Prevalence of liver injury in 445 patients with Corona Virus Disease-19-Single-centre experience from southern India

Saithanyamurthi, Hemamala; Munirathinam, Manoj; Ananthavadivelu, Murali

doi:10.1007/s12664-021-01147-x

Cited by 8 publications

(6 citation statements)

References 15 publications

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“… 8 , 17 A systematic review analyzing the impact of COVID-19 on liver dysfunction placed this prevalence at 36.65% 18 In a recent Indian study 42.4% of patients had elevated ALT leves. 20 In comparison, our study showed a higher prevalence. These differences could possibly be attributed to the cut-offs considered in the respective studies.…”

Section: Discussioncontrasting

confidence: 65%

Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19?

Padmaprakash¹,

Thareja²,

Raman³

et al. 2022

Journal of Clinical and Experimental Hepatology

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Introduction The most dreaded pandemic grappling world now, the Coronavirus Disease 2019 (COVID-19), chiefly involves the respiratory system; nevertheless, it is a multisystem disorder. Its involvement of the hepatic system is considerable; however, still emerging are its clinical implications and effects on morbidity and mortality. The aim of this study is to report on the various aspects of its hepatic involvement by describing the alterations in tests of liver function and its significance in the disease outcome in a cohort of hospitalized COVID-19 patients at a tertiary centre in northern India. Methods This is a retrospective cohort study conducted in a tertiary-care hospital in northern India. All confirmed hospitalized COVID-19 cases aged 15 and above from Apr till Oct 2020 with no pre-existing liver disease were included. The primary endpoint was death at 28 days. Statistical analysis included descriptive analysis, sensitivity-specificity, and univariable and multivariable regression analysis as well as survival analysis. Results A total of 708 COVID-19 patients fulfilled the inclusion criteria included 561 (79.2%) males and 147 (20.8%) females. The median age was 49 (IQR=25) years. Mild and moderate/severe disease were seen in 508 (71.8%) and 200 (28.2) patients respectively. Serum bilirubin, Aspartate-aminotransferase (AST) and Alanine-aminotransferase (ALT) were elevated in 6.92%, 69.91% and 80.22% of patients respectively. In univariable logistic regression, AST [odds ratio; OR 1.008 95% CI (1.005-1.012) per 1 IU/L increase] and ALT [OR 1.005 95% CI (1.002-1.007) per 1 IU/L increase] were significantly associated with the odds of moderate-to-severe disease but only AST was significant after adjustment to age, sex, and comorbidity [adjusted odds ratio; aOR 1.007 95% CI (1.003-1.011) per 1IU/L increase]. Serum albumin was negatively associated with the odds of moderate to severe disease and remained significant in the adjusted model [aOR 0.217 95%CI (0.149-0.316) per 1g/dL increase]. Ninety-six patients succumbed to illness [case fatality rate; CFR 13.6%). In adjusted Cox Proportional-Hazards Model for mortality, AST [adjusted hazard ratio; aHR 1.002 95% CI (1.000-1.003) per 1 IU/L increase] and serum albumin [aHR 0.396 95% CI (0.285-0.549) per 1g/dL increase] showed significant association with mortality. Conclusion Liver function abnormalities are common in COVID 19 patients. In particular, AST and serum albumin levels are effective predictors of disease severity and mortality and can be used as markers of fatal disease in the management as well as prognostication of COVID-19.

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Section: Discussioncontrasting

confidence: 65%

Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19?

Padmaprakash¹,

Thareja²,

Raman³

et al. 2022

Journal of Clinical and Experimental Hepatology

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“…At the initial examination, 6462 studies were obtained, which were screened and evaluated layer by layer according to inclusion and exclusion criteria, and 49 studies were finally included, most of which were retrospective studies, from 10 countries, with a total of 23,611 COVID-19 patients, including 9357 cases complicated with liver injury. [7–55] The flow chart of literature screening is shown in Figure 1. The basic characteristics of the included literature are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Two other studies did not have a clear definition of liver injury, with 1. Hemamala 2021 [7] Retrospective India >1 ULN 445 49.6 (2.2) 298 ab ①②③ 2. Wang 2020 [8] Retrospective China/Beijing >1 ULN 105 45 59 a NR 3.…”

Section: Incidence Of Liver Injury In Patients With Covid-19mentioning

confidence: 99%

Meta-analysis of liver injury in patients with COVID-19

Fan

Jin

et al. 2023

Medicine

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Background: The coronavirus disease 2019 (COVID-19) is a major public health problem threatening human health. It can lead to multiple system complications, among which liver damage is also a common complication of COVID-19. The pathogenesis of liver injury is complex and involves the interaction of multiple factors. This study aims to investigate the incidence and risk factors of liver injury in COVID-19 patients and analyze the impact of liver injury on clinical prognosis of patients, so as to provide corresponding basis for clinical diagnosis and treatment. Methods: PubMed and Cochrane Library were searched in computer to collect original studies on liver injury cases, laboratory indicators and clinical outcomes in COVID-19 patients. Articles were screened according to inclusion and exclusion criteria, and data were meta-analyzed using Stata12.0 software. Results: A total of 49 studies, including 23,611 patients with COVID-19, had a prevalence of liver injury of 39.63%. Subgroup analysis found that patients in the Americas had the highest incidence of liver injury at 43.7% and lowest in Africa (25.99%). The vast majority of liver injury is manifested by aminotransferase or bilirubin levels greater than 1 times the upper limit of normal (49.16%). The older the age, the male, the associated chronic liver disease, and the higher the levels of white blood cells, neutrophils, and C-reactive protein, the higher the risk of liver injury. The use of hormones, hydroxychloroquine, and tocilizumab increases the risk of liver injury. Patients with concurrent liver injury have longer hospital stays, are more likely to progress to severe cases, and have a higher risk of death than patients without liver injury. Conclusion: The incidence of liver injury in COVID-19 patients was high, affected by age, gender, chronic liver disease, inflammatory state and medication, and patients with liver injury were hospitalized longer and were more likely to have a poor prognosis. Therefore, clinical attention should be paid to early intervention.

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“…Prevalence of liver injury in 445 patients of COVID-19: Single-Centre experience from southern India Many Corona Virus Disease-19 (COVID-19) patients, particularly those with severe disease have experienced some form of liver injury [11]. Saithanyamurthi et al from MIOT International, Chennai, India report a single-centre retrospective experience of liver injury from 445 patients admitted with COVID-19 in May 2020 [12]. Abnormal liver tests were defined according to American College of Gastroenterology (ACG) guidelines [13].…”

Section: Living Donor Liver Transplantation For Hepatocellular Carcinoma In Indian Patients -Is the Scenario Different?mentioning

confidence: 99%

Editorial commentary on the Indian Journal of Gastroenterology– May–June 2021

Limdi

2021

Indian J Gastroenterol

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Serum C-reactive protein and neutrophil to lymphocyte ratio as predictors of survival in cirrhotic patients with systemic inflammatory response syndrome and bacterial infection Patients with liver cirrhosis are at risk of significant morbidity and mortality from infectious complications [1]. Data on biochemical surrogates as predictors of infection are scarce. Tapadia et al. from Gleneagles Global Health City, Chennai, India assessed the predictive value of C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) alone and in combination in predicting infection in a cohort of 208 consecutive hospitalized patients with cirrhosis [2].In addition to standard assessments (laboratory, ultrasound and appropriate cultures), CRP and NLR were also obtained. Investigators noted an infection rate of 62% with 58.5% culture positivity and mortality of 30.8%. Optimal cut-off values for NLR and CRP to predict infection were 5.86 and 33.7, respectively. One-month mortality risk was 2-3 times with NLR and CRP above these cut-off values. The combination of NLR + CRP (≥5.86 and ≥ 33.7) increased specificity and diagnostic accuracy for infection suggesting that these may have a role in predicting infection and even culture positivity. Prospective controlled studies are needed to validate this interesting observation.

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Prevalence of liver injury in 445 patients with Corona Virus Disease-19-Single-centre experience from southern India

Cited by 8 publications

References 15 publications

Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19?

Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19?

Meta-analysis of liver injury in patients with COVID-19

Editorial commentary on the Indian Journal of Gastroenterology– May–June 2021

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