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Milivojević V, Bogdanović J, Babić I, Todorović N, Ranković I. Metabolic Associated Fatty Liver Disease (MAFLD) and COVID-19 Infection: An Independent Predictor of Poor Disease Outcome? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1438. [PMID: 37629728 PMCID: PMC10456234 DOI: 10.3390/medicina59081438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Early reports on COVID-19 infection suggested that the SARS-CoV-2 virus solely attacks respiratory tract cells. As the pandemic spread, it became clear that the infection is multiorganic. Metabolic associated fatty liver disease (MAFLD) is a chronic liver disease strongly associated with insulin resistance and diabetes. The aim of this study was to assess a possible interplay between MAFLD and COVID-19 infection and its implication in COVID-19 outcome. Materials and Methods: A retrospective observational study, including 130 COVID-19 positive patients was conducted. MAFLD diagnosis was made based on the International Consensus criteria. Patients were divided into two groups, group A (MAFLD) and group B (nonMAFLD). Anthropometric and laboratory analysis were obtained. COVID-19 severity was assessed using the NEWS2 score. Disease outcome was threefold and regarded as discharged, patients who required mechanical ventilation (MV), and deceased patients. Results: MAFLD prevalence was 42%, 67% of patients were discharged, and 19% needed MV. Mortality rate was 14%. MAFLD patients were significantly younger (p < 0.001), and had higher body mass index (p < 0.05), respiratory rate (p < 0.05) and systolic blood pressure (p < 0.05) than nonMAFLD patients. Regarding metabolic syndrome and inflammatory markers: group A had significantly higher glycemia at admission (p = 0.008), lower HDL-c (p < 0.01), higher triglycerides (p < 0.01), CRP (p < 0.001), IL-6 (p < 0.05) and ferritin (p < 0.05) than group B. MAFLD was associated with more prevalent type 2 diabetes (p = 0.035) and hypertension (p < 0.05). MAFLD patients had a more severe disease course (NEWS2 score, 6.5 ± 0.5 vs. 3 ± 1.0, p < 0.05). MAFLD presence was associated with lower patient discharge (p < 0.01) and increased need for MV (p = 0.024). Multiple regression analysis showed that BMI (p = 0.045), IL-6 (p = 0.03), and MAFLD (p < 0.05) are significant independent risk factors for a poor COVID-19 outcome. Conclusions: The prevalence of MAFLD is relatively high. MAFLD patients had a more severe COVID-19 clinical course and worse disease outcome. Our results imply that early patient stratification and risk assessment are mandatory in order to avoid poor outcomes.
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Affiliation(s)
- Vladimir Milivojević
- Clinic for Gastroenterology and Hepatology University Clinical Centre of Serbia, Dr Koste Todorovica 2, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Jelena Bogdanović
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Diseases University Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Ivana Babić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases University Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Nevena Todorović
- Clinic for Infectious and Tropical Diseases University Clinical Centre of Serbia, Bulevar Oslobođenja 16, 11000 Belgrade, Serbia
| | - Ivan Ranković
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK;
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Maia JC, Bertoncello KCG, de Souza SDS, Locks MOH, Martins SR, Lorenzini E. Validation of a Guideline for Nurses Taking Care of Patients With Liver Cirrhosis in the Context of COVID-19 in the Emergency Department. Gastroenterol Nurs 2023; 46:128-137. [PMID: 36779975 PMCID: PMC10044590 DOI: 10.1097/sga.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/07/2022] [Indexed: 02/14/2023] Open
Abstract
The objective of this study was to prepare and validate the content of a guideline for nursing care of adult patients with liver cirrhosis and COVID-19 treated in the emergency department. The study was conducted in two stages: first, the guideline was developed based on an integrative literature review and existing guidelines on the topic. The guideline was prepared with six domains and 64 care items. In the second stage, 15 specialists in urgency and emergency services performed content validation of the guideline. The data were analyzed using the Content Validity Index, with reliability assessed through Cronbach's α. The judges validated the guide regarding language clarity, objectivity, theoretical relevance, and practical pertinence. The value of the guideline's Content Validity Index was 0.96. Cronbach's α reliability reached a value of 0.93. The judges validated all domains and items of the guideline for theoretical relevance and practical pertinence, to be used by researchers and clinical practice professionals in the nursing area.
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Affiliation(s)
- Jéssica Costa Maia
- Correspondence to: Jéssica Costa Maia, MS, RN, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil ()
| | - Kátia Cilene Godinho Bertoncello
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Sabrina da Silva de Souza
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Melissa Orlandi Honório Locks
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Sabrina Regina Martins
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Elisiane Lorenzini
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
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Schinas G, Polyzou E, Mitropetrou F, Pazionis A, Gogos C, Triantos C, Akinosoglou K. COVID-19 Vaccination in Patients with Chronic Liver Disease. Viruses 2022; 14:v14122778. [PMID: 36560782 PMCID: PMC9785164 DOI: 10.3390/v14122778] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Vaccination against SARS-CoV-2 has become a central public health issue, primarily for vulnerable populations such as individuals with Chronic Liver Disease (CLD). Increased COVID-19-related mortality and disease severity has been noted in this subgroup of patients. Severe COVID-19 tends to further deregulate liver function in patients with chronic liver failure or cirrhosis and even reactivate hepatitis in people living with HBV or HCV. In addition, impaired hepatic function leads to several limitations in possible therapeutic interventions. Chronic hepatic dysregulation, along with the underlying cirrhosis-associated immune dysfunction (CAID), leads to a decreased immune response to vaccination that, in turn, may result in reduced efficacy rates and lowered lasting protection. According to current guidelines, timely vaccination and frequent booster shot administration are deemed necessary in this context. Vaccination-related adverse events are mostly mild in nature and similar to those reported in the general population, whereas the incidence of liver injury following vaccination is relatively rare. We aimed to review available evidence and recommendations associated with COVID-19 vaccination in patients with chronic liver disease, and provide insight to current issues and future directions.
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Affiliation(s)
- Georgios Schinas
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
| | - Eleni Polyzou
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
| | | | | | - Charalambos Gogos
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
| | - Christos Triantos
- Department of Medicine, University of Patras, 26504 Rio, Greece
- Division of Gastroenterology, Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Correspondence: or ; Tel.: +30-6972894651
| | - Karolina Akinosoglou
- Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
- Department of Medicine, University of Patras, 26504 Rio, Greece
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Wong CKH, Au ICH, Cheng WY, Man KKC, Lau KTK, Mak LY, Lui SL, Chung MSH, Xiong X, Lau EHY, Cowling BJ. Remdesivir use and risks of acute kidney injury and acute liver injury among patients hospitalised with COVID-19: a self-controlled case series study. Aliment Pharmacol Ther 2022; 56:121-130. [PMID: 35318694 PMCID: PMC9111503 DOI: 10.1111/apt.16894] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/04/2022] [Accepted: 03/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM To investigate and quantify the risks of AKI and ALI associated with remdesivir use, given the underlying diseases of SARS-CoV-2 infection. METHODS This self-controlled case series (SCCS) study was conducted using electronic hospital records between 23 January 2020 and 31 January 2021 as retrieved from the Hong Kong Hospital Authority which manages all laboratory-confirmed COVID-19 cases in Hong Kong. Outcomes of AKI and ALI were defined using the KDIGO Guideline and Asia Pacific Association of Study of Liver consensus guidelines. Incidence rate ratios (IRR) for AKI and ALI following the administration of remdesivir (exposure) in comparison to a non-exposure period were estimated using the conditional Poisson regression models. RESULTS Of 860 COVID-19 patients administered remdesivir during hospitalisation, 334 (38.8%) and 137 (15.9%) had incident ALI and AKI, respectively. Compared with the baseline period, both ALI and AKI risks were increased significantly during the pre-exposure period (ALI: IRR = 6.169, 95% CI = 4.549-8.365; AKI: IRR = 7.074, 95% CI = 3.763-13.298) and remained elevated during remdesivir treatment. Compared to the pre-exposure period, risks of ALI and AKI were not significantly higher in the first 2 days of remdesivir initiation (ALI: IRR = 1.261, 95% CI = 0.915-1.737; AKI: IRR = 1.261, 95% CI = 0.889-1.789) and between days 2 and 5 of remdesivir treatment (ALI: IRR = 1.087, 95% CI = 0.793-1.489; AKI: IRR = 1.152, 95% CI = 0.821-1.616). CONCLUSION The increased risks of AKI and ALI associated with intravenous remdesivir treatment for COVID-19 may be due to the underlying SARS-CoV-2 infection. The risks of AKI and ALI were elevated in the pre-exposure period, yet no such increased risks were observed following remdesivir initiation when compared to the pre-exposure period.
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Affiliation(s)
- Carlos K. H. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science ParkHong Kong SARChina
| | - Ivan C. H. Au
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Wing Yiu Cheng
- School of Biomedical Sciences, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Kenneth K. C. Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,Research Department of Practice and PolicyUCL School of PharmacyLondonUK
| | - Kristy T. K. Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Lung Yi Mak
- Department of Medicine, School of Clinical Medicine, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,State Key Laboratory of Liver ResearchThe University of Hong KongHong Kong SARChina
| | - Sing Leung Lui
- Department of Medicine, Tung Wah HospitalHong Kong SARChina
| | - Matthew S. H. Chung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Eric H. Y. Lau
- Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science ParkHong Kong SARChina,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of MedicineThe University of Hong KongHong KongSARChina
| | - Benjamin J. Cowling
- Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science ParkHong Kong SARChina,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of MedicineThe University of Hong KongHong KongSARChina
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