-19 but at high risk for severe disease. All but one patient were discharged within 23 days of admission, and no fatalities were recorded. Among high-risk patients with mild-moderate disease, only 2 (9%) progressed to the point of needing supplemental oxygen. Conclusions Our data suggests that RDV is safe in children, with no reported serious AEs. However, the absence of a control group limits the extent to which conclusions can be drawn. RDV may contribute to clinical improvement, particularly in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Adverse effects of remdesivir for the treatment of acute COVID-19 in the pediatric population: a retrospective observational study

Schulz,

Huynh,

Heger

et al. 2024

Mol Cell Pediatr

View full text Add to dashboard Cite

show abstract

“…Due to the absence of a control group in our study, we cannot neglect a potential effect of concurrent SARS-CoV-2-induced hepatotoxicity on the incidence of transaminitis. SARS-CoV-2 has been hypothesized to cause liver injury via direct cytotoxic effects on hepatocytes, as well as through pathological in ammation arising from hypoxia and a dysregulated immune response [27]. However, one study examining RDV in children with COVID-19 found signi cantly higher rates of transaminitis in children receiving RDV compared to those who did not receive the drug, suggesting that RDV itself may contribute to liver enzyme derangements [19].…”

Section: Discussionmentioning

confidence: 99%

Adverse Effects of Remdesivir for the Treatment of Acute COVID-19 in the Pediatric Population

Schulz,

Huynh,

Heger

et al. 2023

Preprint

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Background: Although the severity of Coronavirus Disease 2019 (COVID-19) tends to be lower in children, it can still lead to severe illness, particularly among those with chronic medical conditions. Remdesivir (RDV) is the only U.S. Food and Drug Administration-approved antiviral treatment for high-risk patients >28 days old. However, the available data on the safety of RDV in children is limited. Methods: To address this knowledge gap, a multicenter study involving 65 patients retrospectively analyzed the clinical data from individuals aged <18 who were hospitalized due to COVID-19 and received at least one dose of RDV. Additionally, the study encompassed 22 patients with mild-moderate COVID-19 who were considered at high risk of developing severe disease. Results: 19 children (29%) experienced mild-to-moderate adverse events (AEs) attributed to RDV, including transaminitis in 20% of children, bradycardia in 8%, and hypotension in 5%. AEs did not require discontinuation of RDV, except in one patient who developed premature ventricular contractions. The rate of AEs did not differ between patients with severe COVID-19 and those with mild-moderate COVID-19 but at high risk for severe disease. All but one patient were discharged within 23 days of admission, and no fatalities were recorded. Among high-risk patients with mild-moderate disease, only 2 (9%) progressed to the point of needing supplemental oxygen. Conclusions: Our data suggests that RDV is safe in children, with no reported serious AEs. However, the absence of a control group limits the extent to which conclusions can be drawn. RDV may contribute to clinical improvement, particularly in high-risk patients.

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

Cited by 2 publications

References 77 publications

Adverse effects of remdesivir for the treatment of acute COVID-19 in the pediatric population: a retrospective observational study

Adverse effects of remdesivir for the treatment of acute COVID-19 in the pediatric population: a retrospective observational study

Adverse Effects of Remdesivir for the Treatment of Acute COVID-19 in the Pediatric Population

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