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liver dysfunction on admission worsens clinical manifestations and outcomes of coronavirus disease 2019

Chinese Medical Journal Pulmonary and Critical Care Medicine 2023年第3期1卷 181-187页

作者： Fangying Lu Rong Chen Kandi Xu Jie Huang Dexiang Yang Tao Bai Yusang Xie Yun Ling Kui Liu Wei Du Jiayang Yan Huihuang Lin Jian Li Yun Feng Min Zhou Yi Guo Department of Respiratory and Critical Care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Institute of Respiratory Diseases Shanghai Jiao Tong University School of MedicineShanghai 200025China Department of Critical Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Department of Respiratory Diseases Tongling People’s HospitalTonglingAnhui 244099China Department of Infectious Disease Wuhan Jinyintan HospitalWuhanHubei 430048China Department of Infectious Disease Shanghai Public Health Clinical CenterShanghai 200025China Department of Respiratory and Critical Care Medicine Tongji HospitalTongji Medical College of Huazhong University of Science and TechnologyWuhanHubei 430030China Clinical Research Center Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China

Background:liver dysfunction was common in coronavirus disease 2019(COVID-19),but its association with clinical features and poor prognosis has not been fully delineated.Our study aimed to determine the role of liver dysfunction in COVID-19 and understand the predictors for worse outcomes in patients with liver injury.Methods:We conducted this multicenter,retrospective study in five designated hospitals for COVID-19 manage-ment.Laboratory-confirmed COVID-19 patients were enrolled and classified into the normal live function group and liver dysfunction group according to liver enzymes,bilirubin,and albumin on admission,respectively.Data of baseline,clinical manifestations,and outcomes were collected and compared in the paired groups.Results:Of the 649 included COVID-19 patients,200(30.8%),69(10.6%),and 267(41.1%)patients had elevated liver enzymes,increased bilirubin,and low-level albumin,respectively.Fever,cough,and dyspnea were the most common symptoms and showed an increased proportion in the liver dysfunction group.Compared with patients in the normal liver function group,patients with liver dysfunction manifested decreased lymphocytes,higher level of leukocytes,neutrophils,inflammatory indicators,and cytokines,as well as more severe impairment in kidney function and myocardium.They were more likely to show bilateral involvement and more pulmonary lobes involved according to chest images.With increased proportion of patients who developed severe/critical conditions and needed mechanical ventilation and systemic glucocorticoid therapy,patients with liver dysfunc-tion on admission showed significantly higher in-hospital mortality.Moreover,cardiac troponin I≥1.5 ng/mL was identified as an independent mortality predictor in the elevated liver enzymes group.Conclusion:Patients with liver dysfunction on admission had worse clinical manifestation,and resulted in higher rate of severe/critical type,receiving mechanical ventilation and in-hospital mortality.

关键词： COVID-19 liver dysfunction Clinical manifestation Outcomes Mortality

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COVID-19 and liver dysfunction:What nutritionists need to know

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World Journal of Gastroenterology 2022年第15期28卷 1526-1535页

作者： Ming-Ke Wang Xue-Lu Yu Li-Yun Zhou Hong-Mei Si Ju-Fen Hui Deng-Yong Hou Wei-Peng Li Ji-Shun Yang Department of Disease Control and Prevention Naval Medical Center of PLANaval Medical UniversityShanghai 200052China Medical Care Center Naval Medical Center of PLANaval Medical UniversityShanghai 200052China

The coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field.Patients with COVID-19 usually have respiratory symptoms.However,liver dysfunction is not an uncommon presentation.Additionally,the degree of liver dysfunction is associated with the severity and prognosis of COVID-19.Prevention,diagnosis,and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19,especially in those with liver dysfunction.Recently,a large number of studies have reported that nutrition therapy measures,including natural dietary supplements,vitamins,minerals and trace elements,and probiotics,might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant,antiviral,anti-inflammatory,and positive immunomodulatory effects.This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction,nutritional and metabolic characteristics,nutritional status assessment,and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.

关键词： COVID-19 SARS-CoV-2 liver dysfunction Nutritional status assessment Nutrition therapy

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Fournier gangrene in an infant, complicated with severe sepsis and liver dysfunction: A case report

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World Journal of Clinical Cases 2023年第30期11卷 7398-7402页

作者： Ilirjana Bakalli Saimir Heta Ermira Kola Ermela Celaj Department of Pediatrics UHC“Mother Theresa”Tirana 1024Albania Department of Pediatric Surgery UHC“Mother Theresa”Tirana 1024Albania

BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated with this disease is dependent on the timing of medical care.CASE SUMMARY A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling.Despite ambulatory antibiotic treatment,the child’s clinical condition deteriorated.At the time of admission,the child had necrotizing scrotal fasciitis that had spread to the abdomen.Following reanimation,the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area.Despite optimal antibiotic and supportive therapy,the patient developed severe sepsis with liver dysfunction,making treatment more challenging.CONCLUSION Recognizing Fournier gangrene,prompt referral to pediatric surgery,and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.

关键词： Fournier gangrene Infant Early diagnosis Sepsis liver dysfunction Case report

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liver dysfunction as a cytokine storm manifestation and prognostic factor for severe COVID-19

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World Journal of Hepatology 2021年第12期13卷 2005-2012页

作者： Gergana Taneva Dimitar Dimitrov Tsvetelina Velikova Department of Gastroenterology Sveta Sofia HospitalSofia 1618Bulgaria Department of Clinical Immunology University Hospital LozenetzSofia 1407Bulgaria Medical Faculty Sofia University St.Kliment OhridskiSofia 1407Bulgaria

patients with or without preexisting liver disorders,posing a significant complication and mortality risk.During coronavirus disease 2019(COVID-19),abnormal liver function is typically observed.However,liver injury may occur because of the treatment as well.Ischemia,cytokine storm,and hypoxia were identified as the three major factors contributing to liver damage during COVID-19.Indeed,raised liver enzymes during hospitalizations may be attributed to medications used,as well as sepsis and shock.As a result,the proportion of hospitalized patients afflicted with COVID-19 and pathological liver biomarkers varies from 14%to 53%.Aminotransferases and bilirubin are found most often elevated.Usually,increased gamma-glutamyltransferase,alkaline phosphatase,and decreased serum albumin levels are demonstrated.Additionally,although there is no specific treatment for COVID-19,many of the drugs used to treat the infection are hepatotoxic.In this mini-review,we focus on how liver dysfunction can be one of the features associated with the COVID-19 cytokine storm.Furthermore,data show that liver injury can be an independent predictor of severe COVID-19,the need for hospitalization,and death.

关键词： liver dysfunction liver damage Cytokine storm Prognostic factor COVID-19 Severe COVID-19 SARS-CoV-2 Aspartate aminotransferase Alanine aminotransferase Bilirubin Interleukin-6

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liver dysfunction-related COVID-19:A narrative review

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World Journal of Meta-Analysis 2023年第1期11卷 5-17页

作者： Taghreed S Saeed Al-Rawi Raid M Al-Ani Department of Biochemistry University of Anbar College of MedicineRamadi City 31001AnbarIraq Department of Surgery/Otolaryngology University of Anbar College of MedicineRamadi City 31001AnbarIraq

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.

关键词： liver dysfunction liver function test SARS-CoV-2 Mortality Critical illness COVID-19

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COVID-19 and liver dysfunction:Current Insights and Emergent Therapeutic Strategies

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Journal of Clinical and Translational Hepatology 2020年第1期8卷 18-24页

作者： Gong Feng Kenneth I.Zheng Qin-Qin Yan Rafael S.Rios Giovanni Targher Christopher D.Byrne Sven Van Poucke Wen-Yue Liu Ming-Hua Zheng Xi’an Medical University Xi’anChina NAFLD Research Center Department of Hepatologythe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina Section of Endocrinology Diabetes and MetabolismDepartment of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly Southampton National Institute for Health Research Biomedical Research Center University Hospital SouthamptonSouthampton General HospitalSouthamptonUK Ziekenhuis Oost-Limburg Department of AnesthesiologyCritical CareEmergency Medicine and Pain TherapyGenkBelgium Department of Endocrinology the First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina Institute of Hepatology Wenzhou Medical UniversityWenzhouChina Key Laboratory of Diagnosis and Treatment for The Development of Chronic liver Disease in Zhejiang Province WenzhouChina

The outbreak of coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has attracted increasing worldwide attention.Cases of liver damage or dysfunction(mainly characterized by moderately elevated serum aspartate aminotransferase lev-els)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 per se or other coexisting conditions,such as the use of potentially hepatotoxic drugs and the coexistence of sys-temic inflammatory response,respiratory distress syndrome-induced hypoxia,and multiple organ dysfunction.Based on the current evidence from case reports and case series,this review article focuses on the demographic and clinical characteristics,potential mechanisms,and treatment options for COVID-19-related liver dysfunction.This review also describes the geo-graphical and demographic distribution of COVID-19-related liver dysfunction,as well as possible underlying mechanisms linking COVID-19 to liver dysfunction,in order to facilitate future drug development,prevention,and control measures for COVID-19.

关键词： COVID-19 liver dysfunction SARS-CoV-2

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Association between macronutrients intake and liver dysfunction among tuberculosis patients in Shandong Province

Association between macronutrients intake and liver dysfunct...

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中国营养学会第十五届全国营养科学大会

作者： Liangjie Zhao Yue Li Shanliang Zhao Jing Cai Aiguo Ma Qingdao University Linyi People's Hospital

Tuberculosis patients with liver dysfunction were detrimental to their treatment and prognosis because of immune dysfunction. Malnutrition played a vital role in liver dysfunction;however, there were only limited data. This study aimed to clarify the association between macronutrients intake and liver dysfunction in tuberculosis patients and to explore a new idea of alleviating liver dysfunction in tuberculosis patients with nutritional improvement. Methods In this cross-sectional study, 3052 active tuberculosis patients aged >18 years were included based on the data from primary tuberculosis clinics in Linyi City, China. Basic information was collected by the baseline questionnaire. Macronutrients intake of tuberculosis patients was assessed by the 24-hour dietary recalls. ALT or AST values were measured using an automatic biochemical analyzer. The subjects were divided into normal liver function group and liver dysfunction group based on ALT or AST values greater than 40 U/L. Results Among all the tuberculosis patients, 439(14.4%) had liver dysfunction. The patients with liver dysfunction were more likely to be male, less education and higher alcohol intake among drinkers compared to patients with normal liver function. About the daily intake of macronutrients, compared to normal liver function group, patients with liver dysfunction had significantly less protein(P = 0.008), and fat(P liver dysfunction(all P-trend liver dysfunction whether age, gender, education and daily intake of alcohol were adjusted or not(all

关键词： macronutrients intake liver dysfunction tuberculosis patients

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Population Pharmacokinetic Model-guided Optimization of Intravenous Voriconazole Dosing Regimens in Critically Ill Patients with liver dysfunction

Population Pharmacokinetic Model-guided Optimization of Intr...

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2022第27届广东省药师周大会

作者： Xiao-bin Lin Ka Yin Lui Peng-hao Guo Xiao-man Liu Tao Liang Xiao-guang Hu Li Tong Jing-jing Wu Yan-zhe Xia Pan Chen Guo-ping Zhong Xiao Chen Chang-jie Cai Department of Pharmacy The First Affiliated HospitalSun Yat-sen University Department of Critical Care Medicine The First Affiliated HospitalSun Yat-sen University Department of Clinical Laboratory The First Affiliated HospitalSun Yat-sen University Institute of Clinical Pharmacology School of Pharmaceutical SciencesSun Yat-sen University

Objectives:This prospective study aimed toestablish a population pharmacokinetic(PPK) model ofintravenous voriconazole(VRC)incritically ill patients with liver dysfunction,andto explore the optimal dosing strategies in specific clinical scenariosfor invasive fungal infections(IFIs)caused by common Aspergillus and Candida species.Methods:The PPK analysis was conducted on 297 plasma VRC concentrations from 26 critically ill patientswith liver dysfunction.Model-based simulations with therapeutic range of 2-6 mg/L as the plasma trough concentration(Cmin) target and the free area under the concentration-time curve from 0 h to 24 h(?AUC24) divided by the minimum inhibitory concentration(MIC)(i.e.?AUC24/MIC) ≥ 25 as the effective target were performed to optimize VRC dosing regimensfor Child-Pugh class AandB(CP-A/B) and Child-Pugh class C(CP-C) patients.Results:A two-compartment model with first-order elimination adequately described the data.Significant covariates in the final model werebody weight onboth central and peripheraldistributionvolumeand Child-Pugh class on clearance.Intravenous VRC loading dose of 5 mg/kg every 12 h(q12 h) for the first day was adequate for CP-A/B and CP-C patients to attainthe Cmin target at 24 h.Themaintenance doseregimens of 100 mgq12 h or 200 mgq24 h for CP-A/B patients and 50 mgq12 h or 100 mgq24 h for CP-C patientscould obtain the probability of effective target attainmentof > 90% at an MIC≤ 0.5 mg/L and achieve the cumulative fraction of response of> 90% against C.albicans,C.parapsilosis,C.glabrata,C.krusei,A.fumigatus,and A.flavus.Additionally,the daily VRC dosescould be increased by 50 mg for CP-A/B and CP-C patients at an MIC of 1 mg/L,with plasma Cminmonitoredclosely to avoid serious adverse events.It is recommendedthat an appropriate alternative antifungal agent or a combination therapycould be adopted when an MIC ≥ 2 mg/Lis reported,or whenthe infection iscaused by C.tropicalisbut the MIC valueisnot available.Conclusions:For critically ill patients with liver dysfunction,the lo

关键词： voriconazole population pharmacokinetics dosage optimization liver dysfunction critically ill patients

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Epidemiological features and dynamic changes in blood biochemical indices for COVID-19 patients in Hebi

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World Journal of Clinical Cases 2022年第8期10卷 2404-2419页

作者： Xiao-Bo Nie Bao-Sheng Shi Lin Zhang Wei-Li Niu Ting Xue Lan-Qing Li Xiao-Yun Wei Yan-Dong Wang Wei-Dong Chen Rui-Fang Hou Key Laboratory of Receptors-Mediated Gene Regulation School of Basic Medical SciencesHenan UniversityKaifeng 475004Henan ProvinceChina Department of Infectious Diseases The People’s Hospital of HebiHebi 458031Henan ProvinceChina Department of Infectious Diseases The Third People’s Hospital of HebiHebi 458031Henan ProvinceChina College of Life Science and Technology Beijing University of Chemical TechnologyBeijing 100029Beijing ProvinceChina Department of Infectious Diseases The People’s Hospital of HebiHenan UniversityHebi Key Laboratory of Liver DiseaseHebi 458031Henan ProvinceChina

BACKGROUND Millions of people have died of coronavirus disease 2019(COVID-19)due to severe acute respiratory syndrome coronavirus 2(SARS-Co V-2)infection,and retrospective studies of the disease in local regions are necessary.AIM To characterize the epidemiological features and dynamic changes in blood biochemical indices for SARS-Co V-2-infected patients in Hebi,a representative city with a large floating population in North China.METHODS From January 25 to February 10,2020,the clinical data of patients who tested positive for SARS-Co V-2 by quantitative real-time polymerase chain reaction in Hebi city(China)were evaluated at admission,and laboratory data for hematologic parameters,inflammatory indices,coagulation function indices,liver function indices,blood lipid indices,renal function indices,myocardial enzyme activities and five blood biochemical markers of immunity were evaluated at admission,upon hospitalization and before discharge.RESULTS Sixteen confirmed COVID-19 patients developed pneumonia but were cured after adequate treatment.Fever and fatigue were the common symptoms.The most common laboratory abnormalities of patients at admission were leukopenia,eosinopenia,decreased percentage of eosinophils,elevated high sensitivity C-reactive protein and fibrinogen levels,hypoalbuminemia,mildly increased aspartate transferase activity and levels of bilirubin,and increased levels ofβ2-microglobulin.Importantly,aggravated liver dysfunction was detected in most patients,which may be partially attributed to virus infection as well as medicinal treatment.CONCLUSION This study provides several potential diagnostic markers and dynamic biochemical indices of disease progression to better prevent,diagnose and treat COVID-19 infection.

关键词： COVID-19 Epidemiology Blood biochemical indices Computed tomography imaging liver dysfunction

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A review: Systematic research approach on toxicity model of liver and kidney in laboratory animals

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Animal Models and Experimental Medicine 2022年第5期5卷 436-444页

作者： Abbasali Abbasnezhad Fatemeh Salami Reza Mohebbati Department of Physiology Faculty of MedicineGonabad University of Medical SciencesGonabadIran Department of Physiology Faculty of MedicineMashhad University of Medical SciencesMashhadIran Applied Biomedical Research Center Mashhad University of Medical SciencesMashhadIran

Therapeutic experiments are commonly performed on laboratory animals to inves-tigate the possible mechanism(s)of action of toxic agents as well as drugs or sub-stances under consideration.The use of toxins in laboratory animal models,including rats,is intended to cause toxicity.This study aimed to investigate different models of hepatotoxicity and nephrotoxicity in laboratory animals to help researchers advance their research goals.The current narrative review used databases such as Medline,Web of Science,Scopus,and Embase and appropriate keywords until June 2021.Nephrotoxicity and hepatotoxicity models derived from some toxic agents such as cisplatin,acetaminophen,doxorubicin,some anticancer drugs,and other materials through various signaling pathways are investigated.To understand the models of renal or hepatotoxicity in laboratory animals,we have provided a list of toxic agents and their toxicity procedures in this review.

关键词： animal drug toxicity drug-induced abnormality liver dysfunction renal injury

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