BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 ...BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.展开更多
Liver transplantation(LT)provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma.Despite the increasing number of liver transplants performed each year,the number of LT can...Liver transplantation(LT)provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma.Despite the increasing number of liver transplants performed each year,the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and mortality.Living donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT candidates.Nevertheless,further strategies can be implemented to increase the pool of potential donors in deceased donor LT,such as reducing the rate of organ discards.Utilizing hepatitis C virus(HCV)seropositive liver grafts is one of the expanded donor organ criteria.A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative recipients.Direct-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in transplantation.The American Society of Transplantation advises against performing transplants from HCV-infected liver donors(D+)into HCV-negative recipient(R-)unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such transplants.Proper selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is im-portant.National and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.展开更多
文摘BACKGROUND Various liver and gastrointestinal involvements occur in patients with coronavirus disease 2019(COVID-19)at variable prevalence.Most studies report mild liver function disturbances correlated with COVID-19 severity,though liver failure is unusual.AIM To study liver and gastrointestinal dysfunctions in Egyptian patients with COVID-19 and their relation to disease outcomes METHODS This multicentre cohort study was conducted on 547 Egyptian patients from April 15,2020 to July 29,2020.Consecutive polymerase chain reaction-confirmed COVID-19 cases were included from four quarantine hospitals affiliated to the Egyptian ministry of health.Demographic information,laboratory characteristics,treatments,fibrosis-4(FIB-4)index,COVID-19 severity,and outcomes were recorded and compared according to the degree of liver enzyme elevation and the presence of gastrointestinal symptoms.Follow-ups were conducted until discharge or death.Regression analyses were performed to determine the independent factors affecting mortality.RESULTS This study included 547 patients,of whom 53(9.68%)died during hospitalization and 1 was discharged upon his request.Patients’mean age was 45.04±17.61 years,and 21.98%had severe or critical COVID-19.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were available for 430 and 428 patients,respectively.In total,26%and 32%of patients had elevated ALT and AST,respectively.Significant liver injury with ALT or AST elevation exceeding 3-fold was recorded in 21(4.91%)and 16(3.73%)patients,respectively.Male gender,smoking,hypertension,chronic hepatitis C,and lung involvement were associated with elevated AST or ALT.AST was elevated in 50%of patients over 60-years-old.FIB-4 was significantly higher in patients admitted to the intensive care unit(ICU),those with more severe COVID-19,and non-survivors.The independent variables affecting outcome were supplementary vitamin C intake(1 g daily capsules)[odds ratio(OR):0.05,95%confidence interval(CI):0.008–0.337];lung consolidation(OR:4.540,95%CI:1.155–17.840);ICU admission(OR:25.032,95%CI:7.110–88.128);and FIB-4 score>3.25(OR:10.393,95%CI:2.459-43.925).Among 60(13.98%)patients with gastrointestinal symptoms,52(86.67%)had diarrhoea.Patients with gastrointestinal symptoms were predominantly females with higher body mass index,and 50(83.40%)patients had non-severe COVID-19.CONCLUSION Few Egyptian patients with COVID-19 developed a significant liver injury.The independent variables affecting mortality were supplementary vitamin C intake,lung consolidation,ICU admission,and FIB-4 score.
文摘Liver transplantation(LT)provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma.Despite the increasing number of liver transplants performed each year,the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and mortality.Living donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT candidates.Nevertheless,further strategies can be implemented to increase the pool of potential donors in deceased donor LT,such as reducing the rate of organ discards.Utilizing hepatitis C virus(HCV)seropositive liver grafts is one of the expanded donor organ criteria.A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative recipients.Direct-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in transplantation.The American Society of Transplantation advises against performing transplants from HCV-infected liver donors(D+)into HCV-negative recipient(R-)unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such transplants.Proper selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is im-portant.National and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.
