Hyperammonemia as a manifestation of post-covid syndrome in patients with nonalcoholic fatty liver disease: post-hoc analysis of the LIRA - COVID observational clinical program

Abstract

Post-Covid syndrome (PCS) is considered as a consequence of a previous coronavirus infection. The liver in COVID-19 is one of the most frequently affected organs, with the development of asthenia, cognitive impairment, as well as increased activity of alanine and aspartic transaminases (ALT and AST), which persist in some patients up to 4-6 months after discharge from the hospital. The cause of asthenia may be hyperammonemia (HA), which in COVID-19 is a manifestation of liver dysfunction against the background of the direct cytotoxic effect of SARS-CoV-2 on hepatocytes, which was previously shown as part of the clinical observational program protocol “LIRA - COVID”. Due to the great relevance of the problem of the combination of PCS, non-alcoholic fatty liver disease (NAFLD) and HA a post-hoc analysis of the observational clinical program LIRA - COVID was carried out. It was shown that NAFLD has a significant effect on the level of AST before the start of treatment with L-ornithine - L-aspartate (LOLA). The presence of NAFLD has a significant effect on ammonia levels after 14 days of treatment, since in the group of patients with NAFLD the ammonia level was significantly higher than in the group without NAFLD. It was concluded that it is advisable to include in the examination scheme of patients with PCS and NAFLD, determination of the level of ammonia in the blood, when elevated, the administration of the drug to such patients is justified LOLA course for 4 weeks at a standard dose of 9 g per day.