This is important in anesthesia due to the drugs we use are often metabolized by the liver.
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Age over 50 years, male sex and use of lopinavir-ritonavir were the independent risk factors of liver injury in coronavirus disease 2019 (COVID-19) patients, according to a study published in the Journal of Medical Virology.
Jian Wang, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, and colleagues retrospectively analysed data of 228 COVID-19 patients without chronic liver diseases (CLD) who were hospitalized between January 18, 2020 and February 29, 2020 at 10 designated hospitals in 10 cities of Jiangsu province, China. The median age of patients was 44.5 (interquartile range, 32.0-57.0) years and 49.1% were males.
On admission, 67 (29.4%) patients showed abnormal liver function on admission, with increased levels of alanine aminotransferase (ALT; 11%), aspartate aminotransferase (AST; 13.2%), with gamma-glutamyl transferase (GGT; 12.4%), total bilirubin (Tbil; 7%), and alkaline phosphatase (ALP; 4.5%). In addition, 129 (56.6%) patients showed abnormal liver function during hospitalization, including elevated ALT (36.8%), AST (25.4%), GGT (29.5%) and Tbil (25.9%). During hospitalization, patients received atomized inhalation of interferon α-2b (58.8%), lopinavir-ritonavir (75.4%), arbidol (40.8%), corticosteroids (24.1%) and gamma globulin (11.0%), empirical antibiotic treatment (75.0%). Fifteen (6.7%) patients developed respiratory failure and 2 patients progressed to ARDS. However, no patient developed liver failure.
Multivariate analysis showed that age over 50 years (odds ratio [OR], 2.086; 95% confidence interval [CI], 1.030-4.225; P = 0.041), male sex (OR, 2.737; 95% CI, 1.418-5.284; P = 0.003), and use of lopinavir-ritonavir (OR, 2.504; 95%CI, 1.187-5.283; P = 0.016) were associated with higher risk of liver function abnormality. Meanwhile, atomized inhalation of interferon α-2b was found to be associated with the reduced risk of liver function abnormality (OR, 0.256; 95%CI, 0.126-0.520; P < 0.001).
“In our study, the peak levels of liver function parameters including ALT, AST, GGT, ALP and Tbil were less than 10-fold normal upper limit during the hospitalization. Severe liver function abnormality and liver failure were not observed,” the authors wrote. “Previous studies also reported the occurrence of severe liver-related complications was rare. Most patients with abnormal liver function presented mild to moderate liver damage.”
“We identified that age over 50 years and male sex were the independent risk factors of liver impairment. Thus, more attention should be paid to these patients,” the authors noted. “Previous reports show that drug hepatotoxicity may induce liver impairment. Our study also found that lopinavir-ritonavir increases the risk of liver impairment.”
“Atomized inhalation of interferon α-2b was shown to reduce risk of liver impairment in our study,” the authors wrote. A possible interpretation of the risk reduction, according to the authors, was atomized inhalation of interferon α-2b may reduce the liver impairment caused by the virus by suppressing SARS-CoV-2. Nonetheless, they noted that further studies are needed to validate the findings.
“Mild to moderate liver injury was common in COVID-19 patients in Jiangsu, China. Age over 50 years, male sex and use of lopinavir-ritonavir were the independent risk factors of liver injury in COVID-19 patients. Further studies are still needed to investigate the mechanism of liver injury in patients with COVID-19,” the authors concluded.
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