Drug-Induced Liver Injury and COVID-19 Infection: The Rules Remain the Same

Olry, A.; Meunier, Lucy; Delire, Bénédicte; Larrey, Dominique; Horsmans, Yves; Louët, Hervé Le

doi:10.1007/s40264-020-00954-z

Cited by 92 publications

(107 citation statements)

References 13 publications

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“…None of the patients received tocilizumab or remdesivir. The differences in drug use may be due to the different proportion of patients with severe condition; this finding also indicated that treatment is one of the primary causes of liver damage [18][19][20].…”

Section: Resultsmentioning

confidence: 94%

Liver function recovery of COVID-19 patients after discharge, a follow-up study

An¹,

Song²,

Li³

et al. 2021

Int. J. Med. Sci.

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Objective: The aim of this study was to observe the liver function recovery of COVID-19 patients after discharge. Patients and Methods: A total of 253 discharged COVID-19 patients in Shenzhen city, China were selected. The clinical characteristics of these patients were assessed. A 2-month follow-up and laboratory hematology test were performed to examine the status of patients' liver function. Results: Patients combined with liver diseases, especially fatty liver, are more likely to progress to severe condition (P<0.05). Patients in severe condition and those with liver diseases have higher rates of liver injuries during hospitalization, characterized by a significant increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST, P<0.01). The ALT, AST/ALT, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), and A/G levels showed significant differences in comparison with the control group (P<0.05, and P<0.001); and the outlier ratio of A/G, ALT, GGT and ALP of patients remained abnormal higher within 14 days after discharge (P<0.001). Liver injuries of COVID-19 patients may be related to the epidemiological characteristics, clinical indexes, basic diseases, symptoms, drug treatment during hospitalization and the complications. Indicators of liver function were correlated with cardiac function, renal function, thyroid function, lipid metabolism, glucose metabolism, immune index, leukocyte, erythrocyte, hemoglobin and platelet related indexes. The outlier ratio of TP, ALB and GLB remained extremely low throughout the follow-up period; the outlier ratio of ALT, AST and GGT decreased below 10% from a high level at 40 days after discharged. However, the outlier ratio of A/G, AST/ALT and ALP remained high during the follow-up period. Conclusions: Abnormal liver function might indicate worse recovery of COVID-19 patients. Changes in liver function should be emphasized during long-term follow-up of COVID-19 patients after hospital discharge; the necessity of employing appropriate interventions for liver function repair should be emphasized.

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Section: Resultsmentioning

confidence: 94%

Liver function recovery of COVID-19 patients after discharge, a follow-up study

An¹,

Song²,

Li³

et al. 2021

Int. J. Med. Sci.

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“…DILI can be seen with various antiviral/antibiotics that may be commonly given to patients with COVID-19. (18) In this study, we describe the clinical findings of hospitalized patients with and without COVID-19 related liver injury and attempt to clarify the associated findings underlying COVID-19 related liver injury in severe or critical COVID-19. Specifically, we sought to characterize: 1) the hyperinflammatory response, 2) the specific inflammatory cytokine profile, and 3) the clinical characteristics of hospitalized patients with COVID-19 related liver injury compared to those who never develop liver injury.…”

Section: Accepted Articlementioning

confidence: 99%

Liver Injury in Patients Hospitalized with Coronavirus Disease 2019 Correlates with Hyperinflammatory Response and Elevated Interleukin‐6

Kushner

Halabi

et al. 2020

Hepatol Commun

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Background: Liver injury is commonly seen in coronavirus disease 2019 (COVID-19). However, the mechanism behind liver injury, particularly in severe and critical COVID-19 patients, remains unclear and the clinical course is poorly described. Methods: We conducted a single-center, retrospective cohort study of consecutive hospitalized severe and critically ill COVID-19 patients with or without liver injury who underwent immunologic testing (IL-6, IL-8, TNF-α, and IL-1ß). Liver injury was defined as peak aminotransferases ≥3x ULN

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“… Lopinavir seems less hepatotoxic than ritonavir. References: [ 29 , 30 , 88 , 98 ] Mechanisms of PI-induced hepatic toxicity seem to be multiple with involvement of mitochondrial dysfunction, oxidative stress and endoplasmic reticulum stress. PIs could also be hepatotoxic via indirect mechanisms, in particular by inducing lipodystrophy and insulin resistance.…”

Section: Treatments In Covid-19 Patientsmentioning

confidence: 99%

“…Rare occurrence of acute liver injury, sometimes with jaundice. References: [ 29 , 30 , 90 , 98 ] Possible role of oxidative stress and lipid peroxidation. Possible role of lysosomal membrane permeabilization and release of cathepsin, thus activating the pro-apoptotic protein Bax.…”

Section: Treatments In Covid-19 Patientsmentioning

confidence: 99%

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Treatments in Covid-19 patients with pre-existing metabolic dysfunction-associated fatty liver disease: A potential threat for drug-induced liver injury?

et al. 2020

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Obese patients who often present metabolic dysfunction-associated fatty liver disease (MAFLD) are at risk of severe presentation of coronavirus disease 2019 (COVID-19). These patients are more likely to be hospitalized and receive antiviral agents and other drugs required to treat acute respiratory distress syndrome and systemic inflammation, combat bacterial and fungal superinfections and reverse multi-organ failure. Among these pharmaceuticals, antiretrovirals such as lopinavir/ritonavir and remdesivir, antibiotics and antifungal agents can induce drug-induced liver injury (DILI), whose mechanisms are not always understood. In the present article, we hypothesize that obese COVID-19 patients with MAFLD might be at higher risk for DILI than non-infected healthy individuals or MAFLD patients. These patients present several concomitant factors, which individually can favour DILI: polypharmacy, systemic inflammation at risk of cytokine storm, fatty liver and sometimes nonalcoholic steatohepatitis (NASH) as well as insulin resistance and other diseases linked to obesity. Hence, in obese COVID-19 patients, some drugs might cause more severe (and/or more frequent) DILI, while others might trigger the transition of fatty liver to NASH, or worsen pre-existing steatosis, necroinflammation and fibrosis. We also present the main mechanisms whereby drugs can be more hepatotoxic in MAFLD including impaired activity of xenobiotic-metabolizing enzymes, mitochondrial dysfunction, altered lipid homeostasis and oxidative stress. Although comprehensive investigations are needed to confirm our hypothesis, we believe that the current epidemic of obesity and related metabolic diseases has extensively contributed to increase the number of cases of DILI in COVID-19 patients, which may have participated in presentation severity and death.

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Drug-Induced Liver Injury and COVID-19 Infection: The Rules Remain the Same

Cited by 92 publications

References 13 publications

Liver function recovery of COVID-19 patients after discharge, a follow-up study

Liver function recovery of COVID-19 patients after discharge, a follow-up study

Liver Injury in Patients Hospitalized with Coronavirus Disease 2019 Correlates with Hyperinflammatory Response and Elevated Interleukin‐6

Treatments in Covid-19 patients with pre-existing metabolic dysfunction-associated fatty liver disease: A potential threat for drug-induced liver injury?

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