Severe COVID-19 Associated With Liver Injury in Patients Without Preexisting Liver Disease

Altaf, Abeer; Abbas, Zaigham; Mandviwalla, Haider A; Qadeer, Muhammad Ali; Siyal, Mehreen; Tariq, Mahnoor; Ghafoor, Asmara; Karamat, Muniba; Shahid, Bushra; Ali, Mahnoor

doi:10.7759/cureus.14705

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…Patients in the elevated DBiL group demonstrate a higher risk of mortality. This is consistent with previous findings that COVID-19 patients with abnormal DBiL levels have higher mortality ( 15 – 27 ). Patients with elevated DBiL levels are also more prone to respiratory failure and shock at admission and complications during hospitalization.…”

Section: Discussionsupporting

confidence: 93%

Effect of Direct Bilirubin Level on Clinical Outcome and Prognoses in Severely/Critically Ill Patients With COVID-19

Chen

Liu

et al. 2022

Front. Med.

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ObjectivesWe aimed to investigate how changes in direct bilirubin (DBiL) levels in severely/critically ill the coronavirus disease (COVID-19) patients during their first week of hospital admission affect their subsequent prognoses and mortality.MethodsWe retrospectively enrolled 337 severely/critically ill COVID-19 patients with two consecutive blood tests at hospital admission and about 7 days after. Based on the trend of the two consecutive tests, we categorized patients into the normal direct bilirubin (DBiL) group (224), declined DBiL group (44) and elevated DBiL group (79).ResultsThe elevated DBiL group had a significantly larger proportion of critically ill patients (χ2-test, p < 0.001), a higher risk of ICU admission, respiratory failure, and shock at hospital admission (χ2-test, all p < 0.001). During hospitalization, the elevated DBiL group had significantly higher risks of shock, acute respiratory distress syndrome (ARDS), and respiratory failure (χ2-test, all p < 0.001). The same findings were observed for heart damage (χ2-test, p = 0.002) and acute renal injury (χ2-test, p = 0.009). Cox regression analysis showed the risk of mortality in the elevated DBiL group was 2.27 (95% CI: 1.50–3.43, p < 0.001) times higher than that in the normal DBiL group after adjusted age, initial symptom, and laboratory markers. The Receiver Operating Characteristic curve (ROC) analysis demonstrated that the second test of DBiL was consistently a better indicator of the occurrence of complications (except shock) and mortality than the first test in severely/critically ill COVID-19 patients. The area under the ROC curve (AUC) combined with two consecutive DBiL levels for respiratory failure and death was the largest.ConclusionElevated DBiL levels are an independent indicator for complication and mortality in COVID-19 patients. Compared with the DBiL levels at admission, DBiL levels on days 7 days of hospitalization are more advantageous in predicting the prognoses of COVID-19 in severely/critically ill patients.

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Section: Discussionsupporting

confidence: 93%

Effect of Direct Bilirubin Level on Clinical Outcome and Prognoses in Severely/Critically Ill Patients With COVID-19

Chen

Liu

et al. 2022

Front. Med.

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“…In this prospective observational study done in patients without previous known liver or biliary diseases and using four liver biochemical tests, that is AST, ALT, ALP, and bilirubin as the markers of liver injury, 102(41.63%) out of 245 were found to have a liver injury. It is comparable to most of the previous studies 17 , 18 . As AST and ALT are raised during the process of hepatocellular injury, using only these two markers without bilirubin or ALP, liver injury was present in 94 (38.37%).…”

Section: Discussionsupporting

confidence: 91%

Liver injury at admission and outcomes in patients with COVID-19 disease: a prospective cohort study

Poudel

Mishra

Poudel

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: The liver is one of the common extrapulmonary organs involved in the coronavirus disease 2019 (COVID-19) infection. We aimed to find the prevalence of liver injury at hospital admission and its effects on outcomes. Methods: This is a single-center prospective observational study. All consecutive patients with COVID-19 admitted during the months of May to August 2021 were included in the study. Liver injury was defined as at least 2 times elevation of aspartate transaminase, alanine transaminase, alkaline phosphatase, and bilirubin above the upper limits on normal. The predictive efficacy of liver injury was measured as its effects on outcome variables, that is duration of hospital stay, requirement of ICU admission, mechanical ventilation, and mortality. Presence of liver injury compared with existing biomarkers markers of severe disease, that is lactate dehydrogenase, D-dimer, and C-reactive protein. Results: A total of 245 consecutive adult patients with COVID-19 infection were included in the study. Liver injury was present in 102 (41.63%) of patients. There was a significant association between the presence of liver injury and duration of hospital stay (10.74 vs. 8.9 days; P=0.013), the requirement of ICU admission (12.7 vs. 10.2%; P=0.018), mechanical ventilation (10.6% vs. 6.5%; P=0.003), and mortality (13.1% vs. 6.1%; P<0.001). Liver injury was significantly associated (P<0.001) with the corresponding elevation of serum biomarkers of severity. Conclusion: The presence of liver injury in patients with COVID-19 infection at the time of hospital admission is the independent predictor of poor outcomes and can also be used as the marker of disease severity.

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“…The severity of COVID-19 was ascertained as per the parameters mentioned in a previous study [11] (Supplementary Table 1, Supplemental Digital Content 1, http://links.lww.com/EJGH/A796). The primary outcome of the study was the assessment of the incidence of IBS as per Rome-IV criteria in patients treated for COVID-19 infection.…”

Section: Methodsmentioning

confidence: 99%

Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

Siyal

Abbas

Ashraf

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Objective Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. Methods Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. Results One hundred seventy-eight patients were males (58.7%). The age range was 17–95 years (mean ± SD, 55.9 ± 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035); whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. Conclusion GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.

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Severe COVID-19 Associated With Liver Injury in Patients Without Preexisting Liver Disease

Cited by 9 publications

References 21 publications

Effect of Direct Bilirubin Level on Clinical Outcome and Prognoses in Severely/Critically Ill Patients With COVID-19

Effect of Direct Bilirubin Level on Clinical Outcome and Prognoses in Severely/Critically Ill Patients With COVID-19

Liver injury at admission and outcomes in patients with COVID-19 disease: a prospective cohort study

Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

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