Severe liver failure during SARS-CoV-2 infection

Weber, Sabine; Mayerle, Julia; Irlbeck, Michael; Gerbes, Alexander L.

doi:10.1136/gutjnl-2020-321350

Cited by 65 publications

(66 citation statements)

References 10 publications

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“…There is has been speculation that use of ACE inhibitors may cause upregulation of ACE2 receptors theoretically allowing worse injury by SARS-CoV2. [ 5 ] This patient was not on ACE inhibitors.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 presenting as fulminant hepatic failure

et al. 2020

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Introduction: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) responsible for the COVID-19 pandemic has spread from Wuhan, China in December, 2019 to 216 countries and territories as of September 10, 2020 with 27.74 million cases and 899,911 confirmed deaths. The spectrum of disease is most commonly seen as a viral pneumonia with high grade fevers, shortness of breath, dry cough, and chest pain with radiologic evidence of bilateral, interstitial, ground glass opacities, and peripheral lung consolidation. Liver chemistries are frequently abnormal, with transaminases shown to be one-two times the upper limit of normal in most instances. The full spectrum of gastrointestinal involvement of the SARS-CoV-2 infection has yet to be fully seen. Patient concerns: We present a case of a young woman with SLE who developed severe abdominal pain, nausea and vomiting, rapidly progressing to acute hepatic failure and tested positive for SARS-CoV-2 infection. She had no respiratory symptoms. Diagnosis: A thorough work-up of acute liver failure including liver biopsy confirmed acute hepatitis with viral like changes. Common viral causes of liver failure were ruled out. The patient had no recent travel history. Interventions: The patient was started on hydroxychloroquine due to SLE, treated with N-Acetyl-Cysteine, and methylprednisolone. Outcomes: The patient improved with resolution of encephalopathy and normalization of her liver chemistries without any development of respiratory illness. Conclusion: This case details a unique presentation of likely SARS-CoV-2 infection. Until now, the literature has primarily described a respiratory illness and liver injury with mild transaminase elevations. Significant liver injury progressing to acute liver failure should be considered in those with SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 99%

“…[ 4 ] A second case of SARS-CoV-2 infection with development of severe liver failure has been published however development of hepatic failure ensued days into the disease course and introduction of antiviral therapy. [ 5 ]…”

Section: Introductionmentioning

confidence: 99%

COVID-19 presenting as fulminant hepatic failure

et al. 2020

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“…One should also look for features that might suggest pre-existing or undiagnosed liver disease in these patients. Acute liver failure seems to be rare and is described only in isolated case reports [18].…”

Section: Discussionmentioning

confidence: 99%

Liver Injury in COVID-19 Infection: A Systematic Review

Ghoda¹,

Ghoda²

2020

Cureus

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or novel coronavirus disease (COVID-19) pandemic is sweeping through the world. The overwhelming pathology seems to be in the upper and lower respiratory tract; however, the involvement of other organs, including the liver, has also been reported. Whether liver enzyme derangement is a common feature of COVID-19 is not known. For those patients who have concomitant liver enzyme derangement with COVID-19, the prevalence, extent, and rate of progression to liver failure is not known. In view of unclear evidence regarding this, we conducted a systematic review of the literature on liver injury in COVID-19 patients. The aim of this review was to ascertain whether liver enzyme derangement is a common feature in adult patients with confirmed COVID-19 infection, determine the relation of deranged liver enzymes with outcome or mortality in COVID-19, and determine if liver failure is a common feature of COVID-19. The PubMed and OVID Medline databases were searched systematically. Cross-sectional studies and case-control studies involving adult patients with confirmed COVID-19 and having data on liver enzymes were included. Independent extraction of the data was done by two independent authors. A total of 23 articles were identified by the initial filtering search. Abstracts were reviewed and screened to shortlist studies. A full-text assessment of the shortlisted articles for eligibility criteria identified five articles. Manual searching via the LitCovid (National Library of Medicine tool) search hub produced a further two studies that were eligible. Many of the COVID-19 patients in the various studies had a varying degree of deranged liver enzymes. The degree of injury was mild in most cases; and it appears to correlate with the severity of COVID-19 infection. Severe liver injury causing significant liver damage, liver failure, or death is uncommon. The main limitations of the study were the heterogeneity of studies and incomplete data on the trajectory of liver tests during the disease course as well as the final outcomes of the patients in the studies.

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“…Other drugs described as having the potential to cause hepatotoxicity in COVID-19 included hydroxychloroquine (n=1, 12.5%), tocilizumab (n=2, 25%), and remdesivir (n=1, 12.5%). 12,18,[54][55][56][57][58][59] The methodological characteristics of the finalised studies were also analysed. The largest number of the studies were retrospective observational studies (n=26, 41.9%), followed by meta-analyses (n=10, 16.1%), case reports (n=9, 14.5%), case series (n=7, 11.3%), prospective observational studies (n=3, 4.8%), and others Table 1).…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…Case reports have identified the presence of liver injury across the entire age spectrum, ranging from 55 days to 65 years. 50,57,58,61,62…”

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

confidence: 99%

Incidence, patterns, risk factors, and histopathological findings of liver injury in coronavirus disease 2019 (COVID-19): a scoping review

et al. 2020

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Background: Coronavirus disease 2019 (COVID-19) exhibits many extrapulmonary manifestations, including liver injury. This scoping review aimed to provide insight into the incidence, patterns, risk factors, histopathological findings, and relationship with disease severity of COVID-19-associated liver injury. Furthermore, we identified existing gaps in the research on the hepatic manifestations of COVID-19 and highlighted areas for future investigations. Methods: A scoping review was conducted following the methodological framework suggested by Arksey and O'Mallay. Five online databases, along with grey literature, were searched for articles published until 22 May 2020, and we included 62 articles in the review. The research domains, methodological characteristics, and key conclusions were included in the analysis. Results: Retrospective observational studies comprised more than one third (41.9%) of the included publications, and 77.8% were conducted on living patients. The incidence of liver injury varied widely across the studies (4.8%-78%), and liver injury was frequently associated with severe COVID-19. We identified the following risk factors for liver injury: male sex, lymphopoenia, gastrointestinal involvement, old age, increased neutrophil count,

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Severe liver failure during SARS-CoV-2 infection

Cited by 65 publications

References 10 publications

COVID-19 presenting as fulminant hepatic failure

COVID-19 presenting as fulminant hepatic failure

Liver Injury in COVID-19 Infection: A Systematic Review

Incidence, patterns, risk factors, and histopathological findings of liver injury in coronavirus disease 2019 (COVID-19): a scoping review

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