Patterns and prediction of liver injury with persistent cholestasis in survivors of severe SARS-CoV-2 infection

Nayagam, Jeremy S; Jeyaraj, Rebecca; Mitchell, Tim; Walder, David; Al-Agil, Mohammad; Shek, Anthony; Barker, Richard D.; Teo, James; Maharaj, Ritesh; Agarwal, Kosh; Vlachos, Savvas; Joshi, Deepak; McPhail, Mark

doi:10.1016/j.jinf.2021.03.029

Cited by 8 publications

(9 citation statements)

References 9 publications

(8 reference statements)

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“…The inflammatory indicators in the current study were within the normal range but abnormal ALT, AST, and creatinine values were observed in a few COVID-19 survivors. As reported previously, a proportion of COVID-19 survivors showed abnormal liver function test results during follow-up ( 32 ). Furthermore, 35% of the COVID-19 survivors had an eGFR <90 mL/min per 1.73 m 2 but 13% of these patients presented normal eGFR at the acute phase ( 5 ).…”

Section: Discussionsupporting

confidence: 77%

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis

et al. 2021

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Background: A previous study has shown that 81% of the COVID-19 patients had mild or moderate symptoms. However, most studies on the sequelae in COVID-19 patients focused on severe cases and the long-term follow-up studies on the health consequences in non-severe cases are limited. The current study aimed to assess the sequelae of COVID-19 in patients nearly 1 year after diagnosis with a particular focus on the recovery of patients with non-severe COVID-19.Methods: We enrolled 120 patients infected with SARS-CoV-2 discharged from Wuhan Union hospital west district (designated hospital for COVID-19) and Fangcang shelter hospitals between January 29, 2020 and April 1, 2020. All participants were asked to complete a series of questionnaires to assess their symptoms and quality of life and for psychological evaluation. Also, pulmonary function test, chest CT, 6-min walking test (6MWT), routine blood test, liver and kidney function tests, fasting blood glucose test, lipid test, and immunoglobulin G antibody test were performed to evaluate their health.Results: The mean age of the study population was 51.6 ± 10.8 years. Of the 120 patients, 104 (86.7%) were cases of non-severe COVID-19. The follow-up study was performed between November 23, 2020 and January 11, 2021, and the median time between the diagnosis and the follow-up was 314.5 (IQR, 296–338) days. Sleep difficulties, shortness of breath, fatigue, and joint pain were common symptoms observed during follow-up and nearly one-third of the non-severe cases had these symptoms. A total of 50 (41.7%) and 45 (37.5%) patients reported anxiety and depression, respectively. And 18.3% of the patients showed negative results in the IgG test at the follow-up, which correlated with the severity of the infection (R = 0.203, p = 0.026), and the proportion of IgG negative cases in non-severe COVID-19 patients was higher than that in the severe cases (20.2 vs. 6.3%). Pulmonary diffusion impairment was reported in 30 (26.1%) out of 115 patients, and 24 (24.2%) out of the 99 non-severe cases. The values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, vital capacity (VC), total lung capacity (TLC), and residual volume (RV) were less than the normal range in 1.7, 8.6, 0.9, 11.2, 7.0, and 0.9% of the patients, respectively. A total of 55 (56.7%) out of the 97 patients showed abnormal CT findings, including ground-glass opacities (GGO), bronchiectasis, nodules, lines and bands, and fibrosis. Furthermore, there was a correlation between all the SF-36-domain scores and the duration of hospitalization, pulmonary function, and a 6MWT.Conclusions: At the nearly 1-year follow-up, COVID-19 survivors still had multi-system issues, including those in the respiratory functioning, radiography, quality of life, and anxiety and depression. Moreover, non-severe cases also showed some sequelae and the proportion of IgG negative cases in the non-severe patients was higher than that in severe cases. Therefore, conducting follow-ups and preventing the reinfection of SARS-CoV-2 in this group is necessary.

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Section: Discussionsupporting

confidence: 77%

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis

et al. 2021

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“…Only one study reported intrahepatic strictures in 92% (11/12) of patients hospitalized for severe COVID-19 disease. Furthermore, two studies have also reported persistently elevated ALP and GGT without biliary tract abnormalities in COVID-19 infected patients 7 , 8 . In our series, only one patient (in unvaccinated group) is following up.…”

Section: Discussionmentioning

confidence: 94%

“…COVID-19 induced cholestasis (ALP ≥ 3 ULN [upper limit of normal]) is reported among 1% of severely infected COVID-19 patients at admission and is associated with a poor prognosis 7 . Persistently elevated ALP and GGT are noted in 28% and 53% of patients, respectively, even after two months of COVID-19 infection 8 . However, the data on the outcomes of these patients is still evolving.…”

Section: Author Contributionsmentioning

confidence: 98%

Post-COVID-19 Cholestasis: A Case Series and Review of Literature

Kulkarni¹,

Khlegi²,

Sekaran³

et al. 2022

Journal of Clinical and Experimental Hepatology

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“…Table 1 shows the details of the included studies with the study design, type of population, symptoms, duration, and the information provided. 13 – 62 Supplemental Table 2 shows the excluded studies with reasons of exclusion.…”

Section: Resultsmentioning

confidence: 99%

Gastrointestinal manifestations of long COVID: A systematic review and meta-analysis

Choudhury

Tariq

Jena

et al. 2022

Therap Adv Gastroenterol

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Background: Prolonged symptoms after COVID-19 are an important concern due to the large numbers affected by the pandemic. Objectives: To ascertain the frequency of gastrointestinal (GI) manifestations as part of long GI COVID. Design: A systematic review and meta-analysis of studies reporting GI manifestations in long COVID was performed. Data Sources and Methods: Electronic databases (Medline, Scopus, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) were searched till 21 December 2021 to identify studies reporting frequency of GI symptoms in long COVID. We included studies reporting overall GI manifestations or individual GI symptoms as part of long COVID. We excluded pediatric studies and those not providing relevant information. We calculated the pooled frequency of various symptoms in all patients with COVID-19 and also in those with long COVID using the inverse variance approach. All analysis was done using R version 4.1.1 using packages ‘meta’ and ‘metafor’. Results: A total of 50 studies were included. The frequencies of GI symptoms were 0.12 [95% confidence interval (CI), 0.06–0.22, I2 = 99%] and 0.22 (95% CI, 0.10–0.41, I2 = 97%) in patients with COVID-19 and those with long COVID, respectively. The frequencies of abdominal pain, nausea/vomiting, loss of appetite, and loss of taste were 0.14 (95% CI, 0.04–0.38, I2 = 96%), 0.06 (95% CI, 0.03–0.11, I2 = 98%), 0.20 (95% CI, 0.08–0.43, I2 = 98%), and 0.17 (95% CI, 0.10–0.27, I2 = 95%), respectively, after COVID-19. The frequencies of diarrhea, dyspepsia, and irritable bowel syndrome were 0.10 (95% CI, 0.04–0.23, I2 = 98%), 0.20 (95% CI, 0.06–0.50, I2 = 97%), and 0.17 (95% CI, 0.06–0.37, I2 = 96%), respectively. Conclusion: GI symptoms in patients were seen in 12% after COVID-19 and 22% as part of long COVID. Loss of appetite, dyspepsia, irritable bowel syndrome, loss of taste, and abdominal pain were the five most common GI symptoms of long COVID. Significant heterogeneity and small number of studies for some of the analyses are limitations of the systematic review.

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Patterns and prediction of liver injury with persistent cholestasis in survivors of severe SARS-CoV-2 infection

Cited by 8 publications

References 9 publications

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis

Post-COVID-19 Cholestasis: A Case Series and Review of Literature

Gastrointestinal manifestations of long COVID: A systematic review and meta-analysis

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