Abnormal Liver Enzyme Levels Research Articles

Decreased Hepatic Functional Reserve Increases the Risk of Piperacillin/Tazobactam-Induced Abnormal Liver Enzyme Levels: A Retrospective Case-Control Study.

Piperacillin/tazobactam (PIPC/TAZ), which is a combination of a beta-lactam/beta-lactamase inhibitor, often causes liver enzyme abnormalities. The albumin-bilirubin (ALBI) score is a simple index that uses the serum albumin and total bilirubin levels for estimating hepatic functional reserve. Although patients with low hepatic reserve may be at high risk for drug-induced liver enzyme abnormalities, the relationship between PIPC/TAZ-induced abnormal liver enzymes levels and the ALBI score remains unknown. This study aimed to elucidate the relationship between PIPC/TAZ-induced abnormal liver enzyme levels and the ALBI score. This single-center retrospective case-control study included 335 patients. The primary outcome was PIPC/TAZ-induced abnormal liver enzyme levels. We performed COX regression analysis with male gender, age (≥75 years), alanine aminotransferase level (≥20 IU/L), and ALBI score (≥-2.00) as explanatory factors. To investigate the influence of the ALBI score on the development of abnormal liver enzyme levels, 1:1 propensity score matching between the ≤-2.00 and ≥-2.00 ALBI score groups was performed using the risk factors for drug-induced abnormal liver enzyme levels. The incidence of abnormal liver enzyme levels was 14.0% (47/335). COX regression analysis revealed that an ALBI score ≥-2.00 was an independent risk factor for PIPC/TAZ-induced abnormal liver enzyme levels (adjusted hazard ratio: 3.08, 95% coefficient interval: 1.207-7.835, P = 0.019). After 1:1 propensity score matching, the Kaplan-Meier curve revealed that the cumulative risk for PIPC/TAZ-induced abnormal liver enzyme levels was significantly higher in the ALBI score ≥-2.00 group (n = 76) than in the <-2.00 group (n = 76) (P = 0.033). An ALBI score ≥-2.00 may predict the development of PIPC/TAZ-induced abnormal liver enzyme levels. Therefore, frequent monitoring of liver enzymes should be conducted to minimize the risk of severe PIPC/TAZ-induced abnormal liver enzyme levels in patients with low hepatic functional reserve.

Prevalence, proportions of elevated liver enzyme levels, and long-term cardiometabolic mortality of patients with metabolic dysfunction-associated steatotic liver disease.

This study estimated the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) according to cardiometabolic risk factors. The long-term impacts of MASLD on all-cause and cardiometabolic-specific mortality were evaluated. We enrolled 343 816 adults aged ≥30years who participated in a health screening program from 1997 through 2013. MASLD was identified on the basis of abdominal ultrasonography and metabolic profiles. The participants were further categorized by liver enzyme elevation. Baseline cardiometabolic comorbidities were classified on the basis of self-reported medication use and clinical seromarkers. All-cause and cardiometabolic-specific deaths were determined through computerized data linkage with nationwide death certifications until December 31, 2020. The overall prevalence of MASLD was 36.4%. Among patients with MASLD, 35.9% had abnormal liver enzyme levels. Compared with patients without MASLD, abnormal liver enzymes were positively associated with cardiometabolic comorbidities in patients with MASLD (Pfor trend<0.001). After follow-up, patients with MASLD had a 9%-29% higher risk of all-cause, cardiovascular-related, or diabetes-related mortality. In the groups with MASLD and elevated and normal liver enzyme levels, the multivariate-adjusted hazard ratios for cardiovascular deaths were 1.14 (1.05-1.25) and 1.10 (1.03-1.17), respectively, and those for diabetes deaths were 1.42 (1.05-1.93) and 1.24 (0.98-1.57), respectively, compared with those in the non-MASLD group (Pfor trend<0.001). Individuals with MASLD and elevated liver enzyme levels exhibited significantly higher risks of all-cause and cardiometabolic deaths and should be monitored and given consultation on cardiometabolic modifications.

Prevalence and Associated Factors of Liver Enzyme Abnormalities Among Bangladeshi Women: A Cross-Sectional Study.

Background Liver enzyme abnormalities can indicate underlying liver health issues and are influenced by various factors. This study aimed to investigate the prevalence of liver enzyme abnormalities and their associated factors among nonpregnant and nonlactating (NPNL) women in Bangladesh. Methodology A cross-sectional study was conducted among 251 NPNL Bangladeshi women. Data on demographic, socioeconomic, and health-related variables were collected. Logistic regression analysis was used to determine the association between liver enzyme abnormalities and associated factors. Results The prevalence of liver enzyme abnormalities among participants was determined, with associated factors such as age, body mass index (BMI), monthly income, and food security status examined. Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were observed in 54 (21.5%) and 47 (18.7%) of participants, respectively, with 116 (46.2%) exhibiting an AST/ALT ratio exceeding 1.00. Food insecurity was significantly associated with a higher prevalence of elevated ALT levels (24.4% vs. 8.7%, P = 0.02), as well as low monthly income (18.8%, 14.7% vs. 36.7%, P < 0.01) and higher BMI (11% vs. 27.7% and 25.6%, P = 0.02). Similar trends were observed for AST levels. Moreover, participants with a higher BMI exhibited significantly higher rates of at least one abnormal liver function enzyme (15.9% vs. 34.9%, P = 0.01). Logistic regression analysis revealed a significant association between abnormal liver enzyme levels and certain demographic and socioeconomic factors, specifically BMI and age. Conclusions This study provides insights into the prevalence of liver enzyme abnormalities and their associated factors among NPNL Bangladeshi women. The findings underscore the importance of addressing factors such as BMI and age in mitigating liver health issues in this population. Further research and targeted interventions are warranted to address these concerns effectively.

Effect of Eight Weeks of Vitamin D Consumption and Exercise in Water on Liver Enzymes and Mental Health of Women with Type 2 Diabetes

Background: Several epidemiological studies have investigated the association between vitamin D deficiency and abnormal liver enzyme levels and type 2 diabetes (T2D) with inconsistent conclusions. Objectives: The current research aims to evaluate the effect of eight weeks of vitamin D consumption alongside exercise in water on liver enzymes and the mental health of women with type 2 diabetes. Methods: Forty women with type 2 diabetes aged 40 to 60 were divided into four groups of 10 subjects: (1) exercise in water and vitamin D supplementation, (2) exercise in water, (3) vitamin D supplementation, and (4) control group. The water exercise group performed three exercise sessions per week for eight weeks (Borg scale of 14), and vitamin D supplementation groups consumed 50,000 (IU) vitamin D every week. Liver enzymes and mental health (Beck's Stress and Anxiety (BAI) questionnaire (21 questions, alpha Cronbach 0.92) and depression (BDI-II) questionnaires (21 questions, alpha Cronbach 0.87)) were administered before and after eight weeks of training. The data were analyzed using descriptive and inferential statistics by SPSS software version 21. Kolmogorov-Smirnov test and one-way analysis of variance and paired t-test were used to analyze the data at a significance level of 0.05. Results: Aspartate aminotransferase and alanine aminotransferase decreased significantly after eight weeks in the vitamin D + water exercise and water exercise groups (P &lt; 0.05). Moreover, depression and stress scores significantly decreased after the intervention in the vitamin D + water exercise and water exercise groups (P &lt; 0.05). Conclusions: The findings demonstrated that exercise in water plus vitamin D consumption improved anthropometric indices and liver enzymes and alleviated depression and stress in patients with type 2 diabetes. These two interventions can be combined to reduce type 2 diabetes complications.

EPH163 Association of Weight Loss Agents with the Risk of Abnormal Liver Function: A Population-Based Cross-Sectional Study

Although the widespread use of weight control agents might increase the risk of abnormal liver function, few case reports have described this finding. This study was to compare the associations of weight loss agents with the risk of abnormal liver enzyme levels at the population level.

Assessment of Antioxidant, Antimicrobial, and Acute Toxicology Profiles of Cordia rothii and Viola serpens

Background: Plants possess a vast array of bioactive compounds with strong antioxidant properties, which can be explored for their potential pharmacological activities and utilized as novel therapeutic agents. Objective: The current study was designed to rationally justify the use of Cordia rothii (CR) and Viola serpens (VS) as antioxidants, antibacterials, and antifungals, as they have traditionally been used for such purposes. Methods: Phytochemical screening of aqueous methanolic extracts from CR and VS was conducted, followed by measuring their antioxidant potentials, including total phenolic and flavonoid content, 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) and reducing power capacity. Additionally, in vitro antibacterial and antifungal tests, as well as in vivo acute toxicity assessment were carried out. Results: The phytochemical screening of the CR and VS extracts revealed the presence of saponins, tannins, anthraquinones, and flavonoids. Both extracts exhibited antioxidant scavenging potential with IC50 values of 0.039 and 0.05 mg/ml, respectively. The CR extract displayed bactericidal activity against S.aureus ATCC 6538, S.epidermidis ATCC 12228, and E.coli ATCC 8739, while no antifungal activity was observed in either extract. The LD50 of either extract was calculated to be greater than 10 g/kg/bw. In the acute toxicity study, no toxic effects were observed on body weight, water intake, liver weight, or abnormal liver enzyme levels. Histopathological studies showed no significant abnormalities in the control or extract-treated groups. Conclusion: It can be concluded that the traditional uses of plant extracts possess potent antibacterial and antioxidant properties, which could potentially be utilized as a novel drug.

Evaluation of the therapeutic effect of Olibanum extract against enteric and intramuscular phases of trichinosis in experimentally infected mice.

Trichinosis is a global food-borne zoonotic disease. Most drugs used in its treatment have low bioavailability and reduced activity against larvae. Therefore, there is an urgent need for safe and effective medications. This study aimed to investigate the in vivo anti-parasitic and anti-inflammatory efficacy of olibanum (OL) extract, alone or combined with albendazole (ABZ) during both intestinal and muscular phases of trichinosis. Male Swiss albino mice (n = 130) were allocated to seven groups, with 20 mice in each group except for the negative control group (10 mice): negative control (GI), positive control (GII), OL25- treated (GIII), OL50- treated (GIV), ABZ50- treated (GV), OL25 + ABZ25 (GVI), and OL50 + ABZ25 (GVII). For intestinal and muscular phase analysis, each group was divided into two subgroups based on euthanizing day (6 and 35 days post-infection). The drug's efficacy was evaluated through parasitological, biochemical, histopathological, and immunohistochemical studies. OL extract at both concentrations (25 mg/kg/d, 50 mg/kg/d) significantly reduced adult (53.7% and 68.1%, respectively) and larval counts (57.3% and 78.8%, respectively). It improved the histopathological changes in intestine and muscle. The expression of CD8+ T cells and the serum level of IL-10 increased significantly during both intestinal and muscular phases (P < 0.05) in OL50 treated mice. Additionally, OL decreased abnormal levels of liver enzymes (ALT & AST). Its effects were dose-dependent in both adult and larval stages. In conclusion, OL exhibits promising in vivo activity against both stages of Trichinella spiralis infection, particularly at the intramuscular phase. It can be safe as an alternative treatment for trichinosis.

Drug-induced liver injury causality assessment data from a crosssectional study in Brazil: a call for the use of updated RUCAM in hospital Pharmacy

Objective: to identify the frequency of DILI inpatients from abnormal liver enzyme levels using the updated Roussel Uclaf Causality Assessment Method (RUCAM) causality assessment algorithm, as well as to provide a descriptive analysis of DILI cases. Methods: we conducted a crosssectional study in a medium complexity hospital in southern Brazil. Data regarding DILI was collected retrospectively from electronic medical records (EMR) in 2015. Inclusion criteria were all adult patients (≥ 18 years old) who presented alanine aminotransferase (ALT) greater than twice the superior limit of normality (ALT &gt; 60 UI/L) with concomitant change of aspartate aminotransferase (AST) or alkaline phosphatase (ALP) or change of ALP greater than twice the superior limit of normality (ALP &gt; 250 UI/L) during hospitalization. The RUCAM was applied to all suspected DILI cases. Results: 84,134 inpatients in this period; 178 patients had abnormal liver tests, six patients had sufficient medical information to allow DILI causality assessment, and two patients had DILI described in EMR, although our group could not find suficient information to apply RUCAM retrospectively. Absence of information was mainly related to drug reconciliation at hospital admission, time of onset of suspected drug therapy and no description of previous clinical conditions in EMR. Four patients developed hepatic injury as a result of drug treatment initiated during hospitalization. Suspected drugs were antibiotics, nonsteroidal anti-inflammatory drugs, antiviral, tuberculostatics and platelet antiaggregant. Liver injury pattern was identified as hepatocellular and mixed. Conclusion: DILI appeared as a rare ADR, but absence of data in most EMR affected the application of RUCAM and underestimated DILI frequency. There is an urgency to develop DILI knowledge in Brazilian hospitals. Pharmacists must be aware of the use of the updated RUCAM to prospectively assess possible DILI cases. For future research, we suggest to combine cross-linking DILI tracers such as ICD-10 liver injury codes, abnormal liver biomarkers, search for trigger hepatotoxicity drugs and EMR text search tools, adding artificial intelligence to pharmacovigilance and hospital pharmacy.

Association between long working hours and liver enzymes: evidence from the Korea National Health and Nutrition Examination Survey, 2007-2017.

BackgroundLong working hours causes several health risks, but little is known about its effects on the liver. This study aimed to examine the correlation between working hours and abnormal liver enzyme levels.MethodsWe used data from the Korea National Health and Nutrition Examination Survey IV–VII. For the final 15,316 study participant, the information on working hours was obtained through questionnaires, and liver enzyme levels, consisting of serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), through blood tests. The relationship between weekly working hours and abnormal levels of liver enzymes was analyzed using multiple logistic regression, and a trend test was also conducted.ResultsIn male, working ≥ 61 hours per week was significantly associated with elevated AST and ALT levels compared with working 35–52 hours per week. Even after adjusting for covariates, the odds ratios (ORs) of abnormal AST and ALT increased by 1.51 (95% confidence interval: 1.20–2.05) and 1.25 (1.03–1.52), respectively, and a dose-response relationship was observed. This association was more prominent among the high-risk group, such as those aged > 40 years, obese individuals, worker on non-standard work schedule, pink-collar workers, or temporary worker. No correlation was observed in female.ConclusionsLong working hours are associated with abnormal liver function test results in male. Strict adherence to statutory working hours is necessary to protect workers’ liver health.

What is the influence of cinnamon supplementation on liver enzymes? A systematic review and meta-analysis of randomized controlled trials.

Existing evidence has uncovered the potential health benefits of cinnamon intake; however, its effect on liver function is unclear. Thus, the aim of this systematic review and meta-analysis was to examine the effect of cinnamon supplementation on liver enzymes. Relevant articles were identified through a systematic search in PubMed/Medline, Scopus, Web of Science, Cochrane Library, and Embase up to September 2020. All trials assessing the effect of oral cinnamon supplementation on serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) in adults were included. The pooled effect sizes were obtained using the random-effects model and expressed as mean difference (MD) and 95% confidence intervals (CI). A total of seven original trials (nine treatment arms) involving a total of 256 subjects were included in the final analysis. The pooled analysis indicated that cinnamon supplementation had no significant effect on serum levels of ALT, AST, and ALP. However, there was a significant reduction in ALT levels in patients with type 2 diabetes (MD: -4.01 U/L; 95% CI: -6.86, -1.15) and in trials with low-dose supplementation (<1,500 mg/d), follow-up duration longer than 12 weeks, and in the elderly patients (aged>50 years). The beneficial effects of cinnamon intake were also shown in AST levels in patients with type 2 diabetes and trials with long-term follow-up (>12 weeks). Longer-term, oral cinnamon supplementation may improve serum levels of liver enzymes in patients with type 2 diabetes. Further high-quality studies are needed, especially in populations with abnormal liver enzyme levels, to firmly establish the clinical efficacy of cinnamon on liver function.

Examining Liver Function in Adults with Diabetes in the United States.

Hyperglycemia is the hallmark of various types of diabetes and considered to be a risk factor for several chronic disorders including liver function. Though liver is a dynamic organ, incessant glucotoxicity can lead to altered liver function. The goals of the present study were to examine the association between diabetes with liver functions amongst adults in the United States. We analyzed14,948 adultswith diabetes in the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2016.Diabetes and prediabetes were defined in accordance with theAmerican Diabetes Association 2021 guidelines. The association of demographic characteristics with glycemic levelswas analyzedusing the Chi-square test. A multivariate logistic regression model was constructed to evaluate the associations of glycemic levels with abnormal liver enzyme levels. Regression model was adjusted for age, sex, and ethnicity. The statistical analyses were performed using STATA ver. 14. A. p value of ≤0.05 or≤0.001 was considered statistically significant. A total of 14,948 adults (20 years and above) were included in this study. Sample mean age was 45.5±0.33 yrs., 54% were female, 53% were non-Hispanic White, and 60% had some college or graduate level education. In the overall sample, 19% adults were diabetic and 34% were pre-diabetic. Pre-diabetic glycemic levels were associated over one and half times higher odds of ALT (OR: 1.45, 95% CI: 1.31, 1.60, p<0.001) and over 1.3 times of higher odds AST (OR: 1.30, 95% CI: 1.14, 1.49,p<0.001). On the other hand, diabetic glycemic levels were associated with close to one and half times higher odds of ALT (OR: 1.37, 95% CI: 1.18, 1.59,p<0.001) and AST (OR: 1.48, 95% CI: 1.24, 1.76, p<0.001). On regression analysis, after adjustment, pre-diabetic and diabetic status was associated with high ALT (OR: 1.21, 95%CI: 1.11, 1.32, p<0.001), AST (OR: 1.14, 95%CI: 1.04, 1.27, p<0.05), ALP (OR: 1.40, 95%CI: 1.16, 1.68, p<0.001) and GGT (OR: 1.42, 95%CI: 1.24, 1.63, p<0.001). Our results indicated that diabetes is significantly associated with liver function. This observed association deserves further exploration to understand the longitudinal impact of diabetes on liver function.

952-P: Deranged Liver Enzyme Levels and Indices of Hepatic Steatosis and Fibrosis on the Development of Gestational Diabetes

Objective: Nonalcoholic fatty liver disease has been associated with the development of gestational diabetes (GDM). We sought to determine whether abnormal liver enzyme levels and indices of hepatic steatosis and fibrosis in an entire pregnant population are associated with GDM development. Methods: A retrospective cohort study was conducted on adult women (≥18 years) who delivered at 2 teaching hospitals in Sydney Australia from January 2016 to December 2017. Liver enzymes (aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin (ALB) and bilirubin (BIL)) obtained 12 months pre-gravid, or during pregnancy but prior to GDM screening, were extracted from the hospital pathology database and linked with oral glucose tolerance test results. The Fibrosis-4 (FIB-4) and Hepatic Steatosis Index (HSI) were calculated. Univariate analysis was undertaken to determine the association between deranged liver enzymes, FIB-4, HSI and GDM. Multiple logistic regression, with adjustment for age, ethnicity, pre-gravid body mass index (BMI), parity, prior GDM and family history of diabetes, was conducted to determine if any of these were independent predictors of GDM. Results: Over 2 years, 1429 women had liver enzymes collected. As per IADPSG (2010) criteria, 255 had diagnosed GDM, of which 82 (32.2%) were obese (BMI &amp;gt;30kg/m2), 243 (82.4%) were multiparous, and 223 (87.5%) had prior GDM. Elevated GGT (&amp;gt;35IU/L, p=0.006) and HSI (p=0.005) were associated with development of GDM, whilst low ALB (&amp;lt;35g/L) and elevated ALP (&amp;gt;110IU/L), ALT (&amp;gt;35IU/L), AST (&amp;gt;35IU/L), BIL (&amp;gt;19umol/L) and FIB-4 were not. On adjustment for confounders, elevated GGT (AOR 1.1, 95% CI 0.32-3.8, p=0.88) and HSI (AOR 0.6, 95% CI 0.26-1.3, p=0.21) were not independent predictors of GDM. Conclusions: Our results indicate deranged liver enzymes or clinical indices of hepatic steatosis and fibrosis were not associated with GDM. Disclosure T. Y. L. Chai: None. D. Pasupathy: None. J. George: None. N. Cheung: None.

Nonalcoholic fatty liver disease is a risk factor for glucose intolerance onset in men regardless of alanine aminotransferase status.

IntroductionFatty liver disease (FLD) is a surrogate condition for glucose intolerance development. FLD may involve normal or abnormal liver enzyme levels. Whether FLD is a risk factor for glucose intolerance, regardless of liver enzyme levels, remains unknown. We assessed relationships between the development of impaired fasting glucose (IFG) and FLD, liver enzyme abnormalities, and alcohol consumption.Materials and MethodsWe retrospectively evaluated 8,664 participants with more than two annual health check‐ups. Participants were classified according to sex, alcohol consumption, alanine aminotransferase (ALT) levels, and fatty liver status.ResultsIn univariate analyses, IFG onset among men was related to normal or high ALT levels with FLD in the nonalcoholic and alcoholic groups (P‐trend < 0.01). In multivariate analyses, IFG onset among nonalcoholic men was associated with normal or high ALT levels with FLD, independent of potential confounding factors (P‐trend < 0.01). However, IFG onset was non‐independently associated with any condition among alcoholic men. In univariate analyses, IFG onset among women was related to normal or high ALT levels with FLD in the nonalcoholic group (P‐trend < 0.01) and high ALT levels with FLD in the alcoholic group (P‐trend < 0.05). In multivariate analyses, IFG onset was independently associated with only normal ALT levels in nonalcoholic FLD women.ConclusionsAmong nonalcoholic men and women, FLD was a risk factor for IFG onset, including normal ALT concentrations. Care is needed for individuals with nonalcoholic FLD, regardless of liver injury, possibly helping reduce glucose intolerance risk.

Increased Morbidity and Mortality in COVID-19 Patients with Liver Injury.

BackgroundThere is a high prevalence of liver injury (LI) in patients with coronavirus disease 2019 (COVID-19); however, few large-scale studies assessing risk factors and clinical outcomes in these patients have been done.AimsTo evaluate the risk factors and clinical outcomes associated with LI in a large inpatient cohort of COVID-19 patients.MethodsAdult patients with COVID-19 between March 1 and April 30, 2020, were included. LI was defined as peak levels of alanine aminotransferase/aspartate aminotransferase that were 3 times the ULN or peak levels in alkaline phosphatase/total bilirubin that were 2 times the ULN. Mild elevation in liver enzymes (MEL) was defined as abnormal peak liver enzyme levels lower than the threshold for LI. Patients with MEL and LI were compared to a control group comprising patients with normal liver enzymes throughout hospitalization.ResultsOf 1935 hospitalized COVID-19 patients, 1031 (53.2%) had MEL and 396 (20.5%) had LI. Compared to control patients, MEL and LI groups contained proportionately more men. Patients in the MEL cohort were older compared to control, and African-Americans were more highly represented in the LI group. Patients with LI had an increased risk of mortality (relative risk [RR] 4.26), intensive care unit admission (RR, 5.52), intubation (RR, 11.01), 30-day readmission (RR, 1.81), length of hospitalization, and intensive care unit stay (10.49 and 10.06 days, respectively) compared to control.ConclusionOur study showed that patients with COVID-19 who presented with LI had a significantly increased risk of mortality and poor clinical outcomes.

Prevalence of elevated liver enzymes and their association with type 2 diabetes risk factors in children.

Given their established role in hepatic function and insulin resistance for adults, early screening of type 2 diabetes mellitus (T2DM) in the pediatric population may potentially be improved by the assessment of elevated liver enzymes. Our study enrolled 151 nondiabetic children aged 10-14years. Patients were assessed for demographics and five risk factors for T2DM. The levels of γ-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) levels were determined in serum samples. The effects of demographics and risk factors on abnormal liver enzyme levels were assessed with univariate chi-square analyses and also with multivariate logistic regression analyses, which were controlled for gender. Frequencies for abnormal liver enzyme values were as follows: 13 (9%) for GGT, 5 (3%) for ALT, and 20 (13%) for ALP. Across analyses, two results were consistently statistically significant. Females were more likely to have abnormal ALP levels, and patients with BMI percentile≥95% and with acanthosis nigricans were more likely to have abnormal GGT levels. Our study suggests GGT as potential marker for T2DM discovery in children. Subsequent long-term longitudinal studies would help to more clearly delineate GGT's association with T2DM. Additionally, future studies that elucidate the molecular contribution of GGT elevation to T2DM pathogenesis are needed.

COVID‐19 complications on the digestive system and liver: A current clinical and pathophysiological approach

AbstractThe coronavirus disease‐2019 (COVID‐19) pandemic is a public health threat impacting people all over the world. Although severe acute respiratory coronavirus syndrome (SARS‐CoV‐2) was identified as a virus for the respiratory system, it might be responsible for the digestive symptoms associated with COVID‐19. Common gastrointestinal symptoms in COVID‐19 patients are anorexia, vomiting, nausea, abdominal pain, and diarrhea, in addition to abnormal levels of liver enzymes. While the diagnosis of SARS‐CoV‐2 based essentially on respiratory samples, fecal SARS‐CoV‐2 RNA‐analysis can be used as a diagnostic test. In the current COVID‐19 pandemic, 10% to 50% of patients reported hepatic‐gastrointestinal manifestations, especially those with severe illness. Although the gastrointestinal infection is not completely understood, the tissue injury may be due to the direct cytopathic effect of SARS‐CoV‐2, which can invade through the angiotensin conversion enzyme‐2 (ACE2) receptor. Notably, ACE2 receptor expression has been identified in the gastrointestinal tract and cholangiocytes of the liver. Also, COVID‐19 gastrointestinal influence may be multifactorial and related to the cytokine storm, drug‐induced liver injury, and ischemic hypoxic reperfusion that cause multi‐organ injury. This brief review summarizes the available data on the liver and gastrointestinal complications induced by SARS‐CoV‐2 infection, focusing mainly on the mechanisms of pathogenicity.

Evaluation of liver function in symptomatic COVID-19 patients

Context:The coronavirus disease 2019 (COVID-19) is a viral respiratory illness which was first detected in Wuhan, Hubei Province, China. A few case studies demonstrated that 14–53% of the cases of COVID-19 reported abnormal levels of liver enzymes during disease progression. Patients with severe COVID-19 seem to have higher rates of hepatic dysfunction.Aims:Our aim was to investigate the changes in the liver function test in COVID-19 patients admitted to hospital and its association with the severity of the disease, length of hospital stay, and outcome of patients.Settings and Design:This was a cross-sectional study involving 678 COVID-19 patients, who were admitted at AIIMS, Bhopal.Methods and Material:The case records of 678 patients were evaluated by the research team from the Department of Medicine, AIIMS, Bhopal, and data were analyzed. All laboratory data were obtained. The liver function tests (LFT) including alanine aminotransferase, aspartate aminotransferase, and total bilirubin values were recorded, and liver dysfunction defined as any parameter having more than the upper limit of normal value.Results:From April 2020 to September 2020, a total of 678 COVID-19 patients were screened, and 600 were assessed for eligibility; 78 were excluded due to either significant alcohol history or due to prior liver disease. Among the 600 patients, 265 patients (44.16%) had liver dysfunction while 335 patients (55.83%) had a normal liver function. The patients having a severe disease were more affected by liver dysfunction than the mild disease patients. The average hospital stay was more in those patients having liver dysfunction than in those patients with normal liver function. Among the patients with normal LFT on admission, 97.9% got cured while 2.1% died. Among the patients with liver dysfunction, 80.4% got cured and 19.6% died.Conclusions:Hepatic injury is common in severe COVID-19 patients, which may be caused by direct injury to the bile duct cells by a virus or indirectly by a cytokine storm. The liver function should be evaluated in all symptomatic COVID-19 patients. In patients with pre-existing liver diseases, special attention should be paid to monitoring and treatment.

Liver Enzymes and Inpatient Deaths in COVID-19 Hospitalized Patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [COVID-19] quickly turned into a pandemic. Gastrointestinal involvement, especially liver diseases, is one of the main complications of COVID-19 patients. Objectives: The current study aimed to evaluate the high incidence of liver involvement in COVID-19 hospitalized patients and its association with mortality. Methods: A total of 560 hospitalized patients with a confirmed diagnosis of COVID-19 were included. Death was considered as the outcome. In addition to liver enzymes, demographic, clinical, and other laboratory data were also collected. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels ≥ 40 were considered as abnormal. To investigate the association between abnormal levels of liver enzymes and death, multiple regression logistic was used. Results: According to the findings, 29.1% (95% CI = 25.3% - 32.9%) of patients had high levels (≥ 40 IU) of ALT, and 45.1% (95% CI = 40.9% - 49.3%) had high levels of AST (≥ 40 IU). The frequency (based on %) of high levels of AST (≥ 40 U/liter) was significantly higher in patients who died [67.3% (95% CI = 54.5% - 80.1%] of COVID-19 than those who survived [44.9% (95% CI = 39.7% - 50.0%)] (P-value &lt; 0.001). No significant difference was detected in ALT between expired [29.1% (95% CI = 16.7% - 41.5%)] and survived patients [30.7% (95% CI = 25.9% - 35.5%] (P-value = 0.791). AST was found to have an independent association with death in multiple logistic regression (Wald = 4.429, OR (95% CI) = 1.014 (1.008 - 1.020), P-value = 0.035). Conclusions: Liver involvement is a common finding in COVID-19 hospitalized patients. Higher levels of AST were significantly associated with an increased mortality rate in COVID-19 patients.

COVID-19 associated variations in liver function parameters: a retrospective study

BackgroundCharacteristics of laboratory findings of COVID-19 patients are of great significance for diagnosis and treatment. Studies that have analysed the variations in hepatic profile in correlation with the inflammatory markers...

Frequently abnormal serum gamma-glutamyl transferase activity is associated with future development of fatty liver: a retrospective cohort study

BackgroundNonalcoholic fatty liver disease is characterized by excessive hepatic fat accumulation. Some individuals frequently present elevated gamma-glutamyl transferase (GGT) levels without fatty liver ultrasound images and other abnormal liver enzymes levels. However, whether these individuals are at an elevated risk for developing fatty liver is unclear. We compared fatty liver change rates and risk factors between individuals with frequently elevated GGT levels and those with normal levels.MethodsWe designed a retrospective cohort study on the basis of complete medical checkup records. One group of individuals had presented normal serum GGT levels during the observation period (Normal-GGT group, n = 2713). Another group had had abnormal elevated serum GGT levels frequently (Abnormal-GGT group, n = 264). We determined the fatty liver change incident rates before and after propensity score matching. We explored confounding factors affecting fatty changes in each group using univariate and multivariate Cox models.ResultsThe change incidence rates were 5.80/1000 and 10.02/1000 person-years in the Normal-GGT and Abnormal-GGT groups, respectively. After propensity score matching, the incidence rates were 3.08/1000 and 10.18/1000 person-years in the Normal-GGT and Abnormal-GGT groups, respectively (p = 0.026). The factors associated with fatty liver changes in the Normal-GGT group included body mass index (BMI), hemoglobin, alanine aminotransferase (ALT), albumin, triglyceride (TG), fasting blood sugar, and high-density lipoprotein levels. Those in the Abnormal-GGT group were platelet counts and TG. In our multivariable analysis, BMI, ALT, albumin, and TG levels were independent predictors of fatty changes in the Normal-GGT group, and high TG level was the only independent predictor in the Abnormal-GGT group.ConclusionsThe incidence rate of fatty liver change in the Abnormal-GGT group was higher than that in the Normal-GGT group. Consecutive elevated GGT levels increase the risk for fatty liver, and high TG levels in those individuals further independently increase the risk.