The impact of coronavirus disease 2019 (COVID-19) on liver injury in China

Zhao, Xin; Lei, Zehua; Gao, Fengwei; Xie, Qingyun; Jang, Kangyi; Gong, Jie

doi:10.1097/md.0000000000024369

Cited by 20 publications

(20 citation statements)

References 29 publications

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“…Furthermore, the exposure of mice to DMEM had no effect on alterations in liver enzymes (i.e., levels were identical to those of healthy controls). These findings strongly suggest that MHV-1 leads to severe liver injury; similar observations have been made in patients with SARS-CoV-2 infection [ 46 , 59 , 60 , 61 , 62 , 63 ].…”

Section: Resultssupporting

confidence: 81%

Multi-Organ Histopathological Changes in a Mouse Hepatitis Virus Model of COVID-19

Paidas

Mohamed

Norenberg

et al. 2021

Viruses

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Infection with SARS-CoV-2, the virus responsible for the global COVID-19 pandemic, causes a respiratory illness that can severely impact other organ systems and is possibly precipitated by cytokine storm, septic shock, thrombosis, and oxidative stress. SARS-CoV-2 infected individuals may be asymptomatic or may experience mild, moderate, or severe symptoms with or without pneumonia. The mechanisms by which SARS-CoV-2 infects humans are largely unknown. Mouse hepatitis virus 1 (MHV-1)-induced infection was used as a highly relevant surrogate animal model for this study. We further characterized this animal model and compared it with SARS-CoV-2 infection in humans. MHV-1 inoculated mice displayed death as well as weight loss, as reported earlier. We showed that MHV-1-infected mice at days 7–8 exhibit severe lung inflammation, peribronchiolar interstitial infiltration, bronchiolar epithelial cell necrosis and intra-alveolar necrotic debris, alveolar exudation (surrounding alveolar walls have capillaries that are dilated and filled with red blood cells), mononuclear cell infiltration, hyaline membrane formation, the presence of hemosiderin-laden macrophages, and interstitial edema. When compared to uninfected mice, the infected mice showed severe liver vascular congestion, luminal thrombosis of portal and sinusoidal vessels, hepatocyte degeneration, cell necrosis, and hemorrhagic changes. Proximal and distal tubular necrosis, hemorrhage in interstitial tissue, and the vacuolation of renal tubules were observed. The heart showed severe interstitial edema, vascular congestion, and dilation, as well as red blood cell extravasation into the interstitium. Upon examination of the MHV-1 infected mice brain, we observed congested blood vessels, perivascular cavitation, cortical pericellular halos, vacuolation of neuropils, darkly stained nuclei, pyknotic nuclei, and associated vacuolation of the neuropil in the cortex, as well as acute eosinophilic necrosis and necrotic neurons with fragmented nuclei and vacuolation in the hippocampus. Our findings suggest that the widespread thrombotic events observed in the surrogate animal model for SARS-CoV-2 mimic the reported findings in SARS-CoV-2 infected humans, representing a highly relevant and safe animal model for the study of the pathophysiologic mechanisms of SARS-CoV-2 for potential therapeutic interventions.

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Section: Resultssupporting

confidence: 81%

Multi-Organ Histopathological Changes in a Mouse Hepatitis Virus Model of COVID-19

Paidas

Mohamed

Norenberg

et al. 2021

Viruses

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“…It should be noted that all surgeries performed (including the hernia repair surgeries) could not have been further postponed. Finally, the increase in the number of hepatobiliary surgeries is a possible side effect of the SARS-CoV-2 virus, which directly damages the intrahepatic biliary system [29], while the liver appears as a potential target for infection [30]. In our survey, the increase appeared in the total percentage of hepatobiliary surgeries performed during the pandemic period.…”

Section: Discussionmentioning

confidence: 68%

Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital

et al. 2021

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Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.

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“…[ 10 ] Only a few patients with mild symptoms experienced abnormal LFT values. In a systematic review and meta-analysis by Xin Zhao,[ 16 ] a total of 57 review articles from China were included. They have studied 9,889 confirmed cases of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of liver function in symptomatic COVID-19 patients

Singhai

Pavan

Panda

2021

Journal of Family Medicine and Primary Care

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Context: The coronavirus disease 2019 (COVID-19) is a viral respiratory illness which was first detected in Wuhan, Hubei Province, China. A few case studies demonstrated that 14–53% of the cases of COVID-19 reported abnormal levels of liver enzymes during disease progression. Patients with severe COVID-19 seem to have higher rates of hepatic dysfunction. Aims: Our aim was to investigate the changes in the liver function test in COVID-19 patients admitted to hospital and its association with the severity of the disease, length of hospital stay, and outcome of patients. Settings and Design: This was a cross-sectional study involving 678 COVID-19 patients, who were admitted at AIIMS, Bhopal. Methods and Material: The case records of 678 patients were evaluated by the research team from the Department of Medicine, AIIMS, Bhopal, and data were analyzed. All laboratory data were obtained. The liver function tests (LFT) including alanine aminotransferase, aspartate aminotransferase, and total bilirubin values were recorded, and liver dysfunction defined as any parameter having more than the upper limit of normal value. Results: From April 2020 to September 2020, a total of 678 COVID-19 patients were screened, and 600 were assessed for eligibility; 78 were excluded due to either significant alcohol history or due to prior liver disease. Among the 600 patients, 265 patients (44.16%) had liver dysfunction while 335 patients (55.83%) had a normal liver function. The patients having a severe disease were more affected by liver dysfunction than the mild disease patients. The average hospital stay was more in those patients having liver dysfunction than in those patients with normal liver function. Among the patients with normal LFT on admission, 97.9% got cured while 2.1% died. Among the patients with liver dysfunction, 80.4% got cured and 19.6% died. Conclusions: Hepatic injury is common in severe COVID-19 patients, which may be caused by direct injury to the bile duct cells by a virus or indirectly by a cytokine storm. The liver function should be evaluated in all symptomatic COVID-19 patients. In patients with pre-existing liver diseases, special attention should be paid to monitoring and treatment.

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The impact of coronavirus disease 2019 (COVID-19) on liver injury in China

Cited by 20 publications

References 29 publications

Multi-Organ Histopathological Changes in a Mouse Hepatitis Virus Model of COVID-19

Multi-Organ Histopathological Changes in a Mouse Hepatitis Virus Model of COVID-19

Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital

Evaluation of liver function in symptomatic COVID-19 patients

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