P007 A comprehensive review of drug-induced liver injury in COVID-19 patients; what do we know?

Abstract

<h3>Introduction</h3> Liver impairment was seen in 60% of cases of COVID-19.¹ Drug induced Liver Injury in COVID-19 patients has not been thoroughly reviewed yet.² We aim to study this phenomenon and test the available data. <h3>Methodology</h3> Comprehensive retrospective review was conducted to see the drug-induced liver damage due to COVID-19. One author was assigned to do systematic search from the Advanced Cochrane library, and PubMed from all reported studies and data from December 2019 to December 2020. Search keywords were COVID-19 and liver, COVID-19 and liver injury, SARS-CoV-2 and liver, SARS-CoV-2, and liver injury. Results were checked and reviewed using SPSS version 27. <h3>Results</h3> A Single-Centre Cross-Sectional Study, Cai Q, et al. 2020, 417 patients reported the association of raised liver tests with liver injury and severity of pneumonia. Abnormal liver tests including AST, ALT, and GGT were reported in 76.3% of patients and 21.5% acquired liver injury during admission. Liver enzymes were more prominently high during hospital stay over 3ULN (upper limit units), specifically ALT and GGT 37% and 41% (p = 0.006) respectively whereas AST and TBIL was raised up to 20% and 10% (p = 0.002). Retrospective case series of 113 deceased patients, Chen T, et al. 2020, analysed to understand the risk factors. All 113 deceased received treatment of Antiviral therapy Eighty-nine (79%), Glucocorticoid therapy Ninety-nine (88%), Antibiotics 105 (93%), Intravenous immunoglobulin therapy 39% (n=44), Interferon inhalation 22% (n=22), Oxygen treatment 113 (100%) including high flow nasal cannula 68% (n=77). Lopinavir and ritonavir were reportedly linked with COVID-19 associated liver injury whereas, in this retrospective analysis few deceased cases 89; 79% (p = 0.009) received monotherapy or combined treatment of oseltamivir, arbidol, or lopinavir and ritonavir. <h3>Conclusion</h3> Lopinavir and ritonavir have been associated with liver injury development in COVID-19 patient. Elevated AST levels with the use of antifungals. Drug-induced liver injury in COVID-19 patients is a complex process and more critical research needs to be conducted. <h3>References</h3> Gadour E, Shrwani K, Hassan Z. Covid-19 induced hepatitis (CIH), definition and diagnostic criteria of a poorly understood new clinical syndrome. <i>World J Gastroenterol, Hepatol and Endoscop</i> 2020;<b>1</b>(2):1–6. Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, <i>et al</i>. Characteristics of liver tests in COVID-19 patients. J Hepatol 2020. http://dx.doi.org/10.1016/j.jhep.2020.04. 006