Liver injury in critically ill patients with COVID-19: a case series

Cardoso, Filipe S.; Pereira, Rui; Germano, Nuno

doi:10.1186/s13054-020-02924-4

Cited by 35 publications

(38 citation statements)

References 5 publications

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“…Authors reported that late cholestasis was frequently observed, while synthetic function was preserved. They hypothesized that cholestasis may be associated to several factors, such as inflammation, parenteral nutrition, or drug toxicity [7]. We report, for the first time, the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery.…”

Section: Introductionmentioning

confidence: 91%

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

et al. 2020

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Background: Since its first documentation, a novel coronavirus (SARS-CoV-2) infection has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19). Severe forms of acute respiratory failure can develop. In addition, SARS-CoV-2 may affect organs other than the lung, such as the liver, with frequent onset of late cholestasis. We here report the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic and gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery. Case presentation: A 59-year-old Caucasian male, affected by acute respiratory failure secondary to SARS-CoV-2 infection was admitted to our intensive care unit (ICU). Due to the severity of the disease, invasive mechanical ventilation was instituted and SARS-CoV-2 treatment (azithromycin 250 mg once-daily and hydroxychloroquine 200 mg trice-daily) started. Enoxaparin 8000 IU twice-daily was also administered subcutaneously. At day 8 of ICU admission, the clinical condition improved and patient was extubated. At day 32, patient revealed abdominal pain without signs of peritonism at examination, with increased inflammatory and cholestasis indexes at blood tests. At a first abdominal CT scan, perihepatic effusion and a relaxed gallbladder with dense content were detected. The surgeon decided to wait and see the evolution of clinical conditions. The day after, conditions further worsened and a laparotomic cholecystectomy was performed. A relaxed and perforated ischemic gangrenous gallbladder, with a local tissue inflammation and perihepatic fluid, was intraoperatively met. The gallbladder and a sample of omentum, adherent to the gallbladder, were also sent for histological examination. Hematoxylin-eosin-stained slides display inflammatory infiltration and endoluminal obliteration of vessels, with wall breakthrough, hemorrhagic infarction, and nerve hypertrophy of the gallbladder. The mucosa of the gallbladder appears also atrophic. Omentum vessels also appear largely thrombosed. Immunohistochemistry demonstrates an endothelial overexpression of medium-size vessels (anti-CD31), while not in micro-vessels, with a remarkable activity of macrophages (anti-CD68) and T helper lymphocytes (anti-CD4)

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Section: Introductionmentioning

confidence: 91%

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

et al. 2020

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“…Meta-regression scatter plot representing the correlation between BMI and IMV is shown in Figure S2. 15,[28][29][30][31][32][33][34] No correlation was found F I G U R E 2 Odds ratios for intensive care unit admission in patients with obesity versus patients without obesity. BMI, body mass index; CI, confidence interval; ICU, intensive care unit F I G U R E 3 Odds ratios for invasive mechanical ventilation (IMV) in patients with obesity versus patients without obesity.…”

Section: Meta-regressionmentioning

confidence: 98%

“…Among COVID-19 patients admitted to the ICU, 40% to 100% of patients require IMV. 33,46,47 Excessive body mass and obstructive sleep apnea might complicate different forms of respiratory support and endotracheal intubation. 48,49 Prolonged endotracheal intubation time, which is more frequently present in patients with obesity, also increases the risk of infection of the medical staff.…”

Section: Obesity and Icu Admissionmentioning

confidence: 99%

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

et al. 2020

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Summary The disease course of COVID‐19 varies from asymptomatic infection to critical condition leading to mortality. Identification of prognostic factors is important for prevention and early treatment. We aimed to examine whether obesity is a risk factor for the critical condition in COVID‐19 patients by performing a meta‐analysis. The review protocol was registered onto PROSPERO (CRD42020185980). A systematic search was performed in five scientific databases between 1 January and 11 May 2020. After selection, 24 retrospective cohort studies were included in the qualitative and quantitative analyses. We calculated pooled odds ratios (OR) with 95% confidence intervals (CIs) in meta‐analysis. Obesity was a significant risk factor for intensive care unit (ICU) admission in a homogenous dataset (OR = 1.21, CI: 1.002‐1.46; I2 = 0.0%) as well as for invasive mechanical ventilation (IMV) (OR = 2.05, CI: 1.16‐3.64; I2 = 34.86%) in COVID‐19. Comparing body mass index (BMI) classes with each other, we found that a higher BMI always carries a higher risk. Obesity may serve as a clinical predictor for adverse outcomes; therefore, the inclusion of BMI in prognostic scores and improvement of guidelines for the intensive care of patients with elevated BMI are highly recommended.

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“…It is previously established that patients with severe SARS and MERS had a higher incidence of multiple organ dysfunction syndromes including liver damage, acute heart/kidney injury, coagulation dysfunction, and even death (42,43). And a lot of research has shown the clinical characteristics and laboratory ndings associated with different degrees of multiple organs in patients with COVID-19 (17,42,44). In our study, liver damage and acute heart/kidney injury had been considered to occur in more than a third of patients.…”

Section: Risk Factors For Disease Progressionmentioning

confidence: 99%

A Comprehensive Evaluation of Early Predictors of Disease Progression in Patients with COVID-19: A Case Control Study

Tang

Liu

et al. 2020

Preprint

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Background: The 2019 coronavirus disease (COVID-19) has become an unprecedented public health crisis with nearly 16 million confirmed cases and 630,000 deaths worldwide. Methods: We retrospectively investigated the demographic, clinical, laboratory, radiological and treatment data of COVID-19 patients consecutively enrolled from January 18 to May 15, 2020, in Taihe and Jinzhou central hospital. Results: Of all 197 patients, the median age was 66.5 years (IQR 7-76), and 120 (60.9%) patients were males. We identified 88 (44.7%) of 197 COVID-19 patients as the disease progression (aggravation) cases. The aggravation cases tend to have more medical comorbidity: hypertension (34.1%), diabetes (30.7%), and presented with dyspnea (34.1%), neutrophilia (60.2%), and lymphocytopenia (73.9%), compared with those without. And the patients with disease progression showed significantly higher level of Fibrinogen (Fbg), D-dimer, IL-6, C-reactive protein (CRP), procalcitonin (PCT), and serum ferritin, and were more prone to develop organ damage in the liver, kidney, and heart (P<0.05). Multivariable regression showed that advanced age, comorbidities, lymphopenia, and elevated level of Fbg, lactate dehydrogenase (LDH), Cardiac troponin (CTnI), IL-6, serum ferritin were the significant predictors of disease progression. Further, we investigated antibody responses to SARS-CoV-2 and found that the levels of IgM and IgG were significantly higher in the disease progression cases compared to non-progression cases from 3 weeks after symptom onset. In addition, the disease progression group tended to peak later and has a more vigorous IgM/IgG response against SARS-CoV-2. Further, we performed Kaplan-Meier analysis and found that 61.6% of patients had not experienced ICU transfer or survival from hospital within 25 days from admission.Conclusions: Investigating the potential factors of advanced age, comorbidities and elevated level of IL-6, serum ferritin and Kaplan-Meier analysis enables early identification and management of patients with poor prognosis. Detection of the dynamic antibody may offer vital clinical information during the course of SARS-CoV-2 and provide prognostic value for patients infection.

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Liver injury in critically ill patients with COVID-19: a case series

Cited by 35 publications

References 5 publications

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

A Comprehensive Evaluation of Early Predictors of Disease Progression in Patients with COVID-19: A Case Control Study

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