Impact of cytokine storm and systemic inflammation on liver impairment patients infected by SARS-CoV-2: Prospective therapeutic challenges

Ali, Fares E.M.; Mohammedsaleh, Zuhair M.; Ali, Mahmoud Mohammed Ahmed; Ghogar, Osama M

doi:10.3748/wjg.v27.i15.1531

Cited by 22 publications

(14 citation statements)

References 212 publications

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“…The systemic inflammatory response syndrome, particularly the cytokine storm, is one of the key pathophysiologic processes behind the development of severe disease in COVID-19 [ 50 ]. The presence of fibrosis may worsen the virus-induced cytokine storm and add to the severity of COVID-19 by the production of proinflammatory cytokines from the liver [ 51 ]. However, further research is required to investigate the pathways through which advanced liver fibrosis contributes to the COVID-19 pathological mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

Grigoraş

Citu

Cîtu

et al. 2022

JCM

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Several investigations have revealed that COVID-19 causes a significant death rate due to acute respiratory distress syndrome, alterations in the quantity of ACE2 receptor expression, or the intensity of cytokine storm. Similarly, patients with hepatic impairment that are co-infected with SARS-CoV-2 are more likely to display upregulations of ACE2 receptors and cytokine storm overload, which exacerbates hepatic impairment, potentially increasing the death rate. Moreover, it is expected that the aging population develops a higher degree of hepatic fibrosis in association with other comorbid conditions that are likely to influence the course of COVID-19. Therefore, this research was developed to describe the differences in liver test parameters in elderly individuals with COVID-19 in relation to other inflammatory markers and outcomes. This current observational single-center research followed a case-control design of elderly patients hospitalized for SARS-CoV-2 infection. The research was conducted at a tertiary emergency hospital in western Romania during a two-year period. There were 632 patients included in the analysis that were split into two equal groups matched 1:1 based on gender and body mass index. Three hundred sixteen patients made the group of cases with COVID-19 patients older than 65 years, while the other half were the 316 patient controls with COVID-19 that were younger than 65 years old. Disease outcomes showed a higher prevalence of ICU admissions (22.8% vs. 12.7%, p-value < 0.001) and in-hospital mortality (17.1% vs. 8.9%, p-value = 0.002) in the group of cases. Specific and non-specific liver biomarkers were identified as risk factors for mortality in the elderly, such as ALP (OR = 1.26), LDH (OR = 1.68), AST (OR = 1.98), and ALT (OR = 2.34). Similarly, patients with APRI and NFS scores higher than 1.5 were, respectively, 2.69 times and, 3.05 times more likely to die from COVID-19, and patients with FIB-4 scores higher than 3.25 were 3.13 times more likely to die during hospitalization for SARS-CoV-2 infection. Our research indicates that abnormally increased liver biomarkers and high liver fibrosis scores are related to a worse prognosis in SARS-CoV-2 infected individuals.

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Section: Discussionmentioning

confidence: 99%

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

Grigoraş

Citu

Cîtu

et al. 2022

JCM

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“… 20 COVID-19 patients infected with SARS-CoV-2 with an impaired liver function exhibit ACE2 receptor overexpression and cytokine storm overexpression, which ultimately exacerbates liver function impairment and mortality. 21 In our study, individual patients with liver function impairment were mainly distinguished by elevated GGT and/or TB. GGT is a standard liver enzyme test which reflects the involvement of the biliary tract.…”

Section: Discussionmentioning

confidence: 60%

Changes in Serum Liver Function for Patients with COVID-19: A 1-Year Follow-Up Study

Zhu¹,

Wang²,

Du³

et al. 2022

IDR

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Objective Abnormal liver function and liver injury related to COVID-19 during hospitalization has received widespread attention. However, the long-term observation of patients’ liver functions after discharge has not been investigated. This study intends to analyze the abnormal liver function in patients one year after they are discharged. Methods Serum liver function tests were analyzed for the first time immediately after hospitalization (T1), before discharge (T2), a median of 14.0 (14.0, 15.0) days after discharge (T3) and 1 year (356.0 (347.8, 367.0) days) after discharge (T4). Patients with at least one serum parameter (ALT, AST, ALP, GGT and TB) exceeding the upper limit of reference range were defined as having abnormal liver function. Results For the 118 COVID-19 patients with a median follow-up time of 376.0 (71.5, 385.3) days from onset to the end of the follow-up after discharge, the proportion with abnormal liver function in T1, T2, T3 and T4 were 32.2%, 45.8%, 54.8% and 28.8%, respectively. The proportion of patients with at least once abnormal liver function detected from T1 to T2, T1 to T3, T1 to T4 was 60.2%, 77.4% and 88.9%, respectively. From T1 to T4, the ALT, AST, GGT and BMI at admission were significantly higher in the patients with persistently abnormal liver function than in the patients with persistently normal liver function. Abnormal liver function was mainly manifested in the elevation of GGT and TB levels. Multivariate logistics regression analysis showed that age and gender-adjusted ALT (odds ratio [OR]=2.041, 95% confidence interval [CI]: 1.170–3.561, P =0.012) at admission was a risk factor for abnormal liver function in the T4 stage. Conclusion Abnormal liver function in patients with COVID-19 can persist from admission to one year after discharge, and therefore, the long-term dynamic monitoring of liver function in patients with COVID-19 is necessary.

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“…However, there are few reports on the severity of hepatic impairment, clinical outcome and mortality rate in patients with different chronic liver diseases co-infected with SARS-CoV-2. Ali et al [ 6 ] summarized the remarkable impact of SARS-CoV-2 on several types of liver diseases, including non-alcoholic fatty liver disease), liver cirrhosis, hepatocellular carcinoma, and hepatitis B and C virus infection. Furthermore, they reviewed the devastating cytokine storm in COVID-19 and concluded that in a similar pattern, hepatic impairment patients co-infected with SARS-CoV-2 could exhibit overexpression of ACE2 receptors and overwhelming cytokine storm, which might worsen the hepatic impairment and increases the mortality rate.…”

Section: To the Editormentioning

confidence: 99%

Should people with chronic liver diseases be vaccinated against COVID-19?

Chen¹,

Zeng²,

Gong³

et al. 2021

WJCC

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Hepatic impairment in coronavirus disease 2019 (COVID-19) may derive from cholangiocyte damage in the beginning, but not from direct infection of hepatocytes. Chronic liver disease patients co-infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exhibited overexpression of angiotensin-converting enzyme 2 receptors and overwhelming cytokine storm. Consensus has been reached that we should encourage as many people as possible to be vaccinated in order to achieve herd immunity. SARS-CoV-2 vaccines can prevent or alleviate severe infection and cytokine storm. It is recommended that all adult patients with chronic liver diseases and liver transplant recipients should receive COVID-19 vaccines using the standard dose and schedule. Data is not yet sufficient to compare the efficacy of different types of vaccines used in chronic liver disease patients.

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Impact of cytokine storm and systemic inflammation on liver impairment patients infected by SARS-CoV-2: Prospective therapeutic challenges

Cited by 22 publications

References 212 publications

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

Changes in Serum Liver Function for Patients with COVID-19: A 1-Year Follow-Up Study

Should people with chronic liver diseases be vaccinated against COVID-19?

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