Hepatic manifestations of COVID-19 and effect of remdesivir on liver function in patients with COVID-19 illness

Aleem, Abdul; Mahadevaiah, Guruprasad; Shariff, Nasir; Kothadia, Jiten P.

doi:10.1080/08998280.2021.1885289

Cited by 39 publications

(37 citation statements)

References 32 publications

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“…However, direct viral infection, indirect host‐immune responses, and treatment drug toxicity could damage liver and induce hepatotoxicity 20 . From the cellular point of view, remdesivir has been demonstrated to be toxic to hepatocytes, and the FDA has cautioned about the incidence of elevated ALT and AST in patients receiving remdesivir, as observed in our patients 9,21 . Furthermore, nephrotoxicity attributed to the remdesivir has been reported in Covdid‐19 patients that may be a consequence of mitochondrial toxicity in renal tubular epithelial cells and accumulation of remdesivir's active metabolite or SBECD 5,22 .…”

Section: Discussionmentioning

confidence: 77%

Linear mixed model analysis to evaluate correlations between remdesivir adverse effects with age and gender of patients with mild Covid‐19 pneumonia

Sedighi

Amanollahi

Moghaddam

et al. 2022

Journal of Medical Virology

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We aimed to assess longitudinal changes in clinical indexes of corona disease 2019 patients with mild pulmonary infection during 5 days of remdesivir therapy and determine the effect of age and gender on remdesivir adverse effects (AE). Patients' clinical data including inflammatory markers, liver and renal function tests, and heart rate (HR) were extracted from medical records. Linear mixed model (LMM) was used to analyze longitudinal changes in patients' clinical indexes. Gender and age were inserted in LMM as covariates to find their correlation with AE and clinical indexes. Of 84 patients, 35 patients met our criteria for the study. There were significant increases in mean levels of white blood cell (WBC; p = 0.005), alanine aminotransferase (ALT; p = 0.001), aspartate aminotransferase (p = 0.001), blood urea nitrogen (BUN; p = 0.001), and creatinine (p = 0.006), whereas mean levels of erythrocyte sedimentation rate (p = 0.005), C-reactive protein (p = 0.001), alkaline phosphatase (p = 0.001), and potassium (p = 0.003) decreased significantly. Estimated glomerular filtration rate (p = 0.001) and HR (p = 0.001) showed a notable decline over the course of treatment. LMM analysis showed that mean changes in WBC (β = 0.94, p = 0.029), creatinine (β = 0.12, p = 0.020), and HR (β = 6.47, p = 0.008) were greater in males than in females. Also, age of patients had a significant effect on the mean changes of WBC (β = −0.02, p = 0.023), sodium (β = −0.06, p = 0.010), BUN (β = 0.23, p = 0.001), and HR (β = −0.29, p = 0.001). Despite no renal and liver dysfunction, Covid-19 patients with mild pulmonary infection may develop some remdesivir AE and attributed side effects might be affected by gender and age of patients.

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Section: Discussionmentioning

confidence: 77%

Linear mixed model analysis to evaluate correlations between remdesivir adverse effects with age and gender of patients with mild Covid‐19 pneumonia

Sedighi

Amanollahi

Moghaddam

et al. 2022

Journal of Medical Virology

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“…In general, this usually spontaneously resolved, and does not lead to liver failure nor specific treatment [4] . Remdesivir can aggravate the perturbation in liver tests [5] . This was not the case the reported patients, none of them had received remdesivir and all of them developed a chronic liver failure and did not have spontaneous resolution of abnormal liver tests.…”

Section: Discussionmentioning

confidence: 99%

Cholangitis in three critically ill patients after a severe CoVID-19 infection

Gourjault

Tarhini

Rahi

et al. 2021

IDCases

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Coronavirus disease 2019 (CoVID-19) is a viral disease. Although the predominant presentation is respiratory disease, other manifestations such as gastrointestinal manifestations are commonly reported. Nevertheless, it has not been associated with chronic cholangitis or hepatic injury. In this study, we report three cases of severe CoVID-19 infection that required ICU admission, intubation, and sedation with ketamine. All three patients had abnormal liver function despite recovery and were diagnosed with cholangitis in the context of CoVID-19.

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“…Baseline LFTs should be done before initiation of therapy and these should be monitored closely during therapy. 109,142 The concentration of remdesivir may be affected by enzyme inducers such as clarithromycin, rifampin, phenytoin, and phenobarbital. 143 Favipiravir increases the concentration of pioglitazone, rosiglitazone, paracetamol, oseltamivir, and hormonal replacement therapy, but does not have significant interactions with immunosuppressive medications or steroids.…”

Section: Covid-19 In Patients With Diagnosed Liver Diseasesmentioning

confidence: 99%

Involvement of the Liver in COVID-19: A Systematic Review

Kariyawasam

Jayarajah

Abeysuriya

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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COVID-19, a respiratory viral infection, has affected 388 million individuals worldwide as of the February 4, 2022. In this review, we have outlined the important liver manifestations of COVID-19 and discussed the possible underlying pathophysiological mechanisms and their diagnosis and management. Factors that may contribute to hepatic involvement in COVID-19 include direct viral cytopathic effects, exaggerated immune responses/systemic inflammatory response syndrome, hypoxia-induced changes, vascular changes due to coagulopathy, endothelitis, cardiac congestion from right heart failure, and drug-induced liver injury. The majority of COVID-19-associated liver symptoms are mild and self-limiting. Thus management is generally supportive. Liver function tests and abdominal imaging are the primary investigations done in relation to liver involvement in COVID-19 patients. However, imaging findings are nonspecific. Severe acute respiratory syndrome coronavirus 2 RNA has been found in liver biopsies. However, there is limited place for liver biopsy in the clinical context, as it does not influence management. Although, the management is supportive in the majority of patients without previous liver disease, special emphasis is needed in those with nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, hepatitis B and C infections, and alcoholic liver disease, and in liver transplant recipients.

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Hepatic manifestations of COVID-19 and effect of remdesivir on liver function in patients with COVID-19 illness

Cited by 39 publications

References 32 publications

Linear mixed model analysis to evaluate correlations between remdesivir adverse effects with age and gender of patients with mild Covid‐19 pneumonia

Linear mixed model analysis to evaluate correlations between remdesivir adverse effects with age and gender of patients with mild Covid‐19 pneumonia

Cholangitis in three critically ill patients after a severe CoVID-19 infection

Involvement of the Liver in COVID-19: A Systematic Review

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