Endocrine disorders frequently lead to metabolic disturbances that significantly affect liver function.Understanding the complex interplay between hormonal imbalances and liver dysfunction is essential for advancing t...Endocrine disorders frequently lead to metabolic disturbances that significantly affect liver function.Understanding the complex interplay between hormonal imbalances and liver dysfunction is essential for advancing targeted therapeutic strategies.This comprehensive review explores the pathophysiological mechanisms linking major endocrine disorders to liver disease,with a focus on the roles of the thyroid,parathyroid,pancreas,adrenal glands,and sex hormones.Thyroid dysfunction is associated with alterations in liver enzyme levels and metabolic regulation,often resulting in hepatic steatosis or cholestasis.Hyperparathyroidism and consequent hypercalcemia have been linked to hepatic calcifications.Insulin resistance,both hepatic and peripheral,contributes to excessive lipid accumulation in the liver,exacerbating steatotic changes.Adrenal gland disorders,particularly in the setting of chronic liver disease,impair cortisol metabolism and may worsen hepatic injury.Additionally,sex hormones such as estrogen and testosterone modulate the progression of liver fibrosis and influence the development of metabolic syndrome.The intricate relationship between endocrine and hepatic systems underscores the need for a multidisciplinary approach in the management of liver disease.Addressing underlying hormonal disturbances may enhance patient outcomes and prevent further hepatic deterioration.Future research should prioritize integrative therapeutic strategies that concurrently target endocrine and liver dysfunction.展开更多
Severe liver dysfunction in pregnancy（SLDP） is rare but serious complications with high mortality rate. This study compared the effectiveness and safety of double-balloon catheter versus intra-amniotic injection of ...Severe liver dysfunction in pregnancy（SLDP） is rare but serious complications with high mortality rate. This study compared the effectiveness and safety of double-balloon catheter versus intra-amniotic injection of ethacridine lactate for the termination of second trimester pregnancy in patients with SLD. A total of 55 patients with indications of labor induction were enrolled and analyzed by retrospective control analysis method. Twenty-three cases adopted Cook double balloon dilation as Cook group, and 32 cases received intra-amniotic injection of ethacridine lactate as EL group. The primary outcome was evaluated by successful abortion rate and the difference in the induction-to-abortion interval. Secondary outcomes included liver function recovery and the frequency of adverse events. Both Cook and EL regimens were effective, with successful abortion rate of 87.0% and 93.8%, respectively（P=0.639）. The induction-to-delivery interval was similar between Cook group and EL group（38.1±21.5 vs. 41.3±17.4, P=0.543）. The liver disease status was more severe in Cook group than in EL group, but it did not show any significant difference after pregnancy termination between the two groups and the improvement rate also did not show any significant difference. Both treatments were safe and there was no significant difference in bleeding and cervical laceration adverse events between the two groups. Our study firstly compared double-balloon catheter and ethacridine lactate for the induction of labor in women with SLD during second trimester pregnancy.展开更多
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.Ho...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.展开更多
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 ma...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.展开更多
Objective:The purpose of this study was to analyze risk factors for development of post-hepatectomy liver dysfunction in primary liver cancer(PLC)patients with concurrent hepatic schistosomiasis and chronic hepatitis....Objective:The purpose of this study was to analyze risk factors for development of post-hepatectomy liver dysfunction in primary liver cancer(PLC)patients with concurrent hepatic schistosomiasis and chronic hepatitis.Methods:A retrospective analysis of 73 PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis,of which 16 patients developed liver dysfunction(persistent ascites or pleural effusion or occurrence of liver-related potentially fatal complications)following hepatectomy,was performed.After clinical characteristics were recorded,preoperative liver function parameters and surgery-related parameters in these patients were assessed.Seventeen potential risk factors for post-hepatectomy liver dysfunction were identified.The association between these potential risk factors and post-hepatectomy liver dysfunction then was analyzed.Results:Univariate analysis showed that liver cirrhosis,intraoperative blood loss,and preoperative total bilirubin were associated with the development of post-hepatectomy liver dysfunction.Multivariate logistic regression analysis of these three factors revealed that intraoperative blood loss≥600 mL and cirrhosis were two independent risk factors for post-hepatectomy liver dysfunction in PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis.Conclusion:Keeping intraoperative blood loss below 600 mL can help avoid the development of post-hepatectomy liver dysfunction in liver cancer patients with concurrent hepatic schistosomiasis and chronic hepatitis.For patients with concomitant liver cirrhosis,every effort should be made to minimize potential liver function impairment induced by other adverse factors.展开更多
HEMOPHAGOCYTIC lymphohistiocytosis(HLH)is an aggressive and potentially fatal syndrome that results from inappropriate activation of lymphocytes and macrophages.It is characterized by fever,hepatosplenomegaly,cytopeni...HEMOPHAGOCYTIC lymphohistiocytosis(HLH)is an aggressive and potentially fatal syndrome that results from inappropriate activation of lymphocytes and macrophages.It is characterized by fever,hepatosplenomegaly,cytopenias,hypertriglyceridemia,hypofibrinogenemia,and pathologic findings of hemophagocytosis in the bone marrow or other tissues.We report an adult HLH case admitted to hepatology department.展开更多
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 w...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.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
Gosnell and colleagues executed a large-scale cohort investigation delineating ethnic disparities in outcomes among individuals with metabolic dysfunction–as-sociated steatotic liver disease/steatohepatitis(MASLD/MAS...Gosnell and colleagues executed a large-scale cohort investigation delineating ethnic disparities in outcomes among individuals with metabolic dysfunction–as-sociated steatotic liver disease/steatohepatitis(MASLD/MASH).Uncovering such heterogeneity is pivotal to optimising management and prognostication,notably for hepatocellular carcinoma,fibrotic progression,and all-cause mortality.The authors furnish granular trajectories for Hispanic vs non-Hispanic popula-tions across the United States and southeastern Texas,alongside a comprehensive appraisal of MASLD/MASH-related event rates.These insights provide an indispensable framework for early risk stratification and the tailoring of thera-peutic algorithms and surveillance regimens.The study underscores the necessity for nuanced appreciation of MASLD/MASH outcome profiles and associated management strategies,while interrogating regional variation in disease burden,the benefits of integrated metabolic care,and the potential of lifestyle inter-ventions to attenuate complications and improve prognosis.展开更多
Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver diseas...Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since childhood.More recently,this term has been further replaced with metabolic associated steatotic liver disease.It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments.However,comparable pediatric data remain limited.Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.展开更多
Background and objective:In northern China's cold regions,the prevalence of metabolic dysfunction-associated steatotic liver disease(MASLD)exceeds 50%,significantly higher than the national and global rates.MASLD ...Background and objective:In northern China's cold regions,the prevalence of metabolic dysfunction-associated steatotic liver disease(MASLD)exceeds 50%,significantly higher than the national and global rates.MASLD is an important risk factor for cardiovascular and cerebrovascular diseases,including coronary heart disease,stroke,and tumors,with no specific therapeutic drugs currently available.The ethanol extract of cassia seed(CSEE)has shown promise in lowering blood lipids and improving hepatic steatosis,but its mechanism in treating MASLD remains underexplored.This study aims to investigate the therapeutic effects and mechanisms of CSEE.Methods:MASLD models were established in male Wistar rats and golden hamsters using a high fat diet(HFD).CSEE(10,50,250 mg/kg)was administered via gavage for six weeks.Serum levels of total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),aspartate aminotransferase(AST),and alanine aminotransferase(ALT),as well as liver TC and TG,were measured using biochemical kits.Histopathological changes in the liver were evaluated using Oil Red O staining,Hematoxylin-eosin(H&E)staining,and transmission electron microscopy(TEM).HepG2 cell viability was assessed using the cell counting kit-8(CCK8)and Calcein-AM/PI staining.Network pharmacology was used to analyze drug-disease targets,and western blotting was used to confirm these predictions.Results:CSEE treatment significantly reduced serum levels of TC,TG,LDL-C,ALT,and AST,and improved liver weight,liver index,and hepatic lipid deposition in rats and golden hamsters.In addition,CSEE alleviated free fatty acid(FFA)-induced lipid deposition in HepG2 cells.Molecular biology experiments demonstrated that CSEE increased the protein levels of p-AMPK,p-ACC,PPARα,CPT1A,PI3K P110 and p-AKT,while decreasing the protein levels of SREBP1,FASN,C/EBPα,and PPARγ,thus improving hepatic lipid metabolism and reducing lipid deposition.The beneficial effects of CSEE were reversed by small molecule inhibitors of the signaling pathways in vitro.Conclusion:CSEE improves liver lipid metabolism and reduces lipid droplet deposition in Wistar rats and golden hamsters with MASLD by activating hepatic AMPK,PPARα,and PI3K/AKT signaling pathways.展开更多
BACKGROUND Colorectal polyps are commonly observed in patients with chronic liver disease(CLD)and pose a significant clinical concern because of their potential for malignancy.AIM To explore the clinical characteristi...BACKGROUND Colorectal polyps are commonly observed in patients with chronic liver disease(CLD)and pose a significant clinical concern because of their potential for malignancy.AIM To explore the clinical characteristics of colorectal polyps in patients with CLD,a nomogram was established to predict the presence of adenomatous polyps(AP).METHODS Patients with CLD who underwent colonoscopy at Tianjin Second People’s Hospital from January 2020 to May 2023 were evaluated.Clinical data including laboratory results,colonoscopy findings,and pathology reports were collected.Key variables for the nomogram were identified through least absolute shrinkage and selection operator regression,followed by multivariate logistic regression.The performance of the model was evaluated using the area under the receiver area under curve,as well as calibration curves and decision curve analysis.RESULTS The study enrolled 870 participants who underwent colonoscopy,and the detection rate of AP in patients with CLD was 28.6%.Compared to individuals without polyps,six risk factors were identified as predictors for AP occurrence:Age,male sex,body mass index,alcohol consumption,overlapping metabolic dysfunction-associated steatotic liver disease,and serum ferritin levels.The novel nomogram(AP model)demonstrated an area under curve of 0.801(95%confidence interval:0.756-0.845)and 0.785(95%confidence interval:0.712-0.858)in the training and validation groups.Calibration curves indicated good agreement among predicted and actual probabilities(training:χ^(2)=11.860,P=0.157;validation:χ^(2)=7.055,P=0.530).The decision curve analysis underscored the clinical utility of the nomogram for predicting the risk of AP.CONCLUSION The AP model showed reasonable accuracy and provided a clinical foundation for predicting the occurrence of AP in patients with CLD,which has a certain predictive value.展开更多
The diagnosis of non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver en...The diagnosis of non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver enzymes,gender,basal metabolic index,and presence of diabetic mellitus is not sufficient to exclude other causes of deranged liver enzymes especially medications and autoimmune related liver diseases.As the guideline suggests ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD,as it provides additional diagnostic information and the combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy and evident from previous similar studies too.展开更多
A broad spectrum of liver disorders and their associated complications most notably hepatic encephalopathy impact millions of individuals worldwide,including conditions such as non-alcoholic fatty liver disease,alcoho...A broad spectrum of liver disorders and their associated complications most notably hepatic encephalopathy impact millions of individuals worldwide,including conditions such as non-alcoholic fatty liver disease,alcoholic liver injury,viral hepatitis,hepatic fibrosis,cirrhosis,and hepatocellular carcinoma.The underlying pathogenic mechanisms are multifactorial,encompassing oxidative stress,inflammatory cascades,mitochondrial impairment,and disturbances in immune homeostasis.Hepatic encephalopathy patients experience cognitive impairment,mood disturbances,and psychomotor dysfunction,significantly reducing quality of life through mechanisms including oxidative stress,neuroinflammation,and neurotransmitter imbalances.The nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway serves as a critical antioxidative defense mechanism in these conditions.Nrf2 regulates the expression of protective enzymes,while HO-1 exerts anti-inflammatory,anti-apoptotic,and antifibrotic effects through heme degradation products.Natural herbal monomers as Nrf2 activators offer advantages of low toxicity,multi-target actions,and extensive traditional use.Various herbal monomers demonstrate specific effects against different liver diseases:In fatty liver,baicalin alleviates lipid accumulation and inflammation;In alcoholic liver disease,curcumin enhances Nrf2 activity reducing oxidative damage;In drug-induced liver injury,dihydromyricetin mitigates oxidative stress;In viral hepatitis,andrographolide inhibits hepatitis C virus replication;In liver fibrosis,multiple compounds inhibit stellate cell activation.These natural compounds simultaneously alleviate hepatic dysfunction and neuropsychiatric symptoms by modulating the Nrf2/HO-1 pathway,though clinical application still faces challenges such as low bioavailability,requiring further research.展开更多
BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but da...BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but data from cohort studies are scarce.AIM To investigate the association between insulin and pathological LFT,liver disease,and cirrhosis in a populationbased retrospective cohort study.METHODS Anthropometric and cardiometabolic factors of 857 men and 1228 women from prospective cohort studies were used.LFT were obtained at two time points 8 years to 24 years after baseline.Liver disease diagnoses were obtained from nationwide registries.The association between insulin levels and the development of elevated LFT or liver disease and cirrhosis was analyzed.RESULTS Total follow-up was 54054 person-years for women and 27556 person-years for men.Insulin levels were positively correlated with elevated LFT during follow-up,whereas physical activity and coffee consumption were negatively correlated.Individuals with both insulin levels in the upper tertile and alcohol consumption above MASLD thresholds had an increased risk for both liver disease,adjusted hazard ratio(aHR)of 4.3(95%CI:1.6-14.6)and cirrhosis(aHR=4.8,95%CI:1.6-14.6).CONCLUSION This population-based study provides evidence that high insulin levels are a risk factor for development of elevated liver enzymes and clinically manifest liver disease.The results support the concept of metabolic dysfunction associated liver disease.展开更多
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 cha...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.展开更多
Background and Aims:Coronavirus disease 2019(COVID-19)is a new respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2(commonly known as SARS-CoV-2)with multiple organ injuries.The aim...Background and Aims:Coronavirus disease 2019(COVID-19)is a new respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2(commonly known as SARS-CoV-2)with multiple organ injuries.The aim of this study was to analyze COVID-19-associated liver dysfunction(LD),its association with the risk of death and prognosis after discharge.Methods:Three-hundred and fifty-five COVID-19 patients were recruited.Clinical data were collected from electronic medical records.LD was evaluated and its prognosis was tracked.The association between LD and the risk of death was analyzed.Results:Of the 355 COVID-19 patients,211 had mild disease,88 had severe disease,and 51 had critically ill disease.On admission,223(62.8%)patients presented with hypoproteinemia,151(42.5%)with cholestasis,and 101(28.5%)with hepatocellular injury.As expected,LD was more common in critically ill patients.By multivariate logistic regression,male sex,older age and lymphopenia were three important independent risk factors predicting LD among COVID-19 patients.Risk of death analysis showed that the fatality rate was higher in patients with hypoproteinemia than in those without hypoproteinemia(relative risk=9.471,p<0.01).Moreover,the fatality rate was higher in patients with cholestasis than those without cholestasis(relative risk=2.182,p<0.05).Follow-up observation found that more than one hepatic functional index of two-third patients remained abnormal at 14 days after discharge.Conclusions:LD at early disease stage elevates the risk of death of COVID-19 patients.COVID-19-associated LD does not recover completely by 14 days after discharge.展开更多
The recently developed technologies that allow the analysis of each single omics have provided an unbiased insight into ongoing disease processes.However,it remains challenging to specify the study design for the subs...The recently developed technologies that allow the analysis of each single omics have provided an unbiased insight into ongoing disease processes.However,it remains challenging to specify the study design for the subsequent integration strategies that can associate sepsis pathophysiology and clinical outcomes.Here,we conducted a time-dependent multi-omics integration(TDMI)in a sepsis-associated liver dysfunction(SALD)model.We successfully deduced the relation of the Toll-like receptor 4(TLR4)pathway with SALD.Although TLR4 is a critical factor in sepsis progression,it is not specified in single-omics analyses but only in the TDMI analysis.This finding indicates that the TDMI-based approach is more advantageous than single-omics analyses in terms of exploring the underlying pathophysiological mechanism of SALD.Furthermore,TDMI-based approach can be an ideal paradigm for insightful biological interpretations of multi-omics datasets that will potentially reveal novel insights into basic biology,health,and diseases,thus allowing the identification of promising candidates for therapeutic strategies.展开更多
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 ...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.展开更多
Background and Objectives:Macronutrients play a vital role in liver dysfunction and affect tuberculosis treatment and prognosis.However,macronutrients intake was inadequate for most tuberculosis patients.This study ai...Background and Objectives:Macronutrients play a vital role in liver dysfunction and affect tuberculosis treatment and prognosis.However,macronutrients intake was inadequate for most tuberculosis patients.This study aimed to clarify the associations between macronutrients intake or energy percentages and liver dysfunction in tuberculosis patients.Methods and Study Design:In this cross-sectional study,2581 active tuberculosis patients aged≥18 years were included from local tuberculosis clinics in Linyi,China.Macronutrients intake and energy percentages were assessed by 24-hour dietary recalls.The concentration of alanine transferase(ALT)or aspartate transaminase(AST)greater than 40 U/L was defined as liver dysfunction.A restricted cubic spline(RCS)was applied to determine the dose-response relationships.Results:Liver dysfunction was assessed for 14.6%(377 patients)of tuberculosis patients.Higher protein(Q2-Q4 in model 1 and 2)or fat intake and fat-to-energy percentages and lower carbohydrate-to-energy percentages(Q4 in model 1)were associated with a decreased incidence of liver dysfunction(p-trend<0.05).Among those who were male,normal BMI,or consumed energy<1636 kcal/d,inverse associations between protein or fat intake and the risks of liver dysfunction in models were suggested(ptrend<0.05).Moreover,J-shaped curves in RCS were evident in liver dysfunction tuberculosis patients with protein or fat intake(p-nonlinearity<0.05).Conclusions:Significant linear associations between macronutrients intake or energy percentages and liver dysfunction prevalence were found only in male,normal BMI,or less energy intake patients.The shapes of liver dysfunction-morbidity differed significantly by macronutrients intake or energy percentage.展开更多
文摘Endocrine disorders frequently lead to metabolic disturbances that significantly affect liver function.Understanding the complex interplay between hormonal imbalances and liver dysfunction is essential for advancing targeted therapeutic strategies.This comprehensive review explores the pathophysiological mechanisms linking major endocrine disorders to liver disease,with a focus on the roles of the thyroid,parathyroid,pancreas,adrenal glands,and sex hormones.Thyroid dysfunction is associated with alterations in liver enzyme levels and metabolic regulation,often resulting in hepatic steatosis or cholestasis.Hyperparathyroidism and consequent hypercalcemia have been linked to hepatic calcifications.Insulin resistance,both hepatic and peripheral,contributes to excessive lipid accumulation in the liver,exacerbating steatotic changes.Adrenal gland disorders,particularly in the setting of chronic liver disease,impair cortisol metabolism and may worsen hepatic injury.Additionally,sex hormones such as estrogen and testosterone modulate the progression of liver fibrosis and influence the development of metabolic syndrome.The intricate relationship between endocrine and hepatic systems underscores the need for a multidisciplinary approach in the management of liver disease.Addressing underlying hormonal disturbances may enhance patient outcomes and prevent further hepatic deterioration.Future research should prioritize integrative therapeutic strategies that concurrently target endocrine and liver dysfunction.
基金supported by a grant from the National Natural Science Foundation of China(No.81372806)
文摘Severe liver dysfunction in pregnancy（SLDP） is rare but serious complications with high mortality rate. This study compared the effectiveness and safety of double-balloon catheter versus intra-amniotic injection of ethacridine lactate for the termination of second trimester pregnancy in patients with SLD. A total of 55 patients with indications of labor induction were enrolled and analyzed by retrospective control analysis method. Twenty-three cases adopted Cook double balloon dilation as Cook group, and 32 cases received intra-amniotic injection of ethacridine lactate as EL group. The primary outcome was evaluated by successful abortion rate and the difference in the induction-to-abortion interval. Secondary outcomes included liver function recovery and the frequency of adverse events. Both Cook and EL regimens were effective, with successful abortion rate of 87.0% and 93.8%, respectively（P=0.639）. The induction-to-delivery interval was similar between Cook group and EL group（38.1±21.5 vs. 41.3±17.4, P=0.543）. The liver disease status was more severe in Cook group than in EL group, but it did not show any significant difference after pregnancy termination between the two groups and the improvement rate also did not show any significant difference. Both treatments were safe and there was no significant difference in bleeding and cervical laceration adverse events between the two groups. Our study firstly compared double-balloon catheter and ethacridine lactate for the induction of labor in women with SLD during second trimester pregnancy.
基金Supported by Major Construction Program of Military Key Disciplines during the 13^(th)Five-Year Plan Period,No.2020SZ21-15。
文摘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.
文摘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.
文摘Objective:The purpose of this study was to analyze risk factors for development of post-hepatectomy liver dysfunction in primary liver cancer(PLC)patients with concurrent hepatic schistosomiasis and chronic hepatitis.Methods:A retrospective analysis of 73 PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis,of which 16 patients developed liver dysfunction(persistent ascites or pleural effusion or occurrence of liver-related potentially fatal complications)following hepatectomy,was performed.After clinical characteristics were recorded,preoperative liver function parameters and surgery-related parameters in these patients were assessed.Seventeen potential risk factors for post-hepatectomy liver dysfunction were identified.The association between these potential risk factors and post-hepatectomy liver dysfunction then was analyzed.Results:Univariate analysis showed that liver cirrhosis,intraoperative blood loss,and preoperative total bilirubin were associated with the development of post-hepatectomy liver dysfunction.Multivariate logistic regression analysis of these three factors revealed that intraoperative blood loss≥600 mL and cirrhosis were two independent risk factors for post-hepatectomy liver dysfunction in PLC patients with concurrent hepatic schistosomiasis and chronic hepatitis.Conclusion:Keeping intraoperative blood loss below 600 mL can help avoid the development of post-hepatectomy liver dysfunction in liver cancer patients with concurrent hepatic schistosomiasis and chronic hepatitis.For patients with concomitant liver cirrhosis,every effort should be made to minimize potential liver function impairment induced by other adverse factors.
文摘HEMOPHAGOCYTIC lymphohistiocytosis(HLH)is an aggressive and potentially fatal syndrome that results from inappropriate activation of lymphocytes and macrophages.It is characterized by fever,hepatosplenomegaly,cytopenias,hypertriglyceridemia,hypofibrinogenemia,and pathologic findings of hemophagocytosis in the bone marrow or other tissues.We report an adult HLH case admitted to hepatology department.
文摘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.
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Gosnell and colleagues executed a large-scale cohort investigation delineating ethnic disparities in outcomes among individuals with metabolic dysfunction–as-sociated steatotic liver disease/steatohepatitis(MASLD/MASH).Uncovering such heterogeneity is pivotal to optimising management and prognostication,notably for hepatocellular carcinoma,fibrotic progression,and all-cause mortality.The authors furnish granular trajectories for Hispanic vs non-Hispanic popula-tions across the United States and southeastern Texas,alongside a comprehensive appraisal of MASLD/MASH-related event rates.These insights provide an indispensable framework for early risk stratification and the tailoring of thera-peutic algorithms and surveillance regimens.The study underscores the necessity for nuanced appreciation of MASLD/MASH outcome profiles and associated management strategies,while interrogating regional variation in disease burden,the benefits of integrated metabolic care,and the potential of lifestyle inter-ventions to attenuate complications and improve prognosis.
文摘Over recent years,the nomenclature of non-alcoholic fatty liver disease has undergone significant changes.Indeed,in 2020,an expert consensus panel proposed the term“Metabolic(dysfunction)associated fatty liver disease”(MAFLD)to underscore the close association of fatty liver with metabolic abnormalities,thereby highlighting the cardiometabolic risks(such as metabolic syndrome,type 2 diabetes,insulin resistance,and cardiovascular disease)faced by these patients since childhood.More recently,this term has been further replaced with metabolic associated steatotic liver disease.It is worth noting that emerging evidence not only supports a close and independent association of MAFLD with chronic kidney disease in adults but also indicates its interplay with metabolic impairments.However,comparable pediatric data remain limited.Given the progressive and chronic nature of both diseases and their prognostic cardiometabolic implications,this editorial aims to provide a pediatric perspective on the intriguing relationship between MAFLD and renal function in childhood.
基金The animal protocols were approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University(SYDW2019-258).
文摘Background and objective:In northern China's cold regions,the prevalence of metabolic dysfunction-associated steatotic liver disease(MASLD)exceeds 50%,significantly higher than the national and global rates.MASLD is an important risk factor for cardiovascular and cerebrovascular diseases,including coronary heart disease,stroke,and tumors,with no specific therapeutic drugs currently available.The ethanol extract of cassia seed(CSEE)has shown promise in lowering blood lipids and improving hepatic steatosis,but its mechanism in treating MASLD remains underexplored.This study aims to investigate the therapeutic effects and mechanisms of CSEE.Methods:MASLD models were established in male Wistar rats and golden hamsters using a high fat diet(HFD).CSEE(10,50,250 mg/kg)was administered via gavage for six weeks.Serum levels of total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),aspartate aminotransferase(AST),and alanine aminotransferase(ALT),as well as liver TC and TG,were measured using biochemical kits.Histopathological changes in the liver were evaluated using Oil Red O staining,Hematoxylin-eosin(H&E)staining,and transmission electron microscopy(TEM).HepG2 cell viability was assessed using the cell counting kit-8(CCK8)and Calcein-AM/PI staining.Network pharmacology was used to analyze drug-disease targets,and western blotting was used to confirm these predictions.Results:CSEE treatment significantly reduced serum levels of TC,TG,LDL-C,ALT,and AST,and improved liver weight,liver index,and hepatic lipid deposition in rats and golden hamsters.In addition,CSEE alleviated free fatty acid(FFA)-induced lipid deposition in HepG2 cells.Molecular biology experiments demonstrated that CSEE increased the protein levels of p-AMPK,p-ACC,PPARα,CPT1A,PI3K P110 and p-AKT,while decreasing the protein levels of SREBP1,FASN,C/EBPα,and PPARγ,thus improving hepatic lipid metabolism and reducing lipid deposition.The beneficial effects of CSEE were reversed by small molecule inhibitors of the signaling pathways in vitro.Conclusion:CSEE improves liver lipid metabolism and reduces lipid droplet deposition in Wistar rats and golden hamsters with MASLD by activating hepatic AMPK,PPARα,and PI3K/AKT signaling pathways.
基金Supported by the National Natural Science Foundation of China,No.62375202Natural Science Foundation of Tianjin,No.23JCYBJC00950+1 种基金Tianjin Health Science and Technology Project Key Discipline Special,No.TJWJ2022XK034Research Project in Key Areas of Traditional Chinese Medicine in 2024,No.2024022.
文摘BACKGROUND Colorectal polyps are commonly observed in patients with chronic liver disease(CLD)and pose a significant clinical concern because of their potential for malignancy.AIM To explore the clinical characteristics of colorectal polyps in patients with CLD,a nomogram was established to predict the presence of adenomatous polyps(AP).METHODS Patients with CLD who underwent colonoscopy at Tianjin Second People’s Hospital from January 2020 to May 2023 were evaluated.Clinical data including laboratory results,colonoscopy findings,and pathology reports were collected.Key variables for the nomogram were identified through least absolute shrinkage and selection operator regression,followed by multivariate logistic regression.The performance of the model was evaluated using the area under the receiver area under curve,as well as calibration curves and decision curve analysis.RESULTS The study enrolled 870 participants who underwent colonoscopy,and the detection rate of AP in patients with CLD was 28.6%.Compared to individuals without polyps,six risk factors were identified as predictors for AP occurrence:Age,male sex,body mass index,alcohol consumption,overlapping metabolic dysfunction-associated steatotic liver disease,and serum ferritin levels.The novel nomogram(AP model)demonstrated an area under curve of 0.801(95%confidence interval:0.756-0.845)and 0.785(95%confidence interval:0.712-0.858)in the training and validation groups.Calibration curves indicated good agreement among predicted and actual probabilities(training:χ^(2)=11.860,P=0.157;validation:χ^(2)=7.055,P=0.530).The decision curve analysis underscored the clinical utility of the nomogram for predicting the risk of AP.CONCLUSION The AP model showed reasonable accuracy and provided a clinical foundation for predicting the occurrence of AP in patients with CLD,which has a certain predictive value.
文摘The diagnosis of non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver enzymes,gender,basal metabolic index,and presence of diabetic mellitus is not sufficient to exclude other causes of deranged liver enzymes especially medications and autoimmune related liver diseases.As the guideline suggests ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD,as it provides additional diagnostic information and the combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy and evident from previous similar studies too.
文摘BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but data from cohort studies are scarce.AIM To investigate the association between insulin and pathological LFT,liver disease,and cirrhosis in a populationbased retrospective cohort study.METHODS Anthropometric and cardiometabolic factors of 857 men and 1228 women from prospective cohort studies were used.LFT were obtained at two time points 8 years to 24 years after baseline.Liver disease diagnoses were obtained from nationwide registries.The association between insulin levels and the development of elevated LFT or liver disease and cirrhosis was analyzed.RESULTS Total follow-up was 54054 person-years for women and 27556 person-years for men.Insulin levels were positively correlated with elevated LFT during follow-up,whereas physical activity and coffee consumption were negatively correlated.Individuals with both insulin levels in the upper tertile and alcohol consumption above MASLD thresholds had an increased risk for both liver disease,adjusted hazard ratio(aHR)of 4.3(95%CI:1.6-14.6)and cirrhosis(aHR=4.8,95%CI:1.6-14.6).CONCLUSION This population-based study provides evidence that high insulin levels are a risk factor for development of elevated liver enzymes and clinically manifest liver disease.The results support the concept of metabolic dysfunction associated liver disease.
基金supported by grants from the National Natural Science Foundation of China(81500665)High Level Creative Talents from Department of Public Health in Zhejiang Province and Project of New Century 551 Talent Nurturing in Wenzhou+1 种基金GT is supported in part by grants from the University School of Medicine of Verona,Verona,ItalyCDB is supported in part by grants from the Southampton National Institute for Health Research Biomedical Research Centre(IS-BRC-20004),UK.
文摘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.
基金upported by the National Natural Science Foundation of China(Grant Number:81630084)the National Natural Science Foundation Incubation Program of the Second Affiliated Hospital of Anhui Medical University(Grant Number:2019GQFY06).
文摘Background and Aims:Coronavirus disease 2019(COVID-19)is a new respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2(commonly known as SARS-CoV-2)with multiple organ injuries.The aim of this study was to analyze COVID-19-associated liver dysfunction(LD),its association with the risk of death and prognosis after discharge.Methods:Three-hundred and fifty-five COVID-19 patients were recruited.Clinical data were collected from electronic medical records.LD was evaluated and its prognosis was tracked.The association between LD and the risk of death was analyzed.Results:Of the 355 COVID-19 patients,211 had mild disease,88 had severe disease,and 51 had critically ill disease.On admission,223(62.8%)patients presented with hypoproteinemia,151(42.5%)with cholestasis,and 101(28.5%)with hepatocellular injury.As expected,LD was more common in critically ill patients.By multivariate logistic regression,male sex,older age and lymphopenia were three important independent risk factors predicting LD among COVID-19 patients.Risk of death analysis showed that the fatality rate was higher in patients with hypoproteinemia than in those without hypoproteinemia(relative risk=9.471,p<0.01).Moreover,the fatality rate was higher in patients with cholestasis than those without cholestasis(relative risk=2.182,p<0.05).Follow-up observation found that more than one hepatic functional index of two-third patients remained abnormal at 14 days after discharge.Conclusions:LD at early disease stage elevates the risk of death of COVID-19 patients.COVID-19-associated LD does not recover completely by 14 days after discharge.
基金supported by the National Research Foundation of Korea funded by the Korean government[Ministry of Science and ICT(MSIT)](Grant Nos.2021R1A6A3A01086425 and 2022R1A4A1018900).
文摘The recently developed technologies that allow the analysis of each single omics have provided an unbiased insight into ongoing disease processes.However,it remains challenging to specify the study design for the subsequent integration strategies that can associate sepsis pathophysiology and clinical outcomes.Here,we conducted a time-dependent multi-omics integration(TDMI)in a sepsis-associated liver dysfunction(SALD)model.We successfully deduced the relation of the Toll-like receptor 4(TLR4)pathway with SALD.Although TLR4 is a critical factor in sepsis progression,it is not specified in single-omics analyses but only in the TDMI analysis.This finding indicates that the TDMI-based approach is more advantageous than single-omics analyses in terms of exploring the underlying pathophysiological mechanism of SALD.Furthermore,TDMI-based approach can be an ideal paradigm for insightful biological interpretations of multi-omics datasets that will potentially reveal novel insights into basic biology,health,and diseases,thus allowing the identification of promising candidates for therapeutic strategies.
基金This study was supported by the National Natural Science Foun-dation of China(No.81630001)the Shanghai Municipal Key Clini-cal Specialty(No.shslczdzk02202)+2 种基金the Shanghai Top-Priority Clinical Key Disciplines Construction Project(No.2017ZZ02014)the Shanghai Shenkang Hospital Development Center Clinical Science and Technol-ogy Innovation Project(No.SHDC12018102)the Innovative Re-search Team of High-level Local Universities in Shanghai and Zhejiang University special scientific research fund for COVID-19 prevention and control(No.2020XGZX011).
文摘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.
基金supported by Danone nutrition research and education fund Project(DIC2018-09):JCChina Scholarship Council under Grant 202008370119:JCa National Natural Science Foundation of China,grant number 81872610:AM.
文摘Background and Objectives:Macronutrients play a vital role in liver dysfunction and affect tuberculosis treatment and prognosis.However,macronutrients intake was inadequate for most tuberculosis patients.This study aimed to clarify the associations between macronutrients intake or energy percentages and liver dysfunction in tuberculosis patients.Methods and Study Design:In this cross-sectional study,2581 active tuberculosis patients aged≥18 years were included from local tuberculosis clinics in Linyi,China.Macronutrients intake and energy percentages were assessed by 24-hour dietary recalls.The concentration of alanine transferase(ALT)or aspartate transaminase(AST)greater than 40 U/L was defined as liver dysfunction.A restricted cubic spline(RCS)was applied to determine the dose-response relationships.Results:Liver dysfunction was assessed for 14.6%(377 patients)of tuberculosis patients.Higher protein(Q2-Q4 in model 1 and 2)or fat intake and fat-to-energy percentages and lower carbohydrate-to-energy percentages(Q4 in model 1)were associated with a decreased incidence of liver dysfunction(p-trend<0.05).Among those who were male,normal BMI,or consumed energy<1636 kcal/d,inverse associations between protein or fat intake and the risks of liver dysfunction in models were suggested(ptrend<0.05).Moreover,J-shaped curves in RCS were evident in liver dysfunction tuberculosis patients with protein or fat intake(p-nonlinearity<0.05).Conclusions:Significant linear associations between macronutrients intake or energy percentages and liver dysfunction prevalence were found only in male,normal BMI,or less energy intake patients.The shapes of liver dysfunction-morbidity differed significantly by macronutrients intake or energy percentage.
