The İmpact of Elevated Liver Enzymes and İntrahepatic Cholestasis of Pregnancy on the Course of COVID-19 in Pregnant Women

Denızlı, Ramazan; Sakcak, Bedri; Farisoğulları, Nihat; Peker, Melis Ece Men; Sınacı, Selcan; Kara, Özgür; Tekın, Özlem Moraloğlu; Uygur, Dilek

doi:10.1007/s42399-022-01267-1

Cited by 3 publications

(2 citation statements)

References 30 publications

(47 reference statements)

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“…The first step in managing a pregnant patient who presents with COVID-19 and liver injury is to identify the cause of liver damage and exclude obstetric diagnoses. COVID-19-related liver involvement can be mistaken for preeclampsia[ 158 ], HELLP syndrome[ 159 ], acute fatty liver of pregnancy[ 158 ], and intrahepatic cholestasis[ 160 ]. All these conditions warrant early diagnosis and require certain urgent management.…”

Section: Outcome Management and Considerations In Special Populationsmentioning

confidence: 99%

COVID-19 and liver injury: Pathophysiology, risk factors, outcome and management in special populations

Roshanshad¹,

Roshanshad²,

Fereidooni³

et al. 2023

World J Hepatol

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The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 is an ongoing health concern. In addition to affecting the respiratory system, COVID-19 can potentially damage other systems in the body, leading to extra-pulmonary manifestations. Hepatic manifestations are among the common consequences of COVID-19. Although the precise mechanism of liver injury is still questionable, several mechanisms have been hypothesized, including direct viral effect, cytokine storm, hypoxic-ischemic injury, hypoxia-reperfusion injury, ferroptosis, and hepatotoxic medications. Risk factors of COVID-19-induced liver injury include severe COVID-19 infection, male gender, advanced age, obesity, and underlying diseases. The presentations of liver involvement comprise abnormalities in liver enzymes and radiologic findings, which can be utilized to predict the prognosis. Increased gamma-glutamyltransferase, aspartate aminotransferase, and alanine aminotransferase levels with hypoalbuminemia can indicate severe liver injury and anticipate the need for intensive care units’ hospitalization. In imaging, a lower liver-to-spleen ratio and liver computed tomography attenuation may indicate a more severe illness. Furthermore, chronic liver disease patients are at a higher risk for severe disease and death from COVID-19. Nonalcoholic fatty liver disease had the highest risk of advanced COVID-19 disease and death, followed by metabolic-associated fatty liver disease and cirrhosis. In addition to COVID-19-induced liver injury, the pandemic has also altered the epidemiology and pattern of some hepatic diseases, such as alcoholic liver disease and hepatitis B. Therefore, it warrants special vigilance and awareness by healthcare professionals to screen and treat COVID-19-associated liver injury accordingly.

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Section: Outcome Management and Considerations In Special Populationsmentioning

confidence: 99%

COVID-19 and liver injury: Pathophysiology, risk factors, outcome and management in special populations

Roshanshad¹,

Roshanshad²,

Fereidooni³

et al. 2023

World J Hepatol

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“…In comparison, the highest peaks are reported from the South American countries and Scandinavia (28%). 1,[2][3][4][5] While HELLP syndrome is a rare variant of severe PEC, around 12% of these patients suffer from HELLP syndrome. 6 Another rare condition, AFLP complicating the third trimester, affects one in every 16,000 pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan

Butt,

Ali,

Yasmeen

et al. 2023

Pak J Med Sci

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Objective: To determine the etiologies and outcomes of liver disease in pregnancy in a developing country. Method: A total of 336 consecutive pregnant women with liver disease were included in this prospective cohort study conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Center, Karachi from August 2019 to August 2021. Patients’ baseline demographic, clinical, and laboratory data and outcomes were collected on a pre-designed questionnaire. Results: Among all the pregnant females, the most common liver disease was acute hepatitis E virus (HEV) infection (37.2%), followed by preeclampsia (PEC)/eclampsia (EC), hemolysis, elevated liver enzymes & low platelets (HELLP) syndrome, and hyperemesis gravidarum (HG). The most common maternal complications were fulminant hepatic failure (FHF) in 14.9% and placental abruption in 11.0%. Fetal complications included intrauterine death (IUD) in 20.8% and preterm birth in 8.6%. The maternal and neonatal mortality rates were 11.6% and 39.6%, respectively. Among the predictors, low maternal weight, low body mass index (BMI), and low hemoglobin (Hb) were associated with increased maternal mortality. Low fetal weight, height, maternal systolic blood pressure (SBP), and low maternal Hb were independent predictors of fetal mortality. Conclusion: In our cohort of pregnant females in a tertiary care medical center, acute HEV was the most common liver disease, followed by PEC/EC, HELLP, and HG. Maternal and fetal deaths were alarming in this group of patients and demanded careful management. doi: https://doi.org/10.12669/pjms.40.3.7670 How to cite this: Butt N, Ali S, Yasmeen H, Mumtaz K. Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan. Pak J Med Sci. 2024;40(3):---------. doi: https://doi.org/10.12669/pjms.40.3.7670 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The impact of acute and prior SARS-CoV-2 infection on maternal and neonatal outcomes in pregnant women: a single-center retrospective cohort study

Tang,

Chen,

Han

et al. 2023

Preprint

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Background Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection during pregnancy have an adverse impact on perinatal outcomes, including cesarean section, preterm birth, fetal distress. However, it’s uncertain whether these adverse consequences are caused by acute viral infection or post-acute impact of viral infection. Methods We conducted a single-center retrospective cohort study among pregnant women with singleton pregnancy who delivered between 1 December 2022 and 1 February 2023 (n = 2472). The clinical data for mothers and neonates came from medical records on internal healthcare system. Follow-up time spanned from admission to discharge. We investigated the impact of acute and prior SARS-CoV-2 infection on maternal and neonatal outcome. Multivariable logistic models were used to assess the risk of adverse perinatal outcome in pregnant women with acute and prior SARS-CoV-2 infection. Results Compared to the non-infected pregnant women, acute SARS-CoV-2 infected pregnant women had significant higher rates of intrahepatic cholestasis of pregnancy (ICP) (26 women [4.4%] vs. 8 women [1.0%]; aOR, 4.9 [95% CI, 2.2–11.0]; P < 0 .001), preterm birth (༜37 wk) (53women [9.0%] vs. 45 women [5.7%]; aOR, 1.7 [95% CI, 1.1–2.7]; P < 0.05), fetal distress(106 women [18.1%] vs. 82 women [10.4%]; aOR,1.9 [95% CI, 1.4–2.6]; P < 0 .01), first-cesarean section (216 women [36.9%] vs. 239women [30.3%]; aOR, 1.4[95% CI, 1.1–1.8]; P < 0.01) and neonatal unit admission (69 neonates [12%] vs. 64 neonates [8.3%]; aOR, 1.6 [95% CI, 1.1–2.3]; P < 0.05), prior SARS-CoV-2 infection were associated with an increased risk of ICP (40 women [3.7%] vs. 8 women [1.0%]; aOR, 3.9 [95% CI, 1.8–8.5]; P < 0 .001). Conclusions Pregnant women with acute SARS-CoV-2 infection was associated with higher risk of ICP, preterm birth, fetal distress, first-cesarean section and neonatal unit admission. Prior SARS-CoV-2 infection in pregnant women was associated with higher risk ICP. These findings emphasize the need for optimization of strategies for prevention of SARS-CoV-2 infection in pregnant women, especially for acute infection at delivery.

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The İmpact of Elevated Liver Enzymes and İntrahepatic Cholestasis of Pregnancy on the Course of COVID-19 in Pregnant Women

Cited by 3 publications

References 30 publications

COVID-19 and liver injury: Pathophysiology, risk factors, outcome and management in special populations

COVID-19 and liver injury: Pathophysiology, risk factors, outcome and management in special populations

Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan

The impact of acute and prior SARS-CoV-2 infection on maternal and neonatal outcomes in pregnant women: a single-center retrospective cohort study

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