Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complica...Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complications including acute kidney injury,electrolyte disturbance and cardiac instability.Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis.Typically,there is an increase in serum aminotransferases,namely aspartate aminotransferase and alanine aminotransferase.This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy.However,muscle can also be a source of the increased aminotransferase activity.This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association.It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases,and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury.Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury.This review also explores potential approaches to improve the accuracy of our diagnostic tools,so that excessive or unnecessary liver investigations can be avoided.展开更多
BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is the commonest cause of abnormal liver function tests(LFTs).Current upper normal of limit(UNL)of LFTs was derived from a“healthy”population,where undiagnos...BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is the commonest cause of abnormal liver function tests(LFTs).Current upper normal of limit(UNL)of LFTs was derived from a“healthy”population,where undiagnosed MAFLD and viral hepatitis might be suspected.AIM To evaluated potential implications of changes in UNL of alanine aminotransferase(ALT)in MAFLD.METHODS We retrospectively assessed consecutive first referrals with a diagnosis of MAFLD from 2010 to 2017.The conventional UNL of ALT was 45 IU/L for men and 34 IU/L for women,while a low UNL of ALT was 30 IU/L for men and 19 IU/L for women.The UNL of aspartate aminotransferase(AST)was 40 IU/L.RESULTS Total 436 patients were enrolled;of these,288 underwent liver biopsy.Setting a lower UNL reduced the percentage of those with significant disease despite normal ALT;specifically,patients with advanced fibrosis(F≥F3)or definite“metabolic-associated steato-hepatitis(MASH)”(NAS≥5)within normal ALT decreased from 10%to 1%and from 28%to 4%respectively.However,the proportion of those with elevated ALT and no evidence of advanced fibrosis or“definite MASH”increased from 39%to 47%and from 3%to 19%.Overall,LFTs performed poorly in distinguishing“definite MASH”from simple steatosis(receiver operating characteristic areas under the curves 0.59 for ALT and 0.55 for AST).CONCLUSION Liver function tests might both under-and overestimate MASH-related liver disease.Reducing the UNL might not be beneficial and imply an increase in healthcare burden.Risk stratification in MAFLD should rely on a combination of risk factors,not on LFTs alone.展开更多
An isolated liver function test is of little role in selection of liver disease because many harmful liver diseases may be correlated with normal levels of LFT’s. The outline of enzyme abnormalities in the perspectiv...An isolated liver function test is of little role in selection of liver disease because many harmful liver diseases may be correlated with normal levels of LFT’s. The outline of enzyme abnormalities in the perspective of patient’s commonly observed symptoms and laboratory data might be helpful in directing the subsequent diagnosis of liver diseases. Liver Function Tests (LFTs) are most generally used screening blood tests for assessment of different liver diseases and these tests provide a lot of evidence for disease processes whether for the purpose of investigation of supposed liver disease or help in observing the progress of disease action or simply by blood investigation. The evaluation of different liver enzymes simply gives diagnostic information on basic level whether patient’s principal disorder is actually hepatitis or cholestasis in source. However, it is necessary in various cases to evaluate LFTs with knowledge of liver functioning enzyme fractions. The objective of this study was to explore the effects of ascorbic acid supplementation on serum liver function tests in Hepatitis C patients. A total of 100 hepatitis C patients were selected randomly. 50 were given ascorbic acid supplementation for one month along with anti HCV treatment. The other 50 HCV patients took their normal anti HCV treatment without intake of ascorbic acid supplementation, and serum ascorbic acid level and liver function test parameters were observed before and after intake of ascorbic acid in both groups. The liver function parameters determined were aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), serum total bilirubin, direct bilirubin, indirect bilirubin and serum protein (total protein, albumin, globulin and A/G ratio). These parameters along with serum ascorbic acid were measured before and 30 days after vitamin C supplementation. Various abnormally elevated LFTs were also improved more rapidly when compared to other group which was not given ascorbic acid supplements for the period of one month. There was a significant change in levels of some liver function parameters before and after intake of ascorbic acid supplementation, and various abnormally elevated LFTs were also improved when compared to other group which was not given ascorbic acid supplements for the period of one month. The effect of Vitamin C supplementation was more marked on serum aminotransferase levels. After one-month use of ascorbic acid, serum alanine aminotransferase (p < 0.042) and serum aspartate aminotransferase (p < 0.000) levels were significantly decreased in hepatitis C patient group. In HCV group with ascorbic acid supplementation, serum total bilirubin (p < 0.046) and serum direct bilirubin (p < 0.048) were found to be less than the pre values when compared to HCV group without ascorbic acid supplementation. It was also observed that some of protein values were suggestively improved after intake of ascorbic acid supplementation.展开更多
Objective:To explore the application value of liver function and serological index detection in diagnosing fatty liver.Methods:Ninety patients with fatty liver disease(disease group)and ninety healthy subjects(healthy...Objective:To explore the application value of liver function and serological index detection in diagnosing fatty liver.Methods:Ninety patients with fatty liver disease(disease group)and ninety healthy subjects(healthy group)were selected as the subjects of this study.They all underwent liver function index testing and serological index testing.Test results were compared,and the diagnostic accuracy of single and combined tests was evaluated.Results:Liver function indicators of patients in the disease group were higher than those in the healthy group,with severe patients exhibiting higher levels than moderate patients and mild patients(P<0.05).Serological indicators in patients in the disease group were higher than those in the healthy group,with severe patients showing higher levels than moderate patients and mild patients(P<0.05).The diagnostic accuracy of liver function index testing was higher than that of serological index testing,and the accuracy of combined testing was higher than that of single testing(P<0.05).Conclusion:In diagnosing fatty liver,combining liver function testing and serological testing enables the initial diagnosis of the disease and facilitates the accurate assessment of its severity.展开更多
Background The development and growth of children influence values of liver function tests.This study aims to establish age-and gender-specific pediatric reference intervals of liver function among Han children in Cha...Background The development and growth of children influence values of liver function tests.This study aims to establish age-and gender-specific pediatric reference intervals of liver function among Han children in Changchun,China.Methods A total of 1394 healthy Han children,aged 2-14 years,were recruited from communities and schools with informed parental consent in Changchun.The levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),y-glutamyltransferase(GGT),alkaline phosphatase(ALP),total protein(TP),albumin(ALB),total bilirubin(TBIL)and direct bilirubin(DBIL)were measured on Hitachi 7600-210 automatic biochemical analyzer.The age-and gender-specific reference intervals were partitioned using Harris and Boyd's test and calculated using nonparametric rank method.The pediatric reference intervals were validated in five representative hospitals located in different areas in Changchun.Results All the analytes required some levels of age partitioning.Proteins(TP,ALB)and bilirubins(TBIL,DBIL)required no gender partitioning.In contrast,considerable gender partitioning was required for serum ALT,AST,GGT,and ALP.TP,TBIL,and DBIL showed steady increases,and AST showed apparent decreases over time,whereas ALT,GGT,ALP,and ALB demonstrated complex trends of change.ALT and GGT increased sharply in males from 11 to 14 years old.However,ALP declined in females from 13 to 14 years.All five laboratories passed the validation of reference intervals.Conclusions There were apparent age or gender variations of the reference intervals for liver function.When establishing pediatric reference intervals,partitioning according to age and gender is necessary.展开更多
The coronavirus 2019 disease(COVID-19)is caused by a novel coronavirus,severe acute respiratory syndrome coronavirus 2.This disease was designated by the World Health Organization as a pandemic on March 11,2020,which ...The coronavirus 2019 disease(COVID-19)is caused by a novel coronavirus,severe acute respiratory syndrome coronavirus 2.This disease was designated by the World Health Organization as a pandemic on March 11,2020,which is not seen before.There are no classical features among the cases of the disease owing to the involvement of nearly all body tissues by the virus.Hepatic involvement is one of the characteristics of the COVID-19 course.There are six possible mechanisms of such involvement:Direct virus injury,drug-induced effect,inflammatory cytokine storm,hypoxia-ischemic destruction,abnormalities in liver function tests,and pre-existing chronic liver diseases.Liver abnormalities are seen commonly in the severe or critical stage of COVID-19.Therefore,these abnormalities determine the COVID-19 severity and carry a high rate of morbidity and mortality.The elderly and patients with comorbidities like diabetes mellitus and hypertension are more vulnerable to liver involvement.Another issue that needs to be disclosed is the liver manifestations following the COVID-19 vaccination,such as autoimmune hepatitis.Of note,complete vaccination with third and fourth booster doses is necessary for patients with previous chronic liver diseases or those who have been subjected to liver transplantation.This review aims to explore the various aspects of liver dysfunction during the COVID-19 course regarding the epidemiological features,predisposing factors,pathophysiological mechanisms,hepatic manifestations due to COVID-19 or following vaccination,role of liver function tests in the assessment of COVID-19 severity,adverse effects of the therapeutic agents for the disease,and prognosis.展开更多
Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coron...Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coronavirus 2(SARSCoV-2)infection with special attention paid to possible mechanisms of liver damage and abnormalities in liver function tests allowing for the evaluation of the severity of liver disease.Abnormalities in liver function observed in COVID-19 disease are associated with the age and sex of patients,severity of liver injury,presence of comorbidity and pre-treatment.The method of antiviral treatment can also impact on liver function,which manifests as increasing values in liver function tests.Therefore,analysis of variations in liver function tests is necessary in evaluating the progression of liver injury to severe disease.展开更多
<strong>Background:</strong> Individuals with sero-positivity for Hepatitis B and C have been reported. Most seropositive individuals appear healthy. Liver function markers such as AST, ALT, ALP, Bilirubin...<strong>Background:</strong> Individuals with sero-positivity for Hepatitis B and C have been reported. Most seropositive individuals appear healthy. Liver function markers such as AST, ALT, ALP, Bilirubin and total protein levels are markers for assessing liver impairment. This study (i)assessed seroprevalence of HBV, HCV and both HBV and HCV (ii) HBV and or HCV seropositivity and age or gender, (iii) assess gender and liver function markers and (iv) update data on liver function and simple diagnostic markers. <strong>Materials and Methods: </strong>This was a prospective, cross sectional study of asymptomatic individuals presenting at the Clinical Diagnostic Laboratory of Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria from January 2018 to August 2020. Markers of liver function were investigated on hepatitis B and or C sero-positive and negative participants using TC Matrix Chemistry analyser (Teco Diagnostics, USA) and Biobase reagent Kits. Data were analyzed using descriptive and inferential statistics. <strong>Results:</strong> Out of 475 participants, 60.4% were males and 39.6% females. 53% of males and 32.5% of females were sero-positive for HBV while 32.5% of males and 14.5% of females were sero-positive for HCV. 75.3% and 76.1% of Age group 20 - 40 years were sero-positive for Hepatitis B and C respectively. Mean AST levels of 17.49 ± 13.69, 33.46 ± 93.42 and 19.82 ± 12.54 respectively among those sero-positive for HBV, HCV, and both HBV and HCV. Mean ALT levels of 17.68 ± 14.32, 40.26 ± 13.86 and 20.04 ± 12.78 respectively for HBV, HCV and both HBV and HCV sero-positive cases. Mean ALP levels were 77.52 ± 34.0 for HBV sero-positive cases, 82.04 ± 38.45 in HCV and 77.95 ± 30.48 in both HBV and HCV sero-positive cases. Mean Total Bilirubin levels of HBV, HCV and both HBV and HCV sero-positive cases were 13.25 ± 14.52, 14.98 ± 20.74, 10.58 ± 4.91 respectively while Mean Total protein levels were 77.24 ± 6.27 in HBV, 77.87 ± 5.56 in HCV and 77.0 ± 5.99 in both HBV and HCV sero-positive cases. ALP, bilirubin and total protein were all within normal reference values in HBV, HCV and HBV/HCV dual infections. AST and ALT values were significantly elevated in HCV seropositivity compared to HBV single and HBV/BCV dual seropositivity. <strong>Conclusion:</strong> 30% prevalence of HBV, HCV and both HBV and HCV were observed. Age 20 - 40 years was significantly higher in seropositivity for hepatitis B, C and B and C dual seropositivity. More males than females showed seropositivity for hepatitis B and C. There was no significant difference between gender and liver function markers. AST and ALT remain reliable markers of liver function.展开更多
BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursod...BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursodeoxycholic acid(UDCA),which is one of the first-line therapeutic agents for treatment of NAFLD,is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties.AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests,lipid profile,hepatic steatosis and fibrosis,atherogenesis,and ASCVD risk in men and women with NAFLD,as well as to assess the impact of>5%weight reduction on these parameters.METHODS An open-label,multicenter,international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise.The efficacy criteria were liver enzymes,lipid profile,fatty liver index(FLI),noninvasive liver fibrosis tests(nonalcoholic fatty liver disease fibrosis score and liver fibrosis index),carotid intima-media thickness(CIMT),and ASCVD risk score.To test statistical hypotheses,the Wilcoxon test,paired t-test,Fisher’s exact test,and Pearson's chi-squared test were used.RESULTS The alanine aminotransferase(ALT)level changed by-14.1 U/L(-31.0;-5.3)from baseline to 3 mo and by-6.5 U/L(-14.0;0.1)from 3 to 6 mo.The magnitude of ALT,aspartate transaminase,and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo(P<0.001,P<0.01,P<0.001,respectively).At 6 mo,in the total sample,we observed a statistically significant decrease in body weight and levels of FLI:84.9±10.4 vs 72.3±17.6,P<0.001,total cholesterol:6.03±1.36 vs 5.76±1.21,Р<0.001,lowdensity lipoprotein:3.86±1.01 vs 3.66±0.91,Р<0.001,and triglyceride:3.18(2.00;4.29)vs 2.04(1.40;3.16),Р<0.001.No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was found.The CIMT decreased significantly in the total sample(0.985±0.243 vs 0.968±0.237,P=0.013),whereas the highdensity lipoprotein(Р=0.036)and 10-year ASCVD risk(Р=0.003)improved significantly only in women.Fifty-four patients(31%)achieved>5%weight loss.At the end of the study,the FLI decreased significantly in patients with(88.3±10.2 vs 71.4±19.6,P<0.001)and without>5%weight loss(83.5±10.3 vs 72.8±16.7,P<0.001).The changes in ALT,aspartate transaminase,glutamyltransferase,total cholesterol,and low-density lipoprotein levels were similar between the subgroups.CONCLUSION UDCA normalizes liver enzymes greatly within the first 3 mo of treatment,improves lipid profile and hepatic steatosis independent of weight loss,and has a positive effect on CIMT in the total sample and 10-year ASCVD risk in women after 6 mo of treatment.展开更多
Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,...Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,viral hepatitis,alternative hepatic comorbidities and coexisting autoimmune liver diseases(AILDs),requiring an exclusion of secondary conditions before considering liver involvement.The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders.In AILDs,it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis.Commonly co-occurring SRDs in AILDs are Sjögren syndrome(SS),rheumatoid arthritis(RA)or systemic lupus erythematosus(SLE)in autoimmune hepatitis(AIH),and SS,RA or systemic sclerosis in primary biliary cholangitis.Owing to different disease complications and therapies,it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease.Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases.The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario.In this review,we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.展开更多
Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotran...Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotransferases,alkaline phosphatase,gamma-glutamyl transferase,bilirubin,albumin,prothrombin time and international normalized ratio(INR).Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation.Generally,abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild[<5×upper limit of normal(ULN)],moderate(>5-<15×ULN)and severe(>15×ULN).Hepatocellular pattern causes include but are not limited to;non-alcoholic fatty liver disease/non-alcoholic steatohepatitis,alcohol use,chronic viral hepatitis,liver cirrhosis(variable),autoimmune hepatitis,hemochromatosis,Wilson’s disease,alpha-1 antitrypsin deficiency,celiac disease,medication-induced and ischemic hepatitis.Cholestatic pattern causes include but is not limited to;biliary pathology(obstruction,autoimmune),other conditions with hyperbilirubinemia(conjugated and unconjugated).It is crucial to interpret these commonly ordered tests accurately as appropriate further workup,treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.展开更多
The outbreak of novel coronavirus disease 2019(COVID-19)has resulted in global emergence.With the expansion of related research,in addition to respiratory symptoms,digestive system involvement such as nausea,vomiting,...The outbreak of novel coronavirus disease 2019(COVID-19)has resulted in global emergence.With the expansion of related research,in addition to respiratory symptoms,digestive system involvement such as nausea,vomiting,and diarrhea have also been reported with COVID-19.Besides,abnormal liver function is also frequent in biochemical tests of COVID-19 patients,which is correlated with the severity and mortality of the disease course.The etiology of liver injury in patients with COVID-19 might include viral immunologic injury,drug-induced liver injury,the systemic inflammatory response,hypoxic hepatitis,and the exacerbation of preexisting liver disease.Although liver injuries in COVID-19 are often transient and reversible,health workers need to pay attention to preexisting liver disease,monitor liver function,strengthen supportive treatment,and reduce the chance of drug-induced liver injury.This article reviews the epidemiological characteristics,etiology,management,and preventive strategies for liver injury in patients with COVID-19.展开更多
BACKGROUND Severe acute respiratory syndrome coronavirus 2,or coronavirus disease-2019(COVID-19),has infected millions worldwide since its discovery in Wuhan,China in December 2019,but little is still known about the ...BACKGROUND Severe acute respiratory syndrome coronavirus 2,or coronavirus disease-2019(COVID-19),has infected millions worldwide since its discovery in Wuhan,China in December 2019,but little is still known about the disease process.Preliminary research in China notes liver function tests(LFTs)abnormalities are common in COVID-19 patients,suggesting decreased hepatic function,and that abnormalities in LFTs are related to complicated disease course and negative outcomes.However,there has been limited large-scale data assessing COVID-19’s association with liver dysfunction and negative outcomes.AIM To investigate how COVID-19 affects the liver function and disease course in patients infected with the virus treated at Henry Ford Hospital from March to September 2020.METHODS A total of 8028 patients infected with COVID-19 were identified and included in the study at a single academic center.Data from medical charts on laboratory testing including aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(AP),and bilirubin levels,past history of liver disease,and disease course indicators including hospital admission,intensive care unit(ICU)admission,intubation,and death were recorded and analyzed.Elevated liver enzymes were defined as ALT/AST greater than 60,AP greater than 150,or bilirubin greater than 1.5,super-elevated liver enzymes were defined as ALT/AST greater than 120,AP greater than 300,or bilirubin greater than 3.0.RESULTS A total of 8028 COVID-19 patients were identified and included in the study.Data from medical charts on LFTs(namely,AST,ALT,AP,and bilirubin levels),past history of liver disease,and disease course indicators(hospital/ICU admission,intubation,death)were recorded and analyzed.LFTs from 3937 patients were available for interpretation.45% were found to have elevated or super-elevated LFT.When compared to COVID-19 patients without elevated LFTs,this cohort was found to have significantly higher odds of hospital admittance,ICU admission,intubation,and death(all P<0.001).248(3.1%)had a history of liver disease.Those with elevated and super elevated LFTS had significantly higher odds of having a past history of liver disease(P<0.001).CONCLUSION The findings from this study suggest that in patients who have tested positive for COVID-19,those with elevated and super elevated liver enzyme levels have significantly higher odds of hospital admittance,ICU admittance,intubation and death in comparison to those COVID-19 patients without elevated liver enzyme levels.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has had a profound impact on global health,primarily characterized by severe respiratory illness.However,emerging evidence suggests that COVID-19 can also lead...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has had a profound impact on global health,primarily characterized by severe respiratory illness.However,emerging evidence suggests that COVID-19 can also lead to secondary sclerosing cholangitis(SC),referred to as post-COVID-19 cholangiopathy.AIM To synthesize currently reported cases to assess the current state of knowledge on post-COVID-19 cholangiopathy.METHODS Medical Subject Headings and Health Sciences Descriptors were used to retrieve relevant studies,which were combined using Boolean operators.Searches were conducted on electronic databases including Scopus,Web of Science,and MEDLINE(PubMed).Studies published in English,Spanish,or Portuguese were included,with no restrictions on the publication date.Additionally,the reference lists of retrieved studies were manually searched.Simple descriptive analyses were used to summarize the results.Then the data were extracted and assessed based on Reference Citation Analysis(https://www.referencecitationanalysis.com/).RESULTS The initial search yielded a total of 192 articles.After screening,85 articles were excluded due to duplication,leaving 107 articles for further review.Of these,63 full-length articles met the inclusion criteria and were included in the analyses.Most of the patients were male and exhibited elevated liver function tests(93.8%).Magnetic resonance imaging revealed duct thickening with contrast enhancement(47.7%),as well as beading of the intrahepatic ducts(45.7%)with peribiliary contrast enhancement on diffusion(28.7%).Liver biopsy results confirmed SC in most cases(74.4%).Sixteen patients underwent liver transplantation,with three CONCLUSION Post-COVID-19 cholangiopathy is a serious condition that is expected to become increasingly concerning in the coming years,particularly considering long COVID syndromes.Although liver transplantation has been proposed as a potential treatment option,more research is necessary to establish its efficacy and explore other potential treatments.展开更多
Human adenoviruses(HAdVs)can cause acute hepatitis in immunocompromised patients.However,it is unclear whether HAdVs are contributors to hepatitis in immunocompetent children.In this study,the liver function test(LFT)...Human adenoviruses(HAdVs)can cause acute hepatitis in immunocompromised patients.However,it is unclear whether HAdVs are contributors to hepatitis in immunocompetent children.In this study,the liver function test(LFT)results were retrospectively analyzed among children hospitalized(age<14 years)between January 2016 and October 2019 for acute respiratory infection caused by adenoviruses.Alanine transaminase(ALT)and aspartate aminotransferase(AST)levels were elevated in 7.74%and 46.89%of patients,respectively.All patients with>2 folds of the upper limit of ALT or AST levels were infected with HAdV-7 or HAdV-55.Significantly higher levels of ALT,AST,γ-glutamyl transpeptidase(γ-GT),and lower albumin levels were observed in the HAdV-7 infection group than in the HAdV-3 infection group.HAdV-55 infection led to significantly higherγ-GT,total bilirubin,and direct bilirubin levels than the other infection types.The records of four patients with serial monitoring of the LFT results were further analyzed.Multiple indicators remained abnormal during the entire hospitalization in these patients.These results indicate that HAdV infection is often accompanied by abnormal liver function,and HAdV-7 and HAdV-55 might be under-recognized contributors to hepatitis among children.展开更多
Background and Aims:Patients with severe fever with thrombocytopenia syndrome(SFTS)commonly show liver function impairment.This study aimed to characterize the liver function indices in SFTS patients and investigate t...Background and Aims:Patients with severe fever with thrombocytopenia syndrome(SFTS)commonly show liver function impairment.This study aimed to characterize the liver function indices in SFTS patients and investigate their association with mortality.Methods:Clinical information and laboratory results of 459 laboratory-confirmed SFTS patients,including 78 deceased and 381 surviving patients,were retrospectively analyzed.To explore the infectivity of SFTS caused by novel Bunyavirus(SFTSV)in hepatocytes,Huh7 human hepatoma cells were infected with various concentrations of SFTSV in vitro.Results:The proportion of SFTS patients developing liver injury during hospitalization was 73.2%(336/459);the hepatocellular injury was the predominant type.The median time to occurrence of liver injury from disease onset was 8 d.Liver injury in the deceased group occurred earlier than that in the surviving group.Alanine aminotransferase(ALT)level between 2–5 times upper limit of normal(ULN)at 4–6 d and between 5–15 ULN at 7–12 d of disease course were independent predictors of mortality.Alkaline phosphatase(ALP)>2 ULN at 7–9 d and elevated ALP at 10–12 days after disease onset were risk factors for death.ALT and aspartate transaminase(AST)levels were correlated with lymphocyte count and platelet-to-lymphocyte ratio(PLR).Total bilirubin(TB),ALT,AST levels showed positive correlation with viral load.In the in vitro experiment,SFTSV infected and replicated inside Huh7 cells.Conclusions:Liver injury is common in SFTS patients.ALT and ALP were independent predictors of SFTS-related mortality.Frequent monitoring and evaluation of liver function indices are needed for SFTS patients.展开更多
Non-alcoholic fatty liver disease(NAFLD),is a disease spectrum characterized by fat accumulation in hepatocytes presenting as hepatic steatosis to advance disease with active hepatic inflammation,known as nonalcoholic...Non-alcoholic fatty liver disease(NAFLD),is a disease spectrum characterized by fat accumulation in hepatocytes presenting as hepatic steatosis to advance disease with active hepatic inflammation,known as nonalcoholic steatohepatitis.Chronic steatohepatitis will lead to progressive hepatic fibrosis causing cirrhosis and increased risk for developing hepatocellular carcinoma(HCC).Fatty liver disease prevalence has increased at alarming rates alongside obesity,diabetes and metabolic syndrome to become the second most common cause of cirrhosis after alcohol related liver disease worldwide.Given this rise in prevalence,it is becoming increasingly more important to find non-invasive methods to diagnose disease early and stage hepatic fibrosis.Providing clinicians with the tools to diagnose and treat the full spectrum of NAFLD will help prevent known complications such as cirrhosis and HCC and improve quality of life for the patients suffering from this disease.This article discusses the utility of current noninvasive liver function testing in the clinical progression of fatty liver disease along with the imaging modalities that are available.Additionally,we summarize available treatment options including targeted medical therapy through four different pathways,surgical or endoscopic intervention.展开更多
Background and Aim:Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA)have a median survival of less than 6 months.In half of cases,PSC and CCA will be diagnosed either concurrently...Background and Aim:Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA)have a median survival of less than 6 months.In half of cases,PSC and CCA will be diagnosed either concurrently or within a year of one another.The aim of the present study is to demonstrate that the degree of biochemical liver dysfunction is associated with concomitant or impending CCA.Methods:We did a chart review of patients diagnosed with PSC and CCA up to 18 months from presentation (“CCA” group) as well as patients with PSC that underwent transplantation with no sign of CCA in their explanted liver (“nCCA” group).Along with demographic data and follow-up length,we recorded their presenting liver function tests,including alanine and aspartate aminotransferases (ALT,AST),total bilirubin (TBil),alkaline phosphatase (ALP),international normalization ratio (INR),and serum Ca 19-9 levels.Differences between mean values of the two groups were analyzed with a student's t-test.Results:Twenty-four patients were included.The “CCA”group consisted of eight patients,and the “non-CCA” group had 16 patients.There was no significant difference between the two groups in their presenting values of ALT,ALP,or serum Ca 19-9.However,the “CCA” group had significantly higher levels of AST,TBil,and INR.Conclusion:Patients with PSC and concurrent or impending CCA appear to exhibit significantly greater biochemical liver dysfunction than those who do not develop CCA.Therefore,newly-diagnosed PSC patients presenting with these findings may warrant more rigorous evaluation.展开更多
The novel coronavirus disease 2019(COVID-19)pandemic,caused by severe acute respiratory syndrome coronavirus 2,has become a global challenge of unprecedented nature since December 2019.Although most patients with COVI...The novel coronavirus disease 2019(COVID-19)pandemic,caused by severe acute respiratory syndrome coronavirus 2,has become a global challenge of unprecedented nature since December 2019.Although most patients with COVID-19 exhibit mild clinical manifestations and upper respiratory tract involvement,in approximately 5%-10%of patients,the disease is severe and involves multiple organs,leading to multi-organ dysfunction and failure.The liver and gastrointestinal tract are also frequently involved in COVID-19.In the context of liver involvement in patients with COVID-19,many key aspects need to be addressed in both native and transplanted organs.This review focuses on the clinical presentations and laboratory abnormalities of liver function tests in patients with COVID-19 with no prior liver disease,patients with pre-existing liver diseases and liver transplant recipients.A brief overview of the history of COVID-19 and etiopathogenesis of the liver injury will also be described as a prelude to better understanding the above aspects.展开更多
Eosinophilic cholangitis is a rare cause of deranged obstructive liver function tests. It has been described as a great mimicker for malignant biliary strictures and bile duct obstruction. There are only case reports ...Eosinophilic cholangitis is a rare cause of deranged obstructive liver function tests. It has been described as a great mimicker for malignant biliary strictures and bile duct obstruction. There are only case reports available on treatment experience for eosinophilic cholangitis. A large proportion of patients present with biliary strictures for which they have undergone surgery or endoscopic treatment and a small proportion was given systemic corticosteroid. We share our treatment experience using budesonide which has fewer systemic side effects to prednisolone and avoids invasive management.展开更多
文摘Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complications including acute kidney injury,electrolyte disturbance and cardiac instability.Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis.Typically,there is an increase in serum aminotransferases,namely aspartate aminotransferase and alanine aminotransferase.This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy.However,muscle can also be a source of the increased aminotransferase activity.This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association.It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases,and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury.Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury.This review also explores potential approaches to improve the accuracy of our diagnostic tools,so that excessive or unnecessary liver investigations can be avoided.
基金Supported by National Institute of Health Research(NIHR)Biomedical Research Centre based at Imperial College Healthcare
文摘BACKGROUND Metabolic-associated fatty liver disease(MAFLD)is the commonest cause of abnormal liver function tests(LFTs).Current upper normal of limit(UNL)of LFTs was derived from a“healthy”population,where undiagnosed MAFLD and viral hepatitis might be suspected.AIM To evaluated potential implications of changes in UNL of alanine aminotransferase(ALT)in MAFLD.METHODS We retrospectively assessed consecutive first referrals with a diagnosis of MAFLD from 2010 to 2017.The conventional UNL of ALT was 45 IU/L for men and 34 IU/L for women,while a low UNL of ALT was 30 IU/L for men and 19 IU/L for women.The UNL of aspartate aminotransferase(AST)was 40 IU/L.RESULTS Total 436 patients were enrolled;of these,288 underwent liver biopsy.Setting a lower UNL reduced the percentage of those with significant disease despite normal ALT;specifically,patients with advanced fibrosis(F≥F3)or definite“metabolic-associated steato-hepatitis(MASH)”(NAS≥5)within normal ALT decreased from 10%to 1%and from 28%to 4%respectively.However,the proportion of those with elevated ALT and no evidence of advanced fibrosis or“definite MASH”increased from 39%to 47%and from 3%to 19%.Overall,LFTs performed poorly in distinguishing“definite MASH”from simple steatosis(receiver operating characteristic areas under the curves 0.59 for ALT and 0.55 for AST).CONCLUSION Liver function tests might both under-and overestimate MASH-related liver disease.Reducing the UNL might not be beneficial and imply an increase in healthcare burden.Risk stratification in MAFLD should rely on a combination of risk factors,not on LFTs alone.
文摘An isolated liver function test is of little role in selection of liver disease because many harmful liver diseases may be correlated with normal levels of LFT’s. The outline of enzyme abnormalities in the perspective of patient’s commonly observed symptoms and laboratory data might be helpful in directing the subsequent diagnosis of liver diseases. Liver Function Tests (LFTs) are most generally used screening blood tests for assessment of different liver diseases and these tests provide a lot of evidence for disease processes whether for the purpose of investigation of supposed liver disease or help in observing the progress of disease action or simply by blood investigation. The evaluation of different liver enzymes simply gives diagnostic information on basic level whether patient’s principal disorder is actually hepatitis or cholestasis in source. However, it is necessary in various cases to evaluate LFTs with knowledge of liver functioning enzyme fractions. The objective of this study was to explore the effects of ascorbic acid supplementation on serum liver function tests in Hepatitis C patients. A total of 100 hepatitis C patients were selected randomly. 50 were given ascorbic acid supplementation for one month along with anti HCV treatment. The other 50 HCV patients took their normal anti HCV treatment without intake of ascorbic acid supplementation, and serum ascorbic acid level and liver function test parameters were observed before and after intake of ascorbic acid in both groups. The liver function parameters determined were aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), serum total bilirubin, direct bilirubin, indirect bilirubin and serum protein (total protein, albumin, globulin and A/G ratio). These parameters along with serum ascorbic acid were measured before and 30 days after vitamin C supplementation. Various abnormally elevated LFTs were also improved more rapidly when compared to other group which was not given ascorbic acid supplements for the period of one month. There was a significant change in levels of some liver function parameters before and after intake of ascorbic acid supplementation, and various abnormally elevated LFTs were also improved when compared to other group which was not given ascorbic acid supplements for the period of one month. The effect of Vitamin C supplementation was more marked on serum aminotransferase levels. After one-month use of ascorbic acid, serum alanine aminotransferase (p < 0.042) and serum aspartate aminotransferase (p < 0.000) levels were significantly decreased in hepatitis C patient group. In HCV group with ascorbic acid supplementation, serum total bilirubin (p < 0.046) and serum direct bilirubin (p < 0.048) were found to be less than the pre values when compared to HCV group without ascorbic acid supplementation. It was also observed that some of protein values were suggestively improved after intake of ascorbic acid supplementation.
文摘Objective:To explore the application value of liver function and serological index detection in diagnosing fatty liver.Methods:Ninety patients with fatty liver disease(disease group)and ninety healthy subjects(healthy group)were selected as the subjects of this study.They all underwent liver function index testing and serological index testing.Test results were compared,and the diagnostic accuracy of single and combined tests was evaluated.Results:Liver function indicators of patients in the disease group were higher than those in the healthy group,with severe patients exhibiting higher levels than moderate patients and mild patients(P<0.05).Serological indicators in patients in the disease group were higher than those in the healthy group,with severe patients showing higher levels than moderate patients and mild patients(P<0.05).The diagnostic accuracy of liver function index testing was higher than that of serological index testing,and the accuracy of combined testing was higher than that of single testing(P<0.05).Conclusion:In diagnosing fatty liver,combining liver function testing and serological testing enables the initial diagnosis of the disease and facilitates the accurate assessment of its severity.
基金supported by grants from National Science Foundation of China(grant No.81501839)Jilin Science and Technology Development Program(grant Nos.20160101091JC,20150414039GH)Norman Bethune Program of Jilin University(grant No.2012223).
文摘Background The development and growth of children influence values of liver function tests.This study aims to establish age-and gender-specific pediatric reference intervals of liver function among Han children in Changchun,China.Methods A total of 1394 healthy Han children,aged 2-14 years,were recruited from communities and schools with informed parental consent in Changchun.The levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),y-glutamyltransferase(GGT),alkaline phosphatase(ALP),total protein(TP),albumin(ALB),total bilirubin(TBIL)and direct bilirubin(DBIL)were measured on Hitachi 7600-210 automatic biochemical analyzer.The age-and gender-specific reference intervals were partitioned using Harris and Boyd's test and calculated using nonparametric rank method.The pediatric reference intervals were validated in five representative hospitals located in different areas in Changchun.Results All the analytes required some levels of age partitioning.Proteins(TP,ALB)and bilirubins(TBIL,DBIL)required no gender partitioning.In contrast,considerable gender partitioning was required for serum ALT,AST,GGT,and ALP.TP,TBIL,and DBIL showed steady increases,and AST showed apparent decreases over time,whereas ALT,GGT,ALP,and ALB demonstrated complex trends of change.ALT and GGT increased sharply in males from 11 to 14 years old.However,ALP declined in females from 13 to 14 years.All five laboratories passed the validation of reference intervals.Conclusions There were apparent age or gender variations of the reference intervals for liver function.When establishing pediatric reference intervals,partitioning according to age and gender is necessary.
文摘The coronavirus 2019 disease(COVID-19)is caused by a novel coronavirus,severe acute respiratory syndrome coronavirus 2.This disease was designated by the World Health Organization as a pandemic on March 11,2020,which is not seen before.There are no classical features among the cases of the disease owing to the involvement of nearly all body tissues by the virus.Hepatic involvement is one of the characteristics of the COVID-19 course.There are six possible mechanisms of such involvement:Direct virus injury,drug-induced effect,inflammatory cytokine storm,hypoxia-ischemic destruction,abnormalities in liver function tests,and pre-existing chronic liver diseases.Liver abnormalities are seen commonly in the severe or critical stage of COVID-19.Therefore,these abnormalities determine the COVID-19 severity and carry a high rate of morbidity and mortality.The elderly and patients with comorbidities like diabetes mellitus and hypertension are more vulnerable to liver involvement.Another issue that needs to be disclosed is the liver manifestations following the COVID-19 vaccination,such as autoimmune hepatitis.Of note,complete vaccination with third and fourth booster doses is necessary for patients with previous chronic liver diseases or those who have been subjected to liver transplantation.This review aims to explore the various aspects of liver dysfunction during the COVID-19 course regarding the epidemiological features,predisposing factors,pathophysiological mechanisms,hepatic manifestations due to COVID-19 or following vaccination,role of liver function tests in the assessment of COVID-19 severity,adverse effects of the therapeutic agents for the disease,and prognosis.
文摘Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coronavirus 2(SARSCoV-2)infection with special attention paid to possible mechanisms of liver damage and abnormalities in liver function tests allowing for the evaluation of the severity of liver disease.Abnormalities in liver function observed in COVID-19 disease are associated with the age and sex of patients,severity of liver injury,presence of comorbidity and pre-treatment.The method of antiviral treatment can also impact on liver function,which manifests as increasing values in liver function tests.Therefore,analysis of variations in liver function tests is necessary in evaluating the progression of liver injury to severe disease.
文摘<strong>Background:</strong> Individuals with sero-positivity for Hepatitis B and C have been reported. Most seropositive individuals appear healthy. Liver function markers such as AST, ALT, ALP, Bilirubin and total protein levels are markers for assessing liver impairment. This study (i)assessed seroprevalence of HBV, HCV and both HBV and HCV (ii) HBV and or HCV seropositivity and age or gender, (iii) assess gender and liver function markers and (iv) update data on liver function and simple diagnostic markers. <strong>Materials and Methods: </strong>This was a prospective, cross sectional study of asymptomatic individuals presenting at the Clinical Diagnostic Laboratory of Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria from January 2018 to August 2020. Markers of liver function were investigated on hepatitis B and or C sero-positive and negative participants using TC Matrix Chemistry analyser (Teco Diagnostics, USA) and Biobase reagent Kits. Data were analyzed using descriptive and inferential statistics. <strong>Results:</strong> Out of 475 participants, 60.4% were males and 39.6% females. 53% of males and 32.5% of females were sero-positive for HBV while 32.5% of males and 14.5% of females were sero-positive for HCV. 75.3% and 76.1% of Age group 20 - 40 years were sero-positive for Hepatitis B and C respectively. Mean AST levels of 17.49 ± 13.69, 33.46 ± 93.42 and 19.82 ± 12.54 respectively among those sero-positive for HBV, HCV, and both HBV and HCV. Mean ALT levels of 17.68 ± 14.32, 40.26 ± 13.86 and 20.04 ± 12.78 respectively for HBV, HCV and both HBV and HCV sero-positive cases. Mean ALP levels were 77.52 ± 34.0 for HBV sero-positive cases, 82.04 ± 38.45 in HCV and 77.95 ± 30.48 in both HBV and HCV sero-positive cases. Mean Total Bilirubin levels of HBV, HCV and both HBV and HCV sero-positive cases were 13.25 ± 14.52, 14.98 ± 20.74, 10.58 ± 4.91 respectively while Mean Total protein levels were 77.24 ± 6.27 in HBV, 77.87 ± 5.56 in HCV and 77.0 ± 5.99 in both HBV and HCV sero-positive cases. ALP, bilirubin and total protein were all within normal reference values in HBV, HCV and HBV/HCV dual infections. AST and ALT values were significantly elevated in HCV seropositivity compared to HBV single and HBV/BCV dual seropositivity. <strong>Conclusion:</strong> 30% prevalence of HBV, HCV and both HBV and HCV were observed. Age 20 - 40 years was significantly higher in seropositivity for hepatitis B, C and B and C dual seropositivity. More males than females showed seropositivity for hepatitis B and C. There was no significant difference between gender and liver function markers. AST and ALT remain reliable markers of liver function.
文摘BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursodeoxycholic acid(UDCA),which is one of the first-line therapeutic agents for treatment of NAFLD,is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties.AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests,lipid profile,hepatic steatosis and fibrosis,atherogenesis,and ASCVD risk in men and women with NAFLD,as well as to assess the impact of>5%weight reduction on these parameters.METHODS An open-label,multicenter,international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise.The efficacy criteria were liver enzymes,lipid profile,fatty liver index(FLI),noninvasive liver fibrosis tests(nonalcoholic fatty liver disease fibrosis score and liver fibrosis index),carotid intima-media thickness(CIMT),and ASCVD risk score.To test statistical hypotheses,the Wilcoxon test,paired t-test,Fisher’s exact test,and Pearson's chi-squared test were used.RESULTS The alanine aminotransferase(ALT)level changed by-14.1 U/L(-31.0;-5.3)from baseline to 3 mo and by-6.5 U/L(-14.0;0.1)from 3 to 6 mo.The magnitude of ALT,aspartate transaminase,and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo(P<0.001,P<0.01,P<0.001,respectively).At 6 mo,in the total sample,we observed a statistically significant decrease in body weight and levels of FLI:84.9±10.4 vs 72.3±17.6,P<0.001,total cholesterol:6.03±1.36 vs 5.76±1.21,Р<0.001,lowdensity lipoprotein:3.86±1.01 vs 3.66±0.91,Р<0.001,and triglyceride:3.18(2.00;4.29)vs 2.04(1.40;3.16),Р<0.001.No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was found.The CIMT decreased significantly in the total sample(0.985±0.243 vs 0.968±0.237,P=0.013),whereas the highdensity lipoprotein(Р=0.036)and 10-year ASCVD risk(Р=0.003)improved significantly only in women.Fifty-four patients(31%)achieved>5%weight loss.At the end of the study,the FLI decreased significantly in patients with(88.3±10.2 vs 71.4±19.6,P<0.001)and without>5%weight loss(83.5±10.3 vs 72.8±16.7,P<0.001).The changes in ALT,aspartate transaminase,glutamyltransferase,total cholesterol,and low-density lipoprotein levels were similar between the subgroups.CONCLUSION UDCA normalizes liver enzymes greatly within the first 3 mo of treatment,improves lipid profile and hepatic steatosis independent of weight loss,and has a positive effect on CIMT in the total sample and 10-year ASCVD risk in women after 6 mo of treatment.
文摘Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,viral hepatitis,alternative hepatic comorbidities and coexisting autoimmune liver diseases(AILDs),requiring an exclusion of secondary conditions before considering liver involvement.The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders.In AILDs,it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis.Commonly co-occurring SRDs in AILDs are Sjögren syndrome(SS),rheumatoid arthritis(RA)or systemic lupus erythematosus(SLE)in autoimmune hepatitis(AIH),and SS,RA or systemic sclerosis in primary biliary cholangitis.Owing to different disease complications and therapies,it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease.Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases.The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario.In this review,we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.
文摘Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotransferases,alkaline phosphatase,gamma-glutamyl transferase,bilirubin,albumin,prothrombin time and international normalized ratio(INR).Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation.Generally,abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild[<5×upper limit of normal(ULN)],moderate(>5-<15×ULN)and severe(>15×ULN).Hepatocellular pattern causes include but are not limited to;non-alcoholic fatty liver disease/non-alcoholic steatohepatitis,alcohol use,chronic viral hepatitis,liver cirrhosis(variable),autoimmune hepatitis,hemochromatosis,Wilson’s disease,alpha-1 antitrypsin deficiency,celiac disease,medication-induced and ischemic hepatitis.Cholestatic pattern causes include but is not limited to;biliary pathology(obstruction,autoimmune),other conditions with hyperbilirubinemia(conjugated and unconjugated).It is crucial to interpret these commonly ordered tests accurately as appropriate further workup,treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.
基金Supported by the National Key Research and Development Program,No.2017YFC0908903National Natural Science Foundation of China,No.81873565 and No.81900507Hospital Funded Clinical Research,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.17CSK04.
文摘The outbreak of novel coronavirus disease 2019(COVID-19)has resulted in global emergence.With the expansion of related research,in addition to respiratory symptoms,digestive system involvement such as nausea,vomiting,and diarrhea have also been reported with COVID-19.Besides,abnormal liver function is also frequent in biochemical tests of COVID-19 patients,which is correlated with the severity and mortality of the disease course.The etiology of liver injury in patients with COVID-19 might include viral immunologic injury,drug-induced liver injury,the systemic inflammatory response,hypoxic hepatitis,and the exacerbation of preexisting liver disease.Although liver injuries in COVID-19 are often transient and reversible,health workers need to pay attention to preexisting liver disease,monitor liver function,strengthen supportive treatment,and reduce the chance of drug-induced liver injury.This article reviews the epidemiological characteristics,etiology,management,and preventive strategies for liver injury in patients with COVID-19.
文摘BACKGROUND Severe acute respiratory syndrome coronavirus 2,or coronavirus disease-2019(COVID-19),has infected millions worldwide since its discovery in Wuhan,China in December 2019,but little is still known about the disease process.Preliminary research in China notes liver function tests(LFTs)abnormalities are common in COVID-19 patients,suggesting decreased hepatic function,and that abnormalities in LFTs are related to complicated disease course and negative outcomes.However,there has been limited large-scale data assessing COVID-19’s association with liver dysfunction and negative outcomes.AIM To investigate how COVID-19 affects the liver function and disease course in patients infected with the virus treated at Henry Ford Hospital from March to September 2020.METHODS A total of 8028 patients infected with COVID-19 were identified and included in the study at a single academic center.Data from medical charts on laboratory testing including aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(AP),and bilirubin levels,past history of liver disease,and disease course indicators including hospital admission,intensive care unit(ICU)admission,intubation,and death were recorded and analyzed.Elevated liver enzymes were defined as ALT/AST greater than 60,AP greater than 150,or bilirubin greater than 1.5,super-elevated liver enzymes were defined as ALT/AST greater than 120,AP greater than 300,or bilirubin greater than 3.0.RESULTS A total of 8028 COVID-19 patients were identified and included in the study.Data from medical charts on LFTs(namely,AST,ALT,AP,and bilirubin levels),past history of liver disease,and disease course indicators(hospital/ICU admission,intubation,death)were recorded and analyzed.LFTs from 3937 patients were available for interpretation.45% were found to have elevated or super-elevated LFT.When compared to COVID-19 patients without elevated LFTs,this cohort was found to have significantly higher odds of hospital admittance,ICU admission,intubation,and death(all P<0.001).248(3.1%)had a history of liver disease.Those with elevated and super elevated LFTS had significantly higher odds of having a past history of liver disease(P<0.001).CONCLUSION The findings from this study suggest that in patients who have tested positive for COVID-19,those with elevated and super elevated liver enzyme levels have significantly higher odds of hospital admittance,ICU admittance,intubation and death in comparison to those COVID-19 patients without elevated liver enzyme levels.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has had a profound impact on global health,primarily characterized by severe respiratory illness.However,emerging evidence suggests that COVID-19 can also lead to secondary sclerosing cholangitis(SC),referred to as post-COVID-19 cholangiopathy.AIM To synthesize currently reported cases to assess the current state of knowledge on post-COVID-19 cholangiopathy.METHODS Medical Subject Headings and Health Sciences Descriptors were used to retrieve relevant studies,which were combined using Boolean operators.Searches were conducted on electronic databases including Scopus,Web of Science,and MEDLINE(PubMed).Studies published in English,Spanish,or Portuguese were included,with no restrictions on the publication date.Additionally,the reference lists of retrieved studies were manually searched.Simple descriptive analyses were used to summarize the results.Then the data were extracted and assessed based on Reference Citation Analysis(https://www.referencecitationanalysis.com/).RESULTS The initial search yielded a total of 192 articles.After screening,85 articles were excluded due to duplication,leaving 107 articles for further review.Of these,63 full-length articles met the inclusion criteria and were included in the analyses.Most of the patients were male and exhibited elevated liver function tests(93.8%).Magnetic resonance imaging revealed duct thickening with contrast enhancement(47.7%),as well as beading of the intrahepatic ducts(45.7%)with peribiliary contrast enhancement on diffusion(28.7%).Liver biopsy results confirmed SC in most cases(74.4%).Sixteen patients underwent liver transplantation,with three CONCLUSION Post-COVID-19 cholangiopathy is a serious condition that is expected to become increasingly concerning in the coming years,particularly considering long COVID syndromes.Although liver transplantation has been proposed as a potential treatment option,more research is necessary to establish its efficacy and explore other potential treatments.
基金This study was supported by the National Natural Science Foundation of China(82072264,81970003)Natural Science Foundation of Guangdong Province,China(2021A1515011071)The study sponsors had no involvement in the study design,in the collection,analysis and interpretation of data,in the writing of the manuscript,and in the decision to submit the manuscript for publication.
文摘Human adenoviruses(HAdVs)can cause acute hepatitis in immunocompromised patients.However,it is unclear whether HAdVs are contributors to hepatitis in immunocompetent children.In this study,the liver function test(LFT)results were retrospectively analyzed among children hospitalized(age<14 years)between January 2016 and October 2019 for acute respiratory infection caused by adenoviruses.Alanine transaminase(ALT)and aspartate aminotransferase(AST)levels were elevated in 7.74%and 46.89%of patients,respectively.All patients with>2 folds of the upper limit of ALT or AST levels were infected with HAdV-7 or HAdV-55.Significantly higher levels of ALT,AST,γ-glutamyl transpeptidase(γ-GT),and lower albumin levels were observed in the HAdV-7 infection group than in the HAdV-3 infection group.HAdV-55 infection led to significantly higherγ-GT,total bilirubin,and direct bilirubin levels than the other infection types.The records of four patients with serial monitoring of the LFT results were further analyzed.Multiple indicators remained abnormal during the entire hospitalization in these patients.These results indicate that HAdV infection is often accompanied by abnormal liver function,and HAdV-7 and HAdV-55 might be under-recognized contributors to hepatitis among children.
基金supported by the Innovation Team Project of Health Commission of Hubei Province(WJ2019C003)the Nature Science Foundation of Hubei Province(2018CFB471)+4 种基金the Sansheng Thrombocytopenia(TCP)Youth Research Pro-jectthe National Science and Technology Major Project of China(2018ZX10302206,2018ZX10723203,and 2017ZX 10304402-002-005)the National Key R&D Program of Chi-na(2017YFC0908104)the Fundamental Research Funds for the Central Universities(2020kfyXGYJ016)the Ap-plied Basic and Frontier Technology Research Project of Wu-han(2020020601012233).
文摘Background and Aims:Patients with severe fever with thrombocytopenia syndrome(SFTS)commonly show liver function impairment.This study aimed to characterize the liver function indices in SFTS patients and investigate their association with mortality.Methods:Clinical information and laboratory results of 459 laboratory-confirmed SFTS patients,including 78 deceased and 381 surviving patients,were retrospectively analyzed.To explore the infectivity of SFTS caused by novel Bunyavirus(SFTSV)in hepatocytes,Huh7 human hepatoma cells were infected with various concentrations of SFTSV in vitro.Results:The proportion of SFTS patients developing liver injury during hospitalization was 73.2%(336/459);the hepatocellular injury was the predominant type.The median time to occurrence of liver injury from disease onset was 8 d.Liver injury in the deceased group occurred earlier than that in the surviving group.Alanine aminotransferase(ALT)level between 2–5 times upper limit of normal(ULN)at 4–6 d and between 5–15 ULN at 7–12 d of disease course were independent predictors of mortality.Alkaline phosphatase(ALP)>2 ULN at 7–9 d and elevated ALP at 10–12 days after disease onset were risk factors for death.ALT and aspartate transaminase(AST)levels were correlated with lymphocyte count and platelet-to-lymphocyte ratio(PLR).Total bilirubin(TB),ALT,AST levels showed positive correlation with viral load.In the in vitro experiment,SFTSV infected and replicated inside Huh7 cells.Conclusions:Liver injury is common in SFTS patients.ALT and ALP were independent predictors of SFTS-related mortality.Frequent monitoring and evaluation of liver function indices are needed for SFTS patients.
文摘Non-alcoholic fatty liver disease(NAFLD),is a disease spectrum characterized by fat accumulation in hepatocytes presenting as hepatic steatosis to advance disease with active hepatic inflammation,known as nonalcoholic steatohepatitis.Chronic steatohepatitis will lead to progressive hepatic fibrosis causing cirrhosis and increased risk for developing hepatocellular carcinoma(HCC).Fatty liver disease prevalence has increased at alarming rates alongside obesity,diabetes and metabolic syndrome to become the second most common cause of cirrhosis after alcohol related liver disease worldwide.Given this rise in prevalence,it is becoming increasingly more important to find non-invasive methods to diagnose disease early and stage hepatic fibrosis.Providing clinicians with the tools to diagnose and treat the full spectrum of NAFLD will help prevent known complications such as cirrhosis and HCC and improve quality of life for the patients suffering from this disease.This article discusses the utility of current noninvasive liver function testing in the clinical progression of fatty liver disease along with the imaging modalities that are available.Additionally,we summarize available treatment options including targeted medical therapy through four different pathways,surgical or endoscopic intervention.
文摘Background and Aim:Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA)have a median survival of less than 6 months.In half of cases,PSC and CCA will be diagnosed either concurrently or within a year of one another.The aim of the present study is to demonstrate that the degree of biochemical liver dysfunction is associated with concomitant or impending CCA.Methods:We did a chart review of patients diagnosed with PSC and CCA up to 18 months from presentation (“CCA” group) as well as patients with PSC that underwent transplantation with no sign of CCA in their explanted liver (“nCCA” group).Along with demographic data and follow-up length,we recorded their presenting liver function tests,including alanine and aspartate aminotransferases (ALT,AST),total bilirubin (TBil),alkaline phosphatase (ALP),international normalization ratio (INR),and serum Ca 19-9 levels.Differences between mean values of the two groups were analyzed with a student's t-test.Results:Twenty-four patients were included.The “CCA”group consisted of eight patients,and the “non-CCA” group had 16 patients.There was no significant difference between the two groups in their presenting values of ALT,ALP,or serum Ca 19-9.However,the “CCA” group had significantly higher levels of AST,TBil,and INR.Conclusion:Patients with PSC and concurrent or impending CCA appear to exhibit significantly greater biochemical liver dysfunction than those who do not develop CCA.Therefore,newly-diagnosed PSC patients presenting with these findings may warrant more rigorous evaluation.
文摘The novel coronavirus disease 2019(COVID-19)pandemic,caused by severe acute respiratory syndrome coronavirus 2,has become a global challenge of unprecedented nature since December 2019.Although most patients with COVID-19 exhibit mild clinical manifestations and upper respiratory tract involvement,in approximately 5%-10%of patients,the disease is severe and involves multiple organs,leading to multi-organ dysfunction and failure.The liver and gastrointestinal tract are also frequently involved in COVID-19.In the context of liver involvement in patients with COVID-19,many key aspects need to be addressed in both native and transplanted organs.This review focuses on the clinical presentations and laboratory abnormalities of liver function tests in patients with COVID-19 with no prior liver disease,patients with pre-existing liver diseases and liver transplant recipients.A brief overview of the history of COVID-19 and etiopathogenesis of the liver injury will also be described as a prelude to better understanding the above aspects.
文摘Eosinophilic cholangitis is a rare cause of deranged obstructive liver function tests. It has been described as a great mimicker for malignant biliary strictures and bile duct obstruction. There are only case reports available on treatment experience for eosinophilic cholangitis. A large proportion of patients present with biliary strictures for which they have undergone surgery or endoscopic treatment and a small proportion was given systemic corticosteroid. We share our treatment experience using budesonide which has fewer systemic side effects to prednisolone and avoids invasive management.
