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Ritter E, Shusterman E, Prozan L, Kehat O, Weiss Meilik A, Shibolet O, Ablin JN. The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections. J Clin Med 2023; 12:jcm12093335. [PMID: 37176775 PMCID: PMC10179215 DOI: 10.3390/jcm12093335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. AIMS we aimed to compare patterns of abnormal liver function tests in patients suffering from COVID-19 infection and seasonal respiratory viruses: respiratory syncytial virus (RSV) and influenza (A and B). METHODS a retrospective cohort study was performed including 4140 patients admitted to a tertiary medical center between 2010-2020. Liver test abnormalities were classified as hepatocellular, cholestatic or mixed type. Clinical outcomes were defined as 30-day mortality and mechanical ventilation. RESULTS liver function abnormalities were mild to moderate in most patients, and mainly cholestatic. Hepatocellular injury was far less frequent but had a strong association with adverse clinical outcome in RSV, COVID-19 and influenza (odds ratio 5.29 (CI 1.2-22), 3.45 (CI 1.7-7), 3.1 (CI 1.7-6), respectively) COVID-19 and influenza patients whose liver functions did not improve or alternatively worsened after 48 h had a significantly higher risk of death or ventilation. CONCLUSION liver function test abnormalities are frequent among patients with COVID-19 and seasonal respiratory viruses, and are associated with poor clinical outcome. The late liver tests' peak had a twofold risk for adverse outcome. Though cholestatic injury was more common, hepatocellular injury had the greatest prognostic significance 48 h after admission. Our study may provide a viral specific auxiliary prognostic tool for clinicians facing patients with a respiratory virus.
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Affiliation(s)
- Einat Ritter
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Eden Shusterman
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Lior Prozan
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Ahuva Weiss Meilik
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Oren Shibolet
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Jacob Nadav Ablin
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
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Ali FEM, Abd El-Aziz MK, Ali MM, Ghogar OM, Bakr AG. COVID-19 and hepatic injury: cellular and molecular mechanisms in diverse liver cells. World J Gastroenterol 2023; 29:425-449. [PMID: 36688024 PMCID: PMC9850933 DOI: 10.3748/wjg.v29.i3.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) represents a global health and economic challenge. Hepatic injuries have been approved to be associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. The viral tropism pattern of SARS-CoV-2 can induce hepatic injuries either by itself or by worsening the conditions of patients with hepatic diseases. Besides, other factors have been reported to play a crucial role in the pathological forms of hepatic injuries induced by SARS-CoV-2, including cytokine storm, hypoxia, endothelial cells, and even some treatments for COVID-19. On the other hand, several groups of people could be at risk of hepatic COVID-19 complications, such as pregnant women and neonates. The present review outlines and discusses the interplay between SARS-CoV-2 infection and hepatic injury, hepatic illness comorbidity, and risk factors. Besides, it is focused on the vaccination process and the role of developed vaccines in preventing hepatic injuries due to SARS-CoV-2 infection.
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Affiliation(s)
- Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
| | | | - Mahmoud M Ali
- Department of Pharmacology, Al-Azhar University, Assiut 71524, Egypt
| | - Osama M Ghogar
- Department of Biochemistry Faculty of Pharmacy, Badr University in Assiut, Egypt
| | - Adel G Bakr
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
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3
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Saeed U, Piracha ZZ, Uppal SR, Waheed Y, Uppal R. SARS-CoV-2 induced hepatic injuries and liver complications. Front Cell Infect Microbiol 2022; 12:726263. [PMID: 36189356 PMCID: PMC9523111 DOI: 10.3389/fcimb.2022.726263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is resilient, highly pathogenic, and rapidly transmissible. COVID-19 patients have been reported to have underlying chronic liver abnormalities linked to hepatic dysfunction. Discussion Viral RNAs are detectable in fecal samples by RT-PCR even after negative respiratory samples, which suggests that SARS-CoV-2 can affect the gastrointestinal tract and the liver. The case fatality rates are higher among the elderly and those with underlying comorbidities such as hypertension, diabetes, liver abnormality, and heart disease. There is insufficient research on signaling pathways. Identification of molecular mechanisms involved in SARS-CoV-2-induced damages to hepatocytes is challenging. Herein, we demonstrated the multifactorial effects of SARS-CoV-2 on liver injury such as psychological stress, immunopathogenesis, systemic inflammation, ischemia and hypoxia, drug toxicity, antibody-dependent enhancement (ADE) of infection, and several others which can significantly damage the liver. Conclusion During the COVID-19 pandemic, it is necessary for clinicians across the globe to pay attention to SARS-CoV-2-mediated liver injury to manage the rising burden of hepatocellular carcinoma. To face the challenges during the resumption of clinical services for patients with pre-existing liver abnormalities and HCC, the impact of SARS-CoV-2 on hepatocytes should be investigated both in vitro and in vivo.
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Affiliation(s)
- Umar Saeed
- Department of Research and Development, Islamabad Diagnostic Center (IDC), Islamabad, Pakistan
- International Center of Medical Sciences Research(ICMSR), Islamabad, Pakistan
- *Correspondence: Umar Saeed,
| | - Zahra Zahid Piracha
- Department of Research and Development, Islamabad Diagnostic Center (IDC), Islamabad, Pakistan
- International Center of Medical Sciences Research(ICMSR), Islamabad, Pakistan
| | - Sara Rizwan Uppal
- Department of Research and Development, Islamabad Diagnostic Center (IDC), Islamabad, Pakistan
| | - Yasir Waheed
- Department of ORIC, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Rizwan Uppal
- Department of Research and Development, Islamabad Diagnostic Center (IDC), Islamabad, Pakistan
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Elnaggar M, Abomhya A, Elkhattib I, Dawoud N, Doshi R. COVID-19 and liver diseases, what we know so far. World J Clin Cases 2022; 10:3969-3980. [PMID: 35665122 PMCID: PMC9131221 DOI: 10.12998/wjcc.v10.i13.3969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/15/2021] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia outbreak started in December 2019. On March 12, 2020, the World Health Organization (WHO) declared that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a pandemic, and as of May 2021, SARS-CoV-2 has infected over 167.3 million patients, including 3.4 million deaths, reported to WHO. In this review, we will focus on the relationship between SARS-CoV-2 infection and the liver. We will discuss how chronic liver diseases affect the COVID-19 disease course and outcomes. We will also discuss the SARS-CoV-2 effects on the liver, mechanisms of acute liver injury, and potential management plans.
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Affiliation(s)
- Mohamed Elnaggar
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89052, United States
| | - Ahmed Abomhya
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11200, United States
| | - Ismail Elkhattib
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Nabila Dawoud
- Department of Internal Medicine, University of Kentucky, Lexington, KY 40508, United States
| | - Rajkumar Doshi
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ 07503, United States
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5
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Predictive Value of Routine Laboratory Parameters in Hospitalized COVID-19 Patients on Severity of Illness. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1079786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pustake M, Tambolkar I, Giri P, Gandhi C. SARS, MERS and CoVID-19: An overview and comparison of clinical, laboratory and radiological features. J Family Med Prim Care 2022; 11:10-17. [PMID: 35309670 PMCID: PMC8930171 DOI: 10.4103/jfmpc.jfmpc_839_21] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/30/2021] [Accepted: 07/04/2021] [Indexed: 11/04/2022] Open
Abstract
In the 21st century, we have seen a total of three outbreaks by members of the coronavirus family. Although the first two outbreaks did not result in a pandemic, the third and the latest outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) culminated in a pandemic. This pandemic has been extremely significant on a social and international level. As these viruses belong to the same family, they are closely related. Despite their numerous similarities, they have slight distinctions that render them distinct from one another. The Severe Acute Respiratory Distress Syndrome and Middle East Respiratory Syndrome (MERS) cases were reported to have a very high case fatality rate of 9.5 and 34.4% respectively. In contrast, the CoVID-19 has a case fatality rate of 2.13%. Also, there are no clear medical countermeasures for these coronaviruses yet. We can cross information gaps, including cultural weapons for fighting and controlling the spread of MERS-CoV and SARS-CoV-2, and plan efficient and comprehensive defensive lines against coronaviruses that might arise or reemerge in the future by gaining a deeper understanding of these coronaviruses and the illnesses caused by them. The review thoroughly summarises the state-of-the-art information and compares the biochemical properties of these deadly coronaviruses with the clinical characteristics, laboratory features and radiological manifestations of illnesses induced by them, with an emphasis on comparing and contrasting their similarities and differences.
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Prognostic Value of C-Reactive Protein to Lymphocyte Ratio (CLR) in Emergency Department Patients with SARS-CoV-2 Infection. J Pers Med 2021; 11:jpm11121274. [PMID: 34945746 PMCID: PMC8706788 DOI: 10.3390/jpm11121274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
(1) Introduction: According to recent studies, the ratio of C-reactive-protein to lymphocyte is more sensitive and specific than other biomarkers associated to systemic inflammatory processes. This study aimed to determine the prognostic value of CLR on COVID-19 severity and mortality at emergency department (ED) admission. (2) Methods: Between 1 March and 30 April 2020, we carried out a multicenter and retrospective study in six major hospitals of northeast France. The cohort was composed of patients hospitalized for a confirmed diagnosis of moderate to severe COVID-19. (3) Results: A total of 1,035 patients were included in this study. Factors associated with infection severity were the CLR (OR: 1.001, CI 95%: (1.000-1.002), p = 0.012), and the lymphocyte level (OR: 1.951, CI 95%: (1.024-3.717), p = 0.042). In multivariate analysis, the only biochemical factor significantly associated with mortality was lymphocyte rate (OR: 2.308, CI 95%: (1.286-4.141), p = 0.005). The best threshold of CLR to predict the severity of infection was 78.3 (sensitivity 79%; specificity 47%), and to predict mortality, was 159.5 (sensitivity 48%; specificity 70%). (4) Conclusion: The CLR at admission to the ED could be a helpful prognostic biomarker in the early screening and prediction of the severity and mortality associated with SARS-CoV-2 infection.
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8
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Zhao YS, Yu YX. Lymphocyte count predicts the severity of COVID-19: Evidence from a meta-analysis. World J Clin Infect Dis 2021; 11:49-59. [DOI: 10.5495/wjcid.v11.i3.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/03/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In December 2019, coronavirus disease 2019 (COVID-19) was reported firstly in Wuhan, China. COVID-19 is currently a global pandemic.
AIM To assess the suitability of lymphocyte count as a biomarker of COVID-19 severity.
METHODS Five literature databases (PubMed/MEDLINE, Web of Science, Google Scholar, Embase, and Scopus) were searched to identify eligible articles. A meta-analysis was performed to calculate the standard mean difference (SMD) and 95% confidence interval (CI) of lymphocyte counts in coronaviral pneumonia cases.
RESULTS Eight studies, including 1057 patients, were integrated in the meta-analysis. Lymphocyte counts were associated with severe coronavirus (CoV) infection (SMD = 1.35, 95%CI: 1.97 to 0.37, P < 0.001, I2 = 92.6%). In the subgroup analysis stratified by prognosis, lymphocytes were associated with CoV infection mortality (n = 2, SMD = 0.42, 95%CI: 0.66 to 0.19, P < 0.001, I2 = 0.0%), severity (n = 2, SMD = 0.93, 95%CI: 1.20 to 0.67, P < 0.001, I2 = 0.0%), and diagnostic rate (n = 4, SMD = 2.32, 95%CI: 3.60 to 1.04, P < 0.001, I2 = 91.2%).
CONCLUSION Lymphocyte count may represent a simple, rapid, and commonly available laboratory index with which to diagnosis infection and predict the severity of CoV infections, including COVID-19.
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Affiliation(s)
- Yi-Si Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ying-Xi Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Delgado A, Stewart S, Urroz M, Rodríguez A, Borobia AM, Akatbach-Bousaid I, González-Muñoz M, Ramírez E. Characterisation of Drug-Induced Liver Injury in Patients with COVID-19 Detected by a Proactive Pharmacovigilance Program from Laboratory Signals. J Clin Med 2021; 10:jcm10194432. [PMID: 34640458 PMCID: PMC8509270 DOI: 10.3390/jcm10194432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has a wide spectrum of clinical manifestations. An elevation of liver damage markers has been observed in numerous cases, which could be related to the empirical use of potentially hepatotoxic drugs. The aim of this study was to describe the clinical and analytical characteristics and perform a causality analysis from laboratory signals available of drug-induced liver injury (DILI) detected by a proactive pharmacovigilance program in patients hospitalised for COVID-19 at La Paz University Hospital in Madrid (Spain) from 1 March 2020 to 31 December 2020. The updated Roussel Uclaf Causality Assessment Method (RUCAM) was employed to assess DILI causality. A lymphocyte transformation test (LTT) was performed on 10 patients. Ultimately, 160 patients were included. The incidence of DILI (alanine aminotransferase >5, upper limit of normal) was 4.9%; of these, 60% had previous COVID-19 hepatitis, the stay was 8.1 days longer and 98.1% were being treated with more than 5 drugs. The most frequent mechanism was hepatocellular (57.5%), with mild severity (87.5%) and subsequent recovery (88.1%). The most commonly associated drugs were hydroxychloroquine, azithromycin, tocilizumab and ceftriaxone. The highest incidence rate of DILI per 10,000 defined daily doses (DDD) was with remdesivir (992.7/10,000 DDD). Some 80% of the LTTs performed were positive, with a RUCAM score of ≥4. The presence of DILI after COVID-19 was associated with longer hospital stays. An immune mechanism has been demonstrated in a small subset of DILI cases.
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Affiliation(s)
- Ana Delgado
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Stefan Stewart
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Mikel Urroz
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Amelia Rodríguez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | - Alberto M. Borobia
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
| | | | - Miguel González-Muñoz
- Immunology Department, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain;
- Correspondence: (M.G.-M.); (E.R.); Tel./Fax: +34-917-277-558 (M.G.-M.); +34-917-277-559 (E.R.)
| | - Elena Ramírez
- Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, School of Medicine, Autonomous University of Madrid, 28046 Madrid, Spain; (A.D.); (S.S.); (M.U.); (A.R.); (A.M.B.)
- Correspondence: (M.G.-M.); (E.R.); Tel./Fax: +34-917-277-558 (M.G.-M.); +34-917-277-559 (E.R.)
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10
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Wang X, Lei J, Li Z, Yan L. Potential Effects of Coronaviruses on the Liver: An Update. Front Med (Lausanne) 2021; 8:651658. [PMID: 34646834 PMCID: PMC8502894 DOI: 10.3389/fmed.2021.651658] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
The coronaviruses that cause notable diseases, namely, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19), exhibit remarkable similarities in genomic components and pathogenetic mechanisms. Although coronaviruses have widely been studied as respiratory tract pathogens, their effects on the hepatobiliary system have seldom been reported. Overall, the manifestations of liver injury caused by coronaviruses typically involve decreased albumin and elevated aminotransferase and bilirubin levels. Several pathophysiological hypotheses have been proposed, including direct damage, immune-mediated injury, ischemia and hypoxia, thrombosis and drug hepatotoxicity. The interaction between pre-existing liver disease and coronavirus infection has been illustrated, whereby coronaviruses influence the occurrence, severity, prognosis and treatment of liver diseases. Drugs and vaccines used for treating and preventing coronavirus infection also have hepatotoxicity. Currently, the establishment of optimized therapy for coronavirus infection and liver disease comorbidity is of significance, warranting further safety tests, animal trials and clinical trials.
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Affiliation(s)
- Xinyi Wang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lunan Yan
- Liver Surgery Center, West China Hospital of Sichuan University, Chengdu, China
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Shi B, Ye H, Zheng L, Lyu J, Chen C, Heidari AA, Hu Z, Chen H, Wu P. Evolutionary warning system for COVID-19 severity: Colony predation algorithm enhanced extreme learning machine. Comput Biol Med 2021; 136:104698. [PMID: 34426165 PMCID: PMC8323529 DOI: 10.1016/j.compbiomed.2021.104698] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 12/22/2022]
Abstract
Coronavirus Disease 2019 (COVID-19) was distributed globally at the end of December 2019 due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early diagnosis and successful COVID-19 assessment are missing, clinical care is ineffective, and deaths are high. In this study, we investigate whether the level of biochemical indicators helps to discriminate and classify the severity of the COVID-19 using the machine learning method. This research creates an efficient intelligence method for the diagnosis of COVID-19 from the perspective of biochemical indexes. The framework is proposed by integrating an enhanced new stochastic called the colony predation algorithm (CPA) with a kernel extreme learning machine (KELM), abbreviated as ECPA-KELM. The core feature of the approach is the ECPA algorithm which incorporates the two main operators that have been abstained from the grey wolf optimizer and moth-flame optimizer to improve and restore the CPA research functions and are simultaneously used to optimize the parameters and to select features for KELM. The ECPA output is checked thoroughly using IEEE CEC2017 benchmark to verify the capacity of the proposed methodology. Finally, in the diagnosis of COVID-19 using biochemical indexes, the designed ECPA-KELM model and other competing KELM models based on other optimization are used. Checking statistical results will display improved predictive properties for all metrics and higher stability. ECPA-KELM can also be used to discriminate and classify the severity of the COVID-19 as a possible computer-aided method and provide effective early warning for the treatment and diagnosis of COVID-19.
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Affiliation(s)
- Beibei Shi
- Affiliated People's Hospital of Jiangsu University, 8 Dianli Road, Zhenjiang, Jiangsu, 212000, China.
| | - Hua Ye
- Department of Pulmonary and Critical Care Medicine, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, 325600, China.
| | - Long Zheng
- Department of Pulmonary and Critical Care Medicine, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, 325600, China.
| | - Juncheng Lyu
- Weifang Medical University School of Public Health, China.
| | - Cheng Chen
- Center of Clinical Research, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, 214023, China.
| | - Ali Asghar Heidari
- School of Surveying and Geospatial Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | - Zhongyi Hu
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, 325035, China.
| | - Huiling Chen
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, 325035, China.
| | - Peiliang Wu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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12
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Li T, Wang X, Zhuang X, Wang H, Li A, Huang L, Zhang X, Xue Y, Wei F, Ma C. Baseline characteristics and changes of biomarkers in disease course predict prognosis of patients with COVID-19. Intern Emerg Med 2021; 16:1165-1172. [PMID: 33565034 PMCID: PMC7872821 DOI: 10.1007/s11739-020-02560-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of coronavirus disease (COVID-19) has brought great challenges to the world. The objectives of this study were to describe the baseline characteristics and changes of biomarkers of these COVID-19 patients and identify predictive value of the above markers for patient death. Using patient death as the observational endpoints, clinical data of inpatients in a special ward for COVID-19 in Wuhan, China were retrospectively collected. Univariate and multivariate Cox regression analyses were used to evaluate prognostic value of baseline characteristics and laboratory data changes. This study included clinical data of 75 patients. Age, c-reactive protein (CRP) and interleukin-6 levels were independent predictors of patient death. Survivors were characterized as having declining neutrophil counts, D-dimer, N-terminal pronatriuretic peptide, troponin I (TnI) and c-reactive protein levels, while counts of lymphocyte gradually came back. Non-survivors were characterized with increasing white blood cell counts (WBC) and neutrophil counts. Changes of WBC, TnI and interleukin-6 were also independently associated with patient death. Older age, baseline CRP and IL-6 levels may be used as meaningful predictors to identify patients with poor prognosis. Changes of biomarkers should be closely monitored in the management of patients with COVID-19, while constantly increasing levels of WBC, TnI and interleukin-6 in the disease course also predict patient death.
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Affiliation(s)
- Tao Li
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Infectious Disease and Hepatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Wang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China
| | - Xianghua Zhuang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Wang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Respiratory Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ai Li
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Laigang Huang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Rehabilitation Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xingqian Zhang
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China
| | - Yan Xue
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Infectious Disease and Hepatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengtao Wei
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China.
| | - Cheng'en Ma
- Medical Team To Hubei Province, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
- Department of Intensive Care Unit, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Road, Jinan, China.
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13
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Cobre ADF, Stremel DP, Noleto GR, Fachi MM, Surek M, Wiens A, Tonin FS, Pontarolo R. Diagnosis and prediction of COVID-19 severity: can biochemical tests and machine learning be used as prognostic indicators? Comput Biol Med 2021; 134:104531. [PMID: 34091385 PMCID: PMC8164361 DOI: 10.1016/j.compbiomed.2021.104531] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to implement and evaluate machine learning based-models to predict COVID-19' diagnosis and disease severity. METHODS COVID-19 test samples (positive or negative results) from patients who attended a single hospital were evaluated. Patients diagnosed with COVID-19 were categorised according to the severity of the disease. Data were submitted to exploratory analysis (principal component analysis, PCA) to detect outlier samples, recognise patterns, and identify important variables. Based on patients' laboratory tests results, machine learning models were implemented to predict disease positivity and severity. Artificial neural networks (ANN), decision trees (DT), partial least squares discriminant analysis (PLS-DA), and K nearest neighbour algorithm (KNN) models were used. The four models were validated based on the accuracy (area under the ROC curve). RESULTS The first subset of data had 5,643 patient samples (5,086 negatives and 557 positives for COVID-19). The second subset included 557 COVID-19 positive patients. The ANN, DT, PLS-DA, and KNN models allowed the classification of negative and positive samples with >84% accuracy. It was also possible to classify patients with severe and non-severe disease with an accuracy >86%. The following were associated with the prediction of COVID-19 diagnosis and severity: hyperferritinaemia, hypocalcaemia, pulmonary hypoxia, hypoxemia, metabolic and respiratory acidosis, low urinary pH, and high levels of lactate dehydrogenase. CONCLUSION Our analysis shows that all the models could assist in the diagnosis and prediction of COVID-19 severity.
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Affiliation(s)
| | - Dile Pontarolo Stremel
- Department of Forest Engineering and Technology, Universidade Federal Do Paraná, Curitiba, Brazil
| | | | - Mariana Millan Fachi
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Monica Surek
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Astrid Wiens
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil,Corresponding author
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14
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Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2020022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We report clinical features, treatments and outcomes in 18 lung transplant recipients with laboratory confirmed SARS-CoV-2 infection. We performed a single center, retrospective case series study of lung transplant recipients, who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. Clinical, laboratory and radiology findingswere obtained. Treatment regimens and patient outcome data were obtained by reviewing the electronic medical record. Mean age was 49.9 (22–68) years, and twelve (67%) patients were male. The most common symptoms were fever (n = 9, 50%), nausea/vomiting (n = 7, 39%), cough (n = 6, 33%), dyspnea (n = 6, 33%) and fatigue (n = 6, 33%). Headache was reported by five patients (28%). The most notable laboratory findings were elevated levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Computed Tomography (CT) of the chest was performed in all hospitalized patients (n = 11, 7%), and showed ground-glass opacities (GGO) in 11 patients (100%), of whom nine (82%) had GGO combined with pulmonary consolidations. Six (33%) patients received remdesivir, five (28%) intravenous dexamethasone either alone or in combination with remdesivir, and 15 (83%) were treated with broad spectrum antibiotics including co-amoxicillin, tazobactam-piperacillin and meropenem. Four (22%) patients were transferred to the intensive care unit, two patients (11%) required invasive mechanical ventilation who could not be successfully extubated and died. Eighty-nine percent of our patients survived COVID-19 and were cured. Two patients with severe COVID-19 did not survive.
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15
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Chen HL, Yan WM, Chen G, Zhang XY, Zeng ZL, Wang XJ, Qi WP, Wang M, Li WN, Ma K, Xu D, Ni M, Huang JQ, Zhu L, Zhang S, Chen L, Wang HW, Ding C, Zhang XP, Chen J, Yu HJ, Ding HF, Wu L, Xing MY, Song JX, Chen T, Luo XP, Guo W, Han MF, Wu D, Ning Q. CAPRL Scoring System for Prediction of 30-day Mortality in 949 Patients with Coronavirus Disease 2019 in Wuhan, China: A Retrospective, Observational Study. INFECTIOUS DISEASES & IMMUNITY 2021; 1:28-35. [PMID: 38630115 PMCID: PMC8057317 DOI: 10.1097/id9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is a serious and even lethal respiratory illness. The mortality of critically ill patients with COVID-19, especially short term mortality, is considerable. It is crucial and urgent to develop risk models that can predict the mortality risks of patients with COVID-19 at an early stage, which is helpful to guide clinicians in making appropriate decisions and optimizing the allocation of hospital resoureces. Methods In this retrospective observational study, we enrolled 949 adult patients with laboratory-confirmed COVID-19 admitted to Tongji Hospital in Wuhan between January 28 and February 12, 2020. Demographic, clinical and laboratory data were collected and analyzed. A multivariable Cox proportional hazard regression analysis was performed to calculate hazard ratios and 95% confidence interval for assessing the risk factors for 30-day mortality. Results The 30-day mortality was 11.8% (112 of 949 patients). Forty-nine point nine percent (474) patients had one or more comorbidities, with hypertension being the most common (359 [37.8%] patients), followed by diabetes (169 [17.8%] patients) and coronary heart disease (89 [9.4%] patients). Age above 50 years, respiratory rate above 30 beats per minute, white blood cell count of more than10 × 109/L, neutrophil count of more than 7 × 109/L, lymphocyte count of less than 0.8 × 109/L, platelet count of less than 100 × 109/L, lactate dehydrogenase of more than 400 U/L and high-sensitivity C-reactive protein of more than 50 mg/L were independent risk factors associated with 30-day mortality in patients with COVID-19. A predictive CAPRL score was proposed integrating independent risk factors. The 30-day mortality were 0% (0 of 156), 1.8% (8 of 434), 12.9% (26 of 201), 43.0% (55 of 128), and 76.7% (23 of 30) for patients with 0, 1, 2, 3, ≥4 points, respectively. Conclusions We designed an easy-to-use clinically predictive tool for assessing 30-day mortality risk of COVID-19. It can accurately stratify hospitalized patients with COVID-19 into relevant risk categories and could provide guidance to make further clinical decisions.
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Affiliation(s)
- Hui-Long Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei-Ming Yan
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guang Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiao-Yun Zhang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhi-Lin Zeng
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiao-Jing Wang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei-Peng Qi
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Min Wang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei-Na Li
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ke Ma
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dong Xu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ming Ni
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia-Quan Huang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lin Zhu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shen Zhang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liang Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hong-Wu Wang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chen Ding
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiao-Ping Zhang
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hai-Jing Yu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hong-Fang Ding
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liang Wu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ming-You Xing
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | | | - Tao Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiao-Ping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Guo
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mei-Fang Han
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Di Wu
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qin Ning
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Abstract
On 12 March 2020, the WHO declared that the coronavirus disease 2019 (COVID-19) constitutes a pandemic. Cases of liver damage or dysfunction (mainly characterized by moderately elevated serum aspartate aminotransferase levels) have been reported among patients with COVID-19. However, it is currently uncertain whether the COVID-19 related liver damage/dysfunction is due mainly to the viral infection by itself or other coexisting conditions, such as the use of potentially hepatotoxic medications and the coexistence of systemic inflammatory response, respiratory distress syndrome-induced hypoxia, and multiple organ dysfunction. Individuals at high risk for severe COVID-19 are typical of older age and/or present with comorbid conditions such as diabetes, cardiovascular disease, and hypertension. This is also the same profile for those at increased risk for unrecognized underlying liver disease, especially nonalcoholic fatty liver disease. This could make them more susceptible to liver injury from the virus, medications used in supportive management, or hypoxia. So the aim of this review was to illustrate the clinical implications of COVID-19 on the liver in healthy and diseased states as well as the implications of common liver disorders on the outcome of COVID-19.
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Affiliation(s)
- Mona Amin
- Hepatogastroenterology, Cairo University, Cairo, Egypt
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17
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Cichoż-Lach H, Michalak A. Liver injury in the era of COVID-19. World J Gastroenterol 2021; 27:377-390. [PMID: 33584070 PMCID: PMC7856845 DOI: 10.3748/wjg.v27.i5.377] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/25/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has undoubtedly revolutionized the whole globe and given a new point of view on respiratory tract infections. Nevertheless, coronavirus disease 2019 (COVID-19) cannot be perceived as a disease limited only to pneumonia with diverse severity. More and more reports have demonstrated a wide range of possible systemic symptoms, including hepatic complications. Liver injury has been observed in a significant proportion of patients, especially in those with a severe or critical illness. COVID-19 might provoke a deterioration of liver function in patients with already diagnosed chronic liver diseases and without pre-existing liver disorders. The deterioration of liver function worsens the prognosis, increases the risk of a severe course of SARS-CoV-2 infection and prolongs the hospital stay. In general, patients who develop liver dysfunction in COVID-19 are mainly males, elderly people, and those with higher body mass index. The underlying mechanisms for hepatic failure in patients infected with SARS-CoV-2 are still unclear, nevertheless liver damage appears to be directly connected with virus-induced cytopathic effects. A liver injury observed during hospitalization might be simultaneously caused by the use of potentially hepatotoxic drugs, mainly antiviral agents. This minireview focuses on a possible relationship between COVID-19 and the liver, potential molecular mechanisms of liver damage, the characteristics of liver injury and suggested factors predisposing to hepatic manifestations in COVID-19 patients.
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Affiliation(s)
- Halina Cichoż-Lach
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Jaczewskiego 8, Lublin 20-954, Poland
| | - Agata Michalak
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Jaczewskiego 8, Lublin 20-954, Poland
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18
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Metawea MI, Yousif WI, Moheb I. COVID 19 and liver: An A-Z literature review. Dig Liver Dis 2021; 53:146-152. [PMID: 32988758 PMCID: PMC7494329 DOI: 10.1016/j.dld.2020.09.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus pandemic has changed the priorities of the whole medical society. During the clinical course of COVID-19, it has been observed that hepatic injury occurs in a significant proportion of patients, particularly in those with severe or critical illness. In this literature review, we summarize the most recent studies, which covered the pathophysiology of COVID-19 induced liver injury including; hepatic pathological findings, therapy related liver damage, and the effects of the viral infection on pre-existing liver diseasesin context of the most recent recommendations. Conclusions: This review sheds light on the impact of COVID-19 infection on the liver, as well as the prognostic effect of liver laboratory markers on disease outcome. Temporal variations in liver parameters during disease course as well as different patterns of derangement are depicted. More intensive surveillance and individualized therapeutic approaches should be tailored for immunocompromised patients with advanced liver disease, hepatocellular carcinoma, and liver transplant patients. Despite the limited studies on COVID-19 infected patients with preexisting liver disease, this comprehensive overview provides a perspective on the management of liver disease during COVID-19.
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Affiliation(s)
| | | | - Islam Moheb
- MD. Hepatology department, Faculty of Medicine, Alexandria University, Egypt
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19
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Han MW, Wang M, Xu MY, Qi WP, Wang P, Xi D. Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury. World J Clin Cases 2021; 9:528-539. [PMID: 33553391 PMCID: PMC7829721 DOI: 10.12998/wjcc.v9.i3.528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/10/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has posed a serious threat to global public health security. With the increase in the number of confirmed cases globally, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Despite atypical pneumonia as the primary symptom, liver dysfunction has also been observed in many clinical cases and is associated with the mortality risk in patients with COVID-19, like severe acute respiratory syndrome and Middle East respiratory syndrome. Here we will provide a schematic overview of the clinical characteristics and the possible mechanisms of liver injury caused by severe acute respiratory syndrome coronavirus 2 infection, which may provide help for optimizing the management of liver injury and reducing mortality in COVID-19 patients.
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Affiliation(s)
- Mei-Wen Han
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ming Wang
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Meng-Ying Xu
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Wei-Peng Qi
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Peng Wang
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Dong Xi
- Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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20
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Tjendra Y, Al Mana AF, Espejo AP, Akgun Y, Millan NC, Gomez-Fernandez C, Cray C. Predicting Disease Severity and Outcome in COVID-19 Patients: A Review of Multiple Biomarkers. Arch Pathol Lab Med 2020; 144:1465-1474. [PMID: 32818235 DOI: 10.5858/arpa.2020-0471-sa] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/17/2023]
Abstract
CONTEXT.— An abundance of clinical reports focused on specific laboratory parameters have been reported on coronavirus disease 19 (COVID-19), but a systematic analysis synthesizing these findings has not been performed. OBJECTIVE.— To review and summarize the current available literature on the predictive role of various biomarkers in COVID-19 patients. DATA SOURCES.— A literature search was performed using databases including PubMed, medRxiv, and bioRxiv. A total of 72 papers were reviewed, including 54 peer-reviewed papers and 18 non-peer-reviewed preprints. CONCLUSIONS.— Although the markers are considered nonspecific, acute-phase reactants, including C-reactive protein (CRP), ferritin, serum amyloid A (SAA), and procalcitonin, were reported as sensitive markers of acute COVID-19 disease. Significantly elevated white blood cell count; marked lymphopenia; decreased CD3, CD4, or CD8 T-lymphocyte counts; high neutrophil count; thrombocytopenia; and markedly elevated inflammatory biomarkers were associated with severe disease and the risk of developing sepsis with rapid progression. Trends observed by serial laboratory measurements during hospitalization, including progressive decrease of lymphocyte count, thrombocytopenia, elevated CRP, procalcitonin, increased liver enzymes, decreased renal function, and coagulation derangements, were more common in critically ill patient groups and associated with a high incidence of clinical complications. Elevated interleukin 6 level and markedly increased SAA were most often reported in severely and critically ill patients. Indicators of systemic inflammation, such as neutrophil to lymphocyte ratio, systemic immune-inflammation index, or COVID-19 Severity Score, may be used to predict disease severity, outcome, and mortality. Interpretation of the data reported in the studies reviewed here is limited because of the study design (mostly retrospective), limited sample size, and a lack of defined clinical criteria.
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Affiliation(s)
- Youley Tjendra
- Department of Pathology & Laboratory Medicine (Tjendra, Al Mana, Akgun, Millan, Gomez-Fernandez), University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Abdulaziz F Al Mana
- Department of Pathology & Laboratory Medicine (Tjendra, Al Mana, Akgun, Millan, Gomez-Fernandez), University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Andrea P Espejo
- Department of Hematology and Medical Oncology (Espejo), University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Yamac Akgun
- Department of Pathology & Laboratory Medicine (Tjendra, Al Mana, Akgun, Millan, Gomez-Fernandez), University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Nicolas C Millan
- Department of Pathology & Laboratory Medicine (Tjendra, Al Mana, Akgun, Millan, Gomez-Fernandez), University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Carmen Gomez-Fernandez
- Department of Pathology & Laboratory Medicine (Tjendra, Al Mana, Akgun, Millan, Gomez-Fernandez), University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Carolyn Cray
- The Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida (Cray)
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21
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Li J, Yue J, Zhang S, Wu J, Lian R, Zhang R, Cheng P. Relationship between digestive diseases and COVID-19 severity and mortality: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23353. [PMID: 33235103 PMCID: PMC7710250 DOI: 10.1097/md.0000000000023353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Digestive diseases have been often reported in COVID-19 patients, but whether COVID-19 patients with existing digestive comorbidities are at an increased risk of serious disease and death remains unclear. This study aims to evaluate the association between digestive diseases and COVID-19 severity and mortality. METHODS PubMed, Embase.com, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed will be searched to identify relevant studies up to October 1, 2020. We will use the Newcastle-Ottawa quality assessment scale to assess the quality of included studies. We will use Stata to perform pairwise meta-analyses using the random-effects model with the inverse variance method to estimate the association between digestive diseases and the mortality and severity of COVID-19. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity. We will create a "Summary of findings' table presenting our primary and secondary outcomes using the GRADEpro Guideline Development Tool software. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSIONS This study will comprehensively evaluate the association between digestive diseases and the severity and mortality of patients with COVID-19. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.
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Affiliation(s)
- Jinjuan Li
- School of Public Health, Gansu University of Chinese Medicine
| | - Jia Yue
- School of Public Health, Gansu University of Chinese Medicine
| | - Shunan Zhang
- School of Public Health, Gansu University of Chinese Medicine
| | - Jianjun Wu
- School of Public Health, Gansu University of Chinese Medicine
| | - Rongna Lian
- The First Clinical Medical College of Lanzhou University
| | - Ruinian Zhang
- The First Clinical Medical College of Lanzhou University
| | - Peng Cheng
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
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22
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Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has infected over 2 million people worldwide over the course of just several months. Various studies have highlighted that patients infected with COVID-19 may develop various degrees of liver injury. Here, we discuss the impact of underlying liver disease and manifestations of hepatic injury with COVID-19. We also review mechanisms of hepatic injury. METHODS We searched the database PubMed for all studies focused on hepatic injury in COVID-19. RESULTS We identified 13 studies that assessed the impact of underlying liver disease in patients infected with COVID-19 (N=3046). Underlying liver disease was one of the most common known comorbid categories in patients infected with COVID-19. Overall, 25% of the patients identified from the 13 studies had hepatic injury. Twenty-one percent and 24% had elevated alanine transaminase and aspartate transaminase values, respectively. Nine percent of the patients had elevated total bilirubin values. Ten of the 13 studies assessed COVID-19 acuity with severity of hepatic injury. In 9 of the 10 studies, clinical outcomes were worse with hepatic injury. CONCLUSIONS Liver injury is highly prevalent in patients that present with COVID-19. Since the liver is one of the most affected organs outside of the respiratory system in COVID-19, more intensive surveillance is warranted for severe cases, particularly among those with pre-existing advanced liver disease.
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23
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Jothimani D, Venugopal R, Abedin MF, Kaliamoorthy I, Rela M. COVID-19 and the liver. J Hepatol 2020; 73:1231-1240. [PMID: 32553666 PMCID: PMC7295524 DOI: 10.1016/j.jhep.2020.06.006] [Citation(s) in RCA: 315] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023]
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a major public health crisis over the past few months. Overall case fatality rates range between 2-6%; however, the rates are higher in the elderly and those with underlying comorbidities like diabetes, hypertension and heart disease. Recent reports showed that about 2-11% of patients with COVID-19 had underlying chronic liver disease. During the previous SARS epidemic, around 60% of patients were reported to develop various degrees of liver damage. In the current pandemic, hepatic dysfunction has been seen in 14-53% of patients with COVID-19, particularly in those with severe disease. Cases of acute liver injury have been reported and are associated with higher mortality. Hepatic involvement in COVID-19 could be related to the direct cytopathic effect of the virus, an uncontrolled immune reaction, sepsis or drug-induced liver injury. The postulated mechanism of viral entry is through the host angiotensin-converting enzyme 2 (ACE2) receptors that are abundantly present in type 2 alveolar cells. Interestingly, ACE2 receptors are expressed in the gastrointestinal tract, vascular endothelium and cholangiocytes of the liver. The effects of COVID-19 on underlying chronic liver disease require detailed evaluation and, with data currently lacking, further research is warranted in this area.
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Affiliation(s)
- Dinesh Jothimani
- Institute of Liver disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India
| | - Radhika Venugopal
- Institute of Liver disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.
| | - Mohammed Forhad Abedin
- Institute of Liver disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India
| | - Ilankumaran Kaliamoorthy
- Institute of Liver disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India
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24
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Liu Y, Wu S, Qin M, Jiang W, Liu X. Prevalence of Cardiovascular Comorbidities in Coronavirus Disease 2019, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome: Pooled Analysis of Published Data. J Am Heart Assoc 2020; 9:e016812. [PMID: 32673529 PMCID: PMC7660764 DOI: 10.1161/jaha.120.016812] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) is spreading widely around the world. We conducted this meta-analysis to explore the prevalence of cardiovascular comorbidities in COVID-19, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS) cases. Methods and Results Relevant reports updated to April 17, 2020, were searched from PubMed, Embase, Web of Science, and the Cochrane Library with no restriction on language. A random-effects model was used in this meta-analysis to obtain pooled proportions of cardiovascular comorbidities in COVID-19, SARS, and MERS. A total of 22 studies (12 for COVID-19, 4 for SARS, and 6 for MERS) were included in this analysis, and the average age of patients with COVID-19, SARS, and MERS was 46.41±1.79, 39.16±2.25, and 52.51±4.64 years, respectively. Proportions of cardiovascular comorbidities in coronavirus diseases were as follows: COVID-19: proportion of hypertension was 17.1% (95% CI, 13.2%-20.9%), proportion of cardiac disease was 4.5% (95% CI, 3.6%-5.5%) and proportion of diabetes mellitus was 8.5% (95% CI, 5.5%-11.4%); SARS: proportion of hypertension was 4.5% (95% CI, 2.0%-7.0%), proportion of cardiac disease was 2.1% (95% CI, 0.6%-3.7%) and proportion of diabetes mellitus was 3.7% (95% CI, 1.0%-6.4%); MERS: proportion of hypertension was 30.3% (95% CI, 18.3%-42.2%), proportion of cardiac disease was 20.9% (95% CI, 10.7%-31.1%), and proportion of diabetes mellitus was 45.4% (95% CI, 27.3%-63.5%). Conclusions The prevalence of cardiovascular comorbidities varies among different coronavirus-associated diseases. With the development of time, proportions of cardiovascular comorbidities in COVID-19 need further attention.
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Affiliation(s)
- Yang Liu
- Department of CardiologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Shaohui Wu
- Department of CardiologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Mu Qin
- Department of CardiologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Weifeng Jiang
- Department of CardiologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Xu Liu
- Department of CardiologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
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25
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Yufei Y, Mingli L, Xuejiao L, Xuemei D, Yiming J, Qin Q, Hui S, Jie G. Utility of the neutrophil-to-lymphocyte ratio and C-reactive protein level for coronavirus disease 2019 (COVID-19). Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:536-540. [PMID: 32804580 PMCID: PMC7484564 DOI: 10.1080/00365513.2020.1803587] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To investigate the value of the combined detection of the neutrophil-to-lymphocyte ratio
(NLR) and C-reactive protein level (CRP) in the diagnosis of COVID-19. A total of 191
patients with COVID-19 were recruited at the Third Hospital of Wuhan from 21 January 2020
to 20 February 2020. Fifty healthy volunteers were randomly selected as the control group.
Age, gender, white blood cell count (WBC), CRP, lymphocyte percentage, and NLR were
extracted. Quantitative clinical characteristics and laboratory values were compared
between groups. Risk factors and receiver operating characteristic (ROC) curves for
COVID-19 were analyzed. We found that the NLR and CRP were higher, while the lymphocyte
percentage was lower in patients with COVID-19 than in healthy controls. Among patients
confirmed to have COVID-19, the NLR and CRP of the moderate group were lower than those of
severely ill patients (severe, critical and death groups), and the lymphocyte percentage
of the moderate group was higher than that of the critical and death group. There were no
significant differences in WBC among all groups. Logistic regression analysis showed that
the NLR, CRP, and lymphocyte percentage were independent risk factors for COVID-19. The
AUC of the combined determination of NLR and CRP was 0.863, which was higher than that of
NLR, CRP, WBC, and lymphocyte percentage (AUC: 0.835, 0.775, 0.416, and 0.749,
respectively). Our results showed that the NLR and CRP were independent risk factors for COVID-19, and
the combined detection of the NLR and CRP showed improved diagnostic performance for
COVID-19.
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Affiliation(s)
- Yan Yufei
- Department of Laboratory Medicine, Shanghai Kongjiang Hospital, Shanghai, China
| | - Liu Mingli
- Department of Emergency, Shanghai Kongjiang Hospital, Shanghai, China
| | - Li Xuejiao
- Department of Laboratory Diagnosis, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Deng Xuemei
- Department of Infectious Disease, The Third Hospital of Wuhan, Hubei Province, Wuhan, China
| | - Jin Yiming
- Department of Laboratory Medicine, Shanghai Kongjiang Hospital, Shanghai, China
| | - Qin Qin
- Department of Laboratory Diagnosis, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Shen Hui
- Department of Radiology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Guo Jie
- Department of Laboratory Diagnosis, Changhai Hospital, Navy Military Medical University, Shanghai, China
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26
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Parohan M, Yaghoubi S, Seraji A. Liver injury is associated with severe coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis of retrospective studies. Hepatol Res 2020; 50:924-935. [PMID: 32386449 PMCID: PMC7273097 DOI: 10.1111/hepr.13510] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak is a major threat to human beings. Lung injury has been reported as the major outcome of COVID-19 infection. However, liver damage has also been considered to occur in severe cases. The current meta-analysis of retrospective studies was carried out to summarize available findings on the association between liver injury and severity of COVID-19 infection. Online databases including PubMed, Scopus, Web of Science, and Cochrane Library were searched to detect relevant publications up to 1 April 2020, using relevant keywords. To pool data, a fixed- or random-effects model was used depending on the heterogeneity between studies. Furthermore, publication bias test and sensitivity analysis were also applied. In total, 20 retrospective studies with 3428 COVID-19 infected patients (severe cases, n = 1455; mild cases, n = 1973), were included in this meta-analysis. Higher serum levels of aspartate aminotransferase (weighted mean difference, 8.84 U/L; 95% confidence interval [CI] 5.97 to 11.71; P < 0.001), alanine aminotransferase (weighted mean difference, 7.35 U/L; 95% CI, 4.77 to 9.93; P < 0.001), total bilirubin (weighted mean difference, 2.30 mmol/L; 95% CI, 1.24 to 3.36; P < 0.001), and lower serum levels of albumin (weighted mean difference, -4.24 g/L; 95% CI, -6.20 to -2.28; P < 0.001) were associated with a significant increase in the severity of COVID-19 infection. The incidence of liver injury, as assessed by serum analysis (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and albumin levels), seems to be higher in patients with severe COVID-19 infection.
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Affiliation(s)
- Mohammad Parohan
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Sajad Yaghoubi
- Department of Clinical MicrobiologyIranshahr University of Medical SciencesIranshahrIran
| | - Asal Seraji
- Department of Nursing, Damavand BranchIslamic Azad UniversityDamavandIran
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27
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Youssef M, H Hussein M, Attia AS, M Elshazli R, Omar M, Zora G, S Farhoud A, Elnahla A, Shihabi A, Toraih EA, S Fawzy M, Kandil E. COVID-19 and liver dysfunction: A systematic review and meta-analysis of retrospective studies. J Med Virol 2020; 92:1825-1833. [PMID: 32445489 PMCID: PMC7283797 DOI: 10.1002/jmv.26055] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
Recently, Coronavirus Disease 2019 (COVID‐19) pandemic is the most significant global health crisis. In this study, we conducted a meta‐analysis to find the association between liver injuries and the severity of COVID‐19 disease. Online databases, including PubMed, Web of Science, Scopus, and Science direct, were searched to detect relevant publications up to 16 April 2020. Depending on the heterogeneity between studies, a fixed‐ or random‐effects model was applied to pool data. Publication bias Egger's test was also performed. Meta‐analysis of 20 retrospective studies (3428 patients), identified that patients with a severe manifestation of COVID‐19 exhibited significantly higher levels of alanine aminotransferase, aspartate aminotransferase, and bilirubin values with prolonged prothrombin time. Furthermore, lower albumin level was associated with a severe presentation of COVID‐19. Liver dysfunction was associated with a severe outcome of COVID‐19 disease. Close monitoring of the occurrence of liver dysfunction is beneficial in early warning of unfavorable outcomes. Liver dysfunction was associated with a severe outcome of COVID‐19 Sever cases of COVID‐19 patients have high serum levels of ALT, AST and bilirubin with prolonged prothrombin time. Low serum albumin is associated with a severe presentation of COVID‐19 Close monitoring of the occurrence of liver dysfunction is beneficial in early warning of unfavorable COVID‐19 outcomes.
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Affiliation(s)
- Mohanad Youssef
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Mohammad H Hussein
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Abdallah S Attia
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Rami M Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical Therapy, Horus University-Egypt, New Damietta, Egypt
| | - Mahmoud Omar
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Ghassan Zora
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Ashraf S Farhoud
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Ahmad Elnahla
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Areej Shihabi
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
| | - Eman A Toraih
- Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Department of Biochemistry, College of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana
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28
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Liu X, Yue X, Liu F, Wei L, Chu Y, Bao H, Dong Y, Cheng W, Yang L. Analysis of clinical features and early warning signs in patients with severe COVID-19: A retrospective cohort study. PLoS One 2020; 15:e0235459. [PMID: 32589691 PMCID: PMC7319317 DOI: 10.1371/journal.pone.0235459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019. Although previous studies have described the clinical aspects of COVID-19, few studies have focused on the early detection of severe COVID-19. Therefore, this study aimed to identify the predictors of severe COVID-19 and to compare clinical features between patients with severe COVID-19 and those with less severe COVID-19. Patients admitted to designated hospital in the Henan Province of China who were either discharged or died prior to February 15, 2020 were enrolled retrospectively. Additionally, patients who underwent at least one of the following treatments were assigned to the severe group: continuous renal replacement therapy, high-flow oxygen absorption, noninvasive and invasive mechanical ventilation, or extracorporeal membrane oxygenation. The remaining patients were assigned to the non-severe group. Demographic information, initial symptoms, and first visit examination results were collected from the electronic medical records and compared between the groups. Multivariate logistic regression analysis was performed to determine the predictors of severe COVID-19. A receiver operating characteristic curve was used to identify a threshold for each predictor. Altogether,104 patients were enrolled in our study with 30 and 74 patients in the severe and non-severe groups, respectively. Multivariate logistic analysis indicated that patients aged ≥63 years (odds ratio = 41.0; 95% CI: 2.8, 592.4), with an absolute lymphocyte value of ≤1.02×109/L (odds ratio = 6.1; 95% CI = 1.5, 25.2) and a C-reactive protein level of ≥65.08mg/L (odds ratio = 8.9; 95% CI = 1.0, 74.2) were at a higher risk of severe illness. Thus, our results could be helpful in the early detection of patients at risk for severe illness, enabling the implementation of effective interventions and likely lowering the morbidity of COVID-19 patients.
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Affiliation(s)
- Xinkui Liu
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
| | - Xinpei Yue
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
| | - Furong Liu
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
| | - Le Wei
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
| | - Yuntian Chu
- School of Health Care Management, Tongji Medical University, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Honghong Bao
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
| | - Yichao Dong
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
| | - Wenjie Cheng
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
| | - Linpeng Yang
- Medical Records Management Department, The First Affiliated Hospital of Zhenghzou University, Zhengzhou, Henan, China
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29
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Parohan M, Yaghoubi S, Seraji A. Cardiac injury is associated with severe outcome and death in patients with Coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis of observational studies. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:665-677. [PMID: 32567326 PMCID: PMC7678334 DOI: 10.1177/2048872620937165] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic impacting 213 countries/territories and more than 5,934,936 patients worldwide. Cardiac injury has been reported to occur in severe and death cases. This meta-analysis was done to summarize available findings on the association between cardiac injury and severity of COVID-19 infection. Online databases including Scopus, PubMed, Web of Science, Cochrane Library and Google Scholar were searched to detect relevant publications up to 20 May 2020, using relevant keywords. To pool data, a fixed- or random-effects model was used depending on the heterogeneity between studies. In total, 22 studies with 3684 COVID-19 infected patients (severe cases=1095 and death cases=365) were included in this study. Higher serum levels of lactate dehydrogenase (weighted mean difference (WMD) =108.86 U/L, 95% confidence interval (CI)=75.93-141.79, p<0.001) and creatine kinase-MB (WMD=2.60 U/L, 95% CI=1.32-3.88, p<0.001) were associated with a significant increase in the severity of COVID-19 infection. Furthermore, higher serum levels of lactate dehydrogenase (WMD=213.44 U/L, 95% CI=129.97-296.92, p<0.001), cardiac troponin I (WMD=26.35 pg/mL, 95% CI=14.54-38.15, p<0.001), creatine kinase (WMD=48.10 U/L, 95% CI=0.27-95.94, p = 0.049) and myoglobin (WMD=159.77 ng/mL, 95% CI=99.54-220.01, p<0.001) were associated with a significant increase in the mortality of COVID-19 infection. Cardiac injury, as assessed by serum analysis (lactate dehydrogenase, cardiac troponin I, creatine kinase (-MB) and myoglobin), was associated with severe outcome and death from COVID-19 infection.
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Affiliation(s)
- Mohammad Parohan
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Iran
| | - Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iran
| | - Asal Seraji
- Department of Nursing, Damavand Branch, Islamic Azad University, Iran
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30
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Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int 2020; 40:998-1004. [PMID: 32170806 PMCID: PMC7228361 DOI: 10.1111/liv.14435] [Citation(s) in RCA: 536] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), the pathogen of 2019 novel coronavirus disease (COVID-19), has posed a serious threat to global public health. The WHO has declared the outbreak of SARS-CoV-2 infection an international public health emergency. Lung lesions have been considered as the major damage caused by SARS-CoV-2 infection. However, liver injury has also been reported to occur during the course of the disease in severe cases. Similarly, previous studies have shown that liver damage was common in the patients infected by the other two highly pathogenic coronavirus - severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), and associated with the severity of diseases. In this review, the characteristics and mechanism of liver injury caused by SARS-CoV, MERS-CoV as well as SARS-CoV-2 infection were summarized, which may provide help for further studies on the liver injury of COVID-19.
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Affiliation(s)
- Ling Xu
- Department of Infectious DiseasesUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Joint International Laboratory of Infection and ImmunityHuazhong University of Science and TechnologyWuhanChina
| | - Jia Liu
- Department of Infectious DiseasesUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Joint International Laboratory of Infection and ImmunityHuazhong University of Science and TechnologyWuhanChina
| | - Mengji Lu
- Joint International Laboratory of Infection and ImmunityHuazhong University of Science and TechnologyWuhanChina,Institute for VirologyUniversity Hospital of EssenUniversity of Duisburg‐EssenEssenGermany
| | - Dongliang Yang
- Department of Infectious DiseasesUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Joint International Laboratory of Infection and ImmunityHuazhong University of Science and TechnologyWuhanChina
| | - Xin Zheng
- Department of Infectious DiseasesUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina,Joint International Laboratory of Infection and ImmunityHuazhong University of Science and TechnologyWuhanChina
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31
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Fu Y, Sun Y, Lu S, Yang Y, Wang Y, Xu F. Impact of blood analysis and immune function on the prognosis of patients with COVID-19.. [DOI: 10.1101/2020.04.16.20067587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
ABSTRACTIntroductionThis retrospective study investigated the implications of changes in blood parameters and cellular immune function in patients with 2019-coronavirus infected disease (COVID-19).MethodsRecords were reviewed of 85 patients with COVID-19 between February 4 and 16, 2020. The primary outcome was in-hospital mortality at 28 days.ResultsFourteen patients died. The baseline leukocyte count, neutrophil count and hemoglobin was significantly higher in non-survivors compared with survivors, while the reverse was true of lymphocyte count, platelet, PaO2/FiO2, CD3+ count and CD4+ count. The percentage of neutrophil count > 6.3×109/L in death group was significantly higher than that in survival group, and multivariate logistic regression showed neutrophil count was independently associated with mortality. However, there were not significant difference in IgG, IgM, IgA, C3, C4 and the percentage of IgE > 100 IU/ml between the death group and survival group. Areas under the receiver operating characteristic curves of the following at baseline could significantly predict mortality: leukocyte, neutrophil, lymphocyte, CD3+ and CD4+ counts.ConclusionsFor patients with COVID-19, lymphocyte, CD3+ and CD4+ counts that marked decrease suggest a poor outcome. A high neutrophil count is independently associated with mortality. At admission, leukocyte, neutrophil, lymphocyte, CD3+ and CD4+ counts should receive added attention.
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Shokri Afra H, Amiri-Dashatan N, Ghorbani F, Maleki I, Rezaei-Tavirani M. Positive association between severity of COVID-19 infection and liver damage: a systematic review and meta-analysis. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2020; 13:292-304. [PMID: 33244371 DOI: 10.22037/ghfbb.v13i4.2129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The current study aimed to report a pooled analysis of the association of the circulating levels of liver enzymes and total bilirubin with severe and non-severe COVID-19. BACKGROUND The ongoing coronavirus outbreak is an important threat to health worldwide. Epidemiological data representing greater risk of liver failure in patients infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). METHODS Electronic databases were comprehensively searched using Medline, ISI Web of Science, EMBASE, and the Cochrane Library up to July 2020. Outcomes from each relevant study were pooled using a random-effects model. Heterogeneity was analyzed by Q test and I2 statistics. Sensitivity analysis was also evaluated. RESULTS A total of 24 studies were included (4,246 patients) in this study. We found a significant association of COVID-19 severity with increased levels of ALT [SMD: 1.40 U/L; 95% CI (0.93, 1.88); P < 0.05, I2 = 96.5%, P Heterogenity = 0.000 ], AST [SMD: 2.11 U/L; 95% CI (1.40, 2.83); P < 0.05, I2 = 97.9%, P Heterogenity = 0.000], LDH [SMD: 3.88 U/L; 95% CI (2.70, 5); P < 0.05, I2 = 98.7%, P Heterogenity = 0.000] and TBil [SMD: 1.08 mol/L; 95% CI (0.44, 1.72); P = 0.001, I2 = 97.7, P Heterogenity = 0.000], whereas, ALP values [SMD: 0.31; 95% CI (-1.57, 2.20); P = 0.74] was not significant between severe and non-severe COVID-19 patients. Moreover, elevated liver enzymes were found more in males [OR: 1.52, (95% CI 1.26, 1.83), P < 0.05] with severe COVID-19 infection than in females. CONCLUSION The alterations of liver function indexes caused by SARS-CoV-2 infection suggested a potential prognosis biomarker for screening of severe patients at early stages of the disease.
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Affiliation(s)
- Hajar Shokri Afra
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- contributed equally as first author
| | - Nasrin Amiri-Dashatan
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- contributed equally as first author
| | - Fatemeh Ghorbani
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Iradj Maleki
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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33
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Shokri Afra H, Amiri-Dashatan N, Ghorbani F, Maleki I, Rezaei-Tavirani M. Positive association between severity of COVID-19 infection and liver damage: a systematic review and meta-analysis. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2020; 13:292-304. [PMID: 33244371 PMCID: PMC7682972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/18/2020] [Indexed: 11/04/2022]
Abstract
AIM The current study aimed to report a pooled analysis of the association of the circulating levels of liver enzymes and total bilirubin with severe and non-severe COVID-19. BACKGROUND The ongoing coronavirus outbreak is an important threat to health worldwide. Epidemiological data representing greater risk of liver failure in patients infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). METHODS Electronic databases were comprehensively searched using Medline, ISI Web of Science, EMBASE, and the Cochrane Library up to July 2020. Outcomes from each relevant study were pooled using a random-effects model. Heterogeneity was analyzed by Q test and I2 statistics. Sensitivity analysis was also evaluated. RESULTS A total of 24 studies were included (4,246 patients) in this study. We found a significant association of COVID-19 severity with increased levels of ALT [SMD: 1.40 U/L; 95% CI (0.93, 1.88); P < 0.05, I2 = 96.5%, P Heterogenity = 0.000 ], AST [SMD: 2.11 U/L; 95% CI (1.40, 2.83); P < 0.05, I2 = 97.9%, P Heterogenity = 0.000], LDH [SMD: 3.88 U/L; 95% CI (2.70, 5); P < 0.05, I2 = 98.7%, P Heterogenity = 0.000] and TBil [SMD: 1.08 mol/L; 95% CI (0.44, 1.72); P = 0.001, I2 = 97.7, P Heterogenity = 0.000], whereas, ALP values [SMD: 0.31; 95% CI (-1.57, 2.20); P = 0.74] was not significant between severe and non-severe COVID-19 patients. Moreover, elevated liver enzymes were found more in males [OR: 1.52, (95% CI 1.26, 1.83), P < 0.05] with severe COVID-19 infection than in females. CONCLUSION The alterations of liver function indexes caused by SARS-CoV-2 infection suggested a potential prognosis biomarker for screening of severe patients at early stages of the disease.
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Affiliation(s)
- Hajar Shokri Afra
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- contributed equally as first author
| | - Nasrin Amiri-Dashatan
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- contributed equally as first author
| | - Fatemeh Ghorbani
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Iradj Maleki
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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34
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Fu YQ, Sun YL, Lu SW, Yang Y, Wang Y, Xu F. Effect of blood analysis and immune function on the prognosis of patients with COVID-19. PLoS One 2020; 15:e0240751. [PMID: 33125396 PMCID: PMC7598452 DOI: 10.1371/journal.pone.0240751] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/24/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION This retrospective study investigated the implications of changes in blood parameters and cellular immune function in patients with Coronavirus Disease 2019 (COVID-19). METHODS Records were reviewed of 85 patients admitted with COVID-19 between February 4 and 16, 2020. The primary outcome was in-hospital death. RESULTS Fourteen patients died. The baseline leukocyte count, neutrophil count and hemoglobin was significantly higher in non-survivors compared with survivors, while the reverse was true of lymphocyte count, platelet, PaO2/FiO2, CD3+ count and CD4+ count. The percentage of neutrophil count > 6.3×109/L in death group was significantly higher than that in survival group, and multivariate logistic regression showed neutrophil count > 6.3×109/L was independently associated with mortality. However, there were not significant difference in IgG, IgM, IgA, C3, C4 and the percentage of IgE > 100 IU/ml between the death group and survival group. Areas under the receiver operating characteristic curves of the following at baseline could significantly predict mortality: leukocyte, neutrophil, lymphocyte, CD3+ and CD4+ counts. CONCLUSIONS For hospitalized patients with COVID-19, lymphocyte, CD3+ and CD4+ counts that marked decrease suggest a poor outcome. Admission neutrophil count > 6.3 ×109/L is independently associated with mortality. At admission, leukocyte, neutrophil, lymphocyte, CD3+ and CD4+ counts should receive added attention.
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Affiliation(s)
- Yue-Qiang Fu
- Department of Critical Care Medicine, Children’s Hospital, Chongqing Medical University, Chongqing, P.R. China
- Third Batch Chongqing Medical Aid Team to Wuhan City of Hubei Province, Chongqing, P.R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China
| | - Yue-Lin Sun
- Department of Critical Care Medicine, Children’s Hospital, Chongqing Medical University, Chongqing, P.R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China
| | - Si-Wei Lu
- Department of Critical Care Medicine, Children’s Hospital, Chongqing Medical University, Chongqing, P.R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China
| | - Yang Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Yi Wang
- Department of Critical Care Medicine, Children’s Hospital, Chongqing Medical University, Chongqing, P.R. China
- Third Batch Chongqing Medical Aid Team to Wuhan City of Hubei Province, Chongqing, P.R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China
| | - Feng Xu
- Department of Critical Care Medicine, Children’s Hospital, Chongqing Medical University, Chongqing, P.R. China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China
- * E-mail:
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Shin DH, Han SK, Choi PC, Woo HY. Conventional blood tests in predicting influenza A (H1N1) rapidly. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 72:197-203. [DOI: 10.3109/00365513.2011.634022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Hee-Yeon Woo
- Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine,
Seoul, Korea
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Zimmerman O, Rogowski O, Aviram G, Mizrahi M, Zeltser D, Justo D, Dahan E, Arad R, Touvia O, Tau L, Tarabeia J, Berliner S, Paran Y. C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection. BMC Infect Dis 2010; 10:288. [PMID: 20920320 PMCID: PMC2959060 DOI: 10.1186/1471-2334-10-288] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 10/04/2010] [Indexed: 12/27/2022] Open
Abstract
Background Data for predicting which patients with pandemic influenza A (H1N1) infection are likely to run a complicated course are sparse. We retrospectively studied whether the admission serum C-reactive protein (CRP) levels can serve as a predictor of illness severity. Methods Included were all consecutive adult patients who presented to the emergency department (ED) between May-December, 2009 with a flu-like illness, a confirmed diagnosis of pandemic influenza A (H1N1) infection and a serum CRP level measured within 24 hours of presentation. Patients with a proven additional concurrent acute illness (e.g., bacteremia) were excluded. We used the ROC curve analysis, Kaplan-Meier curves and the Cox proportional hazard model to evaluate the predictive ability of CRP as a prognostic factor. Results Seventeen (9%) of the 191 enrolled patients were admitted to the intensive care unit (ICU), of whom eight (4%) required mechanical ventilation and three (2%) died. The median admission serum CRP levels were significantly higher among patients who required subsequent ICU care and mechanical ventilation than among patients who did not (123 mg/L and 112 mg/L vs. 40 mg/L, p < .001 and 43 mg/L, p = .017, respectively). A Cox proportional hazard model identified admission serum CRP levels and auscultatory findings over the lungs as independent prognostic factors for ICU admission. Admission serum CRP levels were the only independent prognostic factor for mechanical ventilation. Thirty days after presenting to the ED, none of the patients with admission serum CRP level <28 mg/L (lower tertile) required either ICU admission or mechanical ventilation. At the same time point, 19% of the patients with admission serum CRP level ≥70 mg/L (upper tertile) needed to be admitted to the ICU and 8% of the same upper tertile group required mechanical ventilation. The differences in the rates between the lower vs. upper tertile groups were significant (Log-Rank p < .001 for ICU and p < .024 for mechanical ventilation). Conclusions In our study group, serum CRP levels obtained in the early ED admission stage from patients presenting with pandemic H1N1 influenza A infection were found to serve as a useful gauge for predicting disease course and assisting in patient management.
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Affiliation(s)
- Ofer Zimmerman
- Department of Internal Medicine D, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Jia N, Feng D, Fang LQ, Richardus JH, Han XN, Cao WC, de Vlas SJ. Case fatality of SARS in mainland China and associated risk factors. Trop Med Int Health 2009; 14 Suppl 1:21-7. [PMID: 19508439 PMCID: PMC7169690 DOI: 10.1111/j.1365-3156.2008.02147.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To analyse the case fatality ratio (CFR) and its risk factors for severe acute respiratory syndrome (SARS) in mainland China by using a comprehensive dataset of all probable cases. METHODS The data of all probable SARS cases were derived from the Infectious Disease Reporting System of the Center of Diseases Control and Hospital Information Systems, during the 2003 epidemic in mainland China. The definition of probable SARS case was consistent with the definition for clinically confirmed SARS issued by the Ministry of Health of the People's Republic of China. We performed univariate and multivariate logistic regression analysis to determine the association of CFR with age, sex, residence location, occupation, the period of the epidemic and the duration from symptom onset to admission into hospital. RESULTS The overall CFR was 6.4% among 5327 probable SARS cases in mainland China. Old age, being a patient during the early period of a local outbreak, and being from Tianjin led to a relatively higher CFR than young age, late stage of a local outbreak and cases from Beijing. Guangdong Province resulted in an even lower CFR compared with Beijing. CONCLUSIONS Because of their deteriorated health status and apparent complications, SARS patients aged >60 years had a much higher risk of dying than younger patients. At the early stage of local outbreaks, lack of experience in patient care and perhaps treatment also led to a relatively higher CFR. The Tianjin SARS outbreak happened mainly within a hospital, leading to a high impact of co-morbidity. The relatively young age of the cases partly explains the low CFR in mainland China compared with other countries and areas affected by SARS.
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Affiliation(s)
- Na Jia
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, P.R. China
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Chan KYK, Ching JCY, Xu MS, Cheung ANY, Yip SP, Yam LYC, Lai ST, Chu CM, Wong ATY, Song YQ, Huang FP, Liu W, Chung PH, Leung GM, Chow EYD, Chan EYT, Chan JCK, Ngan H, Tam P, Chan LC, Sham P, Chan VSF, Peiris M, Lin SCL, Khoo US. Association of ICAM3 genetic variant with severe acute respiratory syndrome. J Infect Dis 2007; 196:271-80. [PMID: 17570115 PMCID: PMC7202406 DOI: 10.1086/518892] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 02/16/2007] [Indexed: 12/12/2022] Open
Abstract
Genetic polymorphisms have been demonstrated to be associated with vulnerability to human infection. ICAM3, an intercellular adhesion molecule important for T cell activation, and FCER2 (CD23), an immune response gene, both located on chromosome 19p13.3 were investigated for host genetic susceptibility and association with clinical outcome. A case-control study based on 817 patients with confirmed severe acute respiratory syndrome (SARS), 307 health care worker control subjects, 290 outpatient control subjects, and 309 household control subjects unaffected by SARS from Hong Kong was conducted to test for genetic association. No significant association to susceptibility to SARS-CoV infection was found for the FCER2 and the ICAM3 single nucleotide polymorphisms. However, patients with SARS homozygous for ICAM3 Gly143 showed significant association with higher lactate dehydrogenase levels (P=.0067; odds ratio [OR], 4.31 [95% confidence interval [CI], 1.37–13.56]) and lower total white blood cell counts (P=.022; OR, 0.30 [95% CI, 0.10–0.89]) on admission. These findings support the role of ICAM3 in the immunopathogenesis of SARS.
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Affiliation(s)
- Kelvin Y. K. Chan
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Johannes C. Y. Ching
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - M. S. Xu
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Annie N. Y. Cheung
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Shea-Ping Yip
- Department of Health Technology and Informatics, Hong Kong Polytechnic UniversityHong Kong
| | | | | | | | | | - You-Qiang Song
- Department of Biochemistry, Hong Kong Jockey Club Clinical Research CentreHong Kong
- Genome Research Center, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Fang-Ping Huang
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Wei Liu
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | | | - G. M. Leung
- Department of Community Medicine, Li Ka Shing Faculty of Medicine, University of Hong KongHong Kong
| | | | - Eric Y. T. Chan
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Jane C. K. Chan
- Hospital Authority Severe Acute Respiratory Syndrome Collaborative Group, Hong Kong Hospital Authority Head OfficeHong Kong
| | - Hextan Ngan
- Department of Obstetrics and Gynecology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Paul Tam
- Department of Surgery, Hong Kong Jockey Club Clinical Research CentreHong Kong
- Genome Research Center, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Li-Chong Chan
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Pak Sham
- Department of Psychiatry, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Vera S. F. Chan
- Department of Biosurgery and Surgical Technology, Imperial College LondonLondon, United Kingdom
| | - Malik Peiris
- Department of Microbiology, Hong Kong Jockey Club Clinical Research CentreHong Kong
| | - Steve C. L. Lin
- Department of Biosurgery and Surgical Technology, Imperial College LondonLondon, United Kingdom
| | - Ui-Soon Khoo
- Department of Pathology, Hong Kong Jockey Club Clinical Research CentreHong Kong
- Reprints or correspondence: Dr. Ui-Soon Khoo, Rm. 324, 3/F, University Pathology Bldg., Dept. of Pathology, University of Hong Kong, Queen Mary Hospital, Pokfulam Rd., Hong Kong ()
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