Hepatic manifestations of coronavirus disease 2019 infection: Clinical and laboratory perspective

Hanif, Farina; Majid, Zain; Ahmed, Shoaib; Luck, Nasir Hassan; Mubarak, Mohammad S.

doi:10.5501/wjv.v11.i6.453

Cited by 4 publications

(5 citation statements)

References 84 publications

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“…In addition, our study found a lower reported prevalence of liver disease as an associated comorbidity at admission (2.1%), whereas Karadeniz et al [25] did not report any such prevalence in their cohort. Several pathways have been proposed in the pathogenesis of liver injury in patients with COVID-19, including the cytopathic effect of the virus, cytokine storm, systemic inflammatory response syndrome, thrombosis, hypoxia and sepsis [38]. In addition, hepatocytes and cholangiocytes express angiotensin-converting enzyme receptor 2 during long COVID-19, thereby incurring a mild derangement of hepatic biomarkers that sometimes result in the development of a cholangiopathy [39].…”

Section: Discussionmentioning

confidence: 99%

Krebs von den Lungen-6 (KL-6) Levels in Post-COVID Follow-Up: Differences According to the Severity of COVID-19

Carpio,

Qasem,

Buño

et al. 2023

JCM

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To evaluate KL-6 levels in medium-term post-COVID and to compare them in three groups categorised by the severity of COVID-19, we conducted a real-world, retrospective, cohort study. Data from the COVID-19 episode and follow-up during the post-COVID phase were extracted from the COVID@HULP and POSTCOVID@HULP databases, respectively. For the post-COVID period we included demographics, medical history, symptoms, quality of life, physical activity, anxiety and depression status and laboratory results. Patients were categorised into three groups based on the severity of COVID-19: Group 1 (inpatient critical), Group 2 (inpatient non-critical) and Group 3 (hospitalised at home). KL-6 was measured during the follow-up of the three groups. In all, 802 patients were included (Group 1 = 59; Group 2 = 296; Group 3 = 447 patients). The median age was 59 years (48–70), and 362 (45.2%) were males. At admission, fibrinogen and ferritin levels were lower in Group 3 than in the other groups (p < 0.001). Follow-up data were obtained 124 days (97–149) after the diagnosis of COVID-19. The median levels of fibrinogen, ferritin and KL-6 at follow-up were 336 mg/dL (276–413), 80.5 ng/mL (36–174.3) and 326 U/mL (240.3–440.3), respectively. KL-6 levels were lower in Group 3 than in the other groups (298 U/mL (231.5–398) vs. 381.5 U/mL (304–511.8) (Group 1) and 372 U/mL (249–483) (Group 2) (p < 0.001)). KL-6 was associated with ferritin (p < 0.001), fibrinogen (p < 0.001), D-dimer (p < 0.001) and gamma-glutamyl transferase (p < 0.001). KL-6 levels are less elevated at medium-term post-COVID follow-up in patients with mild COVID-19 than in those with moderate or severe disease. KL-6 is associated with systemic inflammatory, hepatic enzyme and thrombosis biomarkers.

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Section: Discussionmentioning

confidence: 99%

Krebs von den Lungen-6 (KL-6) Levels in Post-COVID Follow-Up: Differences According to the Severity of COVID-19

Carpio,

Qasem,

Buño

et al. 2023

JCM

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“…The liver has been described as the second organ after the lungs to be involved in the course of the disease, resulting in hepatobiliary complications among up to 29% of patients [24][25][26][27]. Chen et al found patients infected with coronavirus and coexisting abnormalities in liver tests to present a greater risk of systemic inflammatory response syndrome (SIRS) and higher overall mortality rates [28].…”

Section: Hepatic Face Of Novel Coronavirus Infectionmentioning

confidence: 99%

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

Michalak,

Lach,

Szczygieł

et al. 2024

IJMS

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The pandemic period due to coronavirus disease 2019 (COVID-19) revolutionized all possible areas of global health. Significant consequences were also related to diverse extrapulmonary manifestations of this pathology. The liver was found to be a relatively common organ, beyond the respiratory tract, affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Multiple studies revealed the essential role of chronic liver disease (CLD) in the general outcome of coronavirus infection. Present concerns in this field are related to the direct hepatic consequences caused by COVID-19 and pre-existing liver disorders as risk factors for the severe course of the infection. Which mechanism has a key role in this phenomenon—previously existing hepatic disorder or acute liver failure due to SARS-CoV-2—is still not fully clarified. Alcoholic liver disease (ALD) constitutes another not fully elucidated context of coronavirus infection. Should the toxic effects of ethanol or already developed liver cirrhosis and its consequences be perceived as a causative or triggering factor of hepatic impairment in COVID-19 patients? In the face of these discrepancies, we decided to summarize the role of the liver in the whole picture of coronavirus infection, paying special attention to ALD and focusing on the pathological pathways related to COVID-19, ethanol toxicity and liver cirrhosis.

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“…The exact mechanism underlying liver injury in the context of COVID‐19 infection remains not fully elucidated. However, several hypotheses have been suggested, encompassing the direct impact of the virus on cells, immune system dysfunction, systemic inflammatory response syndrome, cytokine storm, sepsis, vascular clotting, hypoxia, and ischemia–reperfusion injury 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…However, several hypotheses have been suggested, encompassing the direct impact of the virus on cells, immune system dysfunction, systemic inflammatory response syndrome, cytokine storm, sepsis, vascular clotting, hypoxia, and ischemia-reperfusion injury. 5,6 We present a case of a 4-year-old girl with thalassemia minor who presented with fever, jaundice, and elevated liver enzymes. Despite initial suspicion of acute viral hepatitis and treatment initiation, further investigations revealed significantly elevated SARS-CoV-2 antibodies, highlighting a rare presentation of COVID-19-associated liver injury.…”

mentioning

confidence: 99%

COVID‐19 presenting as severe acute hepatitis in a pediatric patient with thalassemia minor: A case report

Jamalvi,

Rauf,

Sherali

et al. 2024

Clinical Case Reports

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Key Clinical MessageThis case emphasizes the significance of COVID‐19 in pediatric patients presenting with unusual hepatic manifestations, urging clinicians to broaden their diagnostic lens. The unexpected elevation of SARS‐CoV‐2 antibodies and the effective use of N‐acetyl cysteine highlight the importance of adaptability in treatment strategies.AbstractThis case report presents a unique manifestation of severe hepatic involvement in a 4‐year‐old girl with thalassemia minor and COVID‐19. Despite the absence of prominent respiratory symptoms, the patient exhibited jaundice, elevated liver enzymes, and coagulopathy. Initial suspicion of viral hepatitis was replaced by the discovery of significantly elevated SARS‐CoV‐2 antibodies. A multidisciplinary approach, including gastroenterology consultation and an extensive workup, was pivotal in ruling out alternative etiologies. Unconventional use of N‐acetyl cysteine contributed to clinical improvement, highlighting the need for adaptable treatment strategies. This case underscores the importance of heightened awareness in recognizing atypical presentations of COVID‐19 in pediatric patients, especially those with underlying health conditions. Further exploration into nuanced manifestations and treatment approaches is warranted for comprehensive clinical management.

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Hepatic manifestations of coronavirus disease 2019 infection: Clinical and laboratory perspective

Cited by 4 publications

References 84 publications

Krebs von den Lungen-6 (KL-6) Levels in Post-COVID Follow-Up: Differences According to the Severity of COVID-19

Krebs von den Lungen-6 (KL-6) Levels in Post-COVID Follow-Up: Differences According to the Severity of COVID-19

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

COVID‐19 presenting as severe acute hepatitis in a pediatric patient with thalassemia minor: A case report

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