Abnormal Aminotransferase Levels Research Articles

Bioinformatics based exploration of the anti-NAFLD mechanism of Wang’s empirical formula via TLR4/NF-κB/COX2 pathway

BackgroundNonalcoholic fatty liver disease (NAFLD) has developed as a leading public wellness challenge as a result of changes in dietary patterns. Unfortunately, there is still a lack of effective pharmacotherapy methods for NAFLD. Wang’s empirical formula (WSF) has demonstrated considerable clinical efficacy in treating metabolic disorders for years. Nevertheless, the protective effect of WSF against NAFLD and its underlying mechanism remains poorly understood.MethodsThe NAFLD model was established using a 17-week high-sucrose and high-fat (HSHF) diet with 32 ICR mice. In assessing the therapeutic efficacy of WSF on NAFLD, we detected changes in body weight, viscera weight, biomarkers of glycolipid metabolism in serum and liver, transaminase levels and histopathology of liver with H&E and Oil Red O staining after oral administration. The chemical components in WSF were extensively identified and gathered utilizing the HPLC-Q-TOF/MS system, database mining from HMDB, MassBank, and TCMSP databases, alongside literature searches from CNKI, Wanfang and VIP databases. The forecast of network pharmacology approach was then utilized to investigate the probable mechanisms by which WSF improves NAFLD based on the performance of prospective target identification and pathway enrichment analysis. Besides, molecular docking was also conducted for the verification of combination activities between active components of WSF and core proteins related to NAFLD. In final, validation experiments of obtained pathways were conducted through ELISA, immunohistochemistry (IHC), and western blot (WB) analysis.ResultsPharmacodynamic outcomes indicated that WSF intervention effectively mitigated obesity, fat accumulation in organs, lipid metabolism disorders, abnormal transaminase levels and liver pathology injury in NAFLD mice (P < 0.05, 0.01). A total of 72 existent ingredients of WSF were acquired by HPLC-Q-TOF/MS and database, and 254 common targets (11.6% in total targets) of NAFLD and WSF were identified. Network pharmacology revealed that WSF presses NAFLD via modulating TNF, IL6, AKT1, IL1B, PTGS2 (COX2), and other targets, and the probable pathways were primarily inflammatory signaling pathways, as confirmed by molecular docking. Molecular biology experiments further conformed that WSF could decrease levels of inflammatory factors like IL-1β, IL-6 and TNF-α (P < 0.01) and expression of TLR4, NF-κB and COX-2 (P < 0.05, 0.01) in the liver.ConclusionWSF treatment effectively protects against lipid metabolism disorders and liver inflammation injury in HSHF diet-induced NAFLD mice, and its molecular mechanism might be via suppressing the TLR4/NF-κB/COX-2 inflammatory pathway to reduce the release of inflammatory cytokines in the liver.Graphical abstract

The role of arginase estimation to predict hypertensive disorder of pregnancy at an earlier stage.

To determine the significance of serum arginase estimation as a predictor of pregnancy-induced hypertension and preeclampsia at an early stage. The observational, cross-sectional study was conducted from October 15, 2021, to October 15, 2022, at the Department of Chemical Pathology, in collaboration with the Department of Obstetrics and Gynaecology, Pakistan Railway Hospital, Islamic International Medical College Trust, Rawalpindi, Pakistan, and comprised pregnant women with 20-25 weeks of gestation who were divided into three groups. Those having no complications were placed in control group A, those with pregnancy-induced hypertension in group B, and those with preeclampsia in group C. Serum arginase, uric acid, alanine transaminase, platelet count and spot urinary protein levels were measured for each subject. Data was analysed using SPSS 26. Of the 90 women, 30(33.3%) were in group A with mean age 27.27±2.90 years, 30(33.3%) were in group B with mean age 30.17±2.48 years, and 30(33.3%) were in group C with mean age 29.33±3.11 years. There were significant intergroup differences in the mean levels of serum arginase, serum uric acid, alanine transaminase, platelet count and spot urinary protein (p<0.05). A moderate to marked increase in serum arginase levels in pregnancy-induced hypertension and preeclampsia cases, combined with abnormal serum uric acid and alanine transaminase levels along with low platelet count suggested that serum arginase estimation could be used to predict hypertensive disorders of pregnancy at an early stage.

Point prevalence and clinical profile of patients with delirium admitted in internal medicine department at tertiary care centre in eastern Nepal: a descriptive cross-sectional study.

Delirium, marked by acute disturbances in consciousness and cognition, remains underdiagnosed despite its significant impact on morbidity and mortality. This study investigates the point prevalence and clinical profile of delirium in patients at an eastern Nepal tertiary care centre. A 1-month descriptive cross-sectional study involved 152 Internal Medicine Department patients at BPKIHS, Dharan. Data, collected through face-to-face interviews and the Confusion Assessment Method (CAM), analyzed demographic details, clinical history, and laboratory findings. Ethical clearance and informed consent were obtained. Among 152 participants, 13.2% exhibited delirium, with notable risk factors identified. Elderly patients (≥65 years) and those with nasogastric tubes faced higher risks. Significant associations were found with cardiovascular diseases (P=0.002), central nervous system diseases (P=0.015), and alcoholism (P=0.003). Laboratory findings revealed correlations with elevated creatinine, hyperuremia, and abnormal aspartate aminotransferase levels. The study emphasizes key contributors to delirium, providing valuable insights for clinicians in identifying, preventing, and managing delirium in a hospital setting. This study provides critical insights into delirium prevalence and profiles in Eastern Nepal. Identified risk factors underscore the importance of routine screenings and targeted interventions for at-risk populations. Study limitations, including sample size and single-centre focus, call for further research to validate findings and enhance our understanding of delirium's management across diverse healthcare settings. Overall, the study informs clinical practices and prompts broader exploration of delirium in healthcare contexts.

Pectolinarigenin attenuates hepatic ischemia/reperfusion injury via activation of the PI3K/AKT/Nrf2 signaling pathway

Hepatic ischemia/reperfusion (I/R) injury is an unavoidable complication of liver hepatectomy, transplantation, and systemic shock. Pectolinarigenin (Pec) is a flavonoid with many biological activities, which include anti-inflammatory, anti-apoptotic, and antioxidant stress. This study explored whether Pec pretreatment could reduce hepatic I/R injury and the potential mechanisms at play. After pretreatment of mice and AML12 cells with Pec, I/R and hypoxia/reoxygenation (H/R) models were established. By examining markers related to liver injury, cell viability, oxidative stress, inflammatory response, and apoptosis, the effect of Pec on important processes involved in hepatic I/R injury was assessed. Protein levels associated with the PI3K/AKT/Nrf2 pathway were analyzed by relative quantification to investigate possible pathways through which Pec plays a role in the I/R process. Pec treatment corrected abnormal transaminase levels resulting from I/R injury, improved liver injury, and increased AML12 cell viability. Moreover, Pec treatment inhibited oxidative stress, inflammation and apoptosis and could activate the PI3K/AKT/Nrf2 pathway during I/R and H/R. Further studies found that LY294002 (PI3K inhibitor) suppressed the protective effect of Pec on hepatic I/R injury. In summary, our results show that Pec inhibits oxidative stress, inflammatory responses, and apoptosis, thereby attenuating I/R-induced liver injury and H/R-induced cell damage via activation of the PI3K/AKT/Nrf2 pathway.

Diagnostic performance of the fibrosis-4 index and the NAFLD fibrosis score for screening at-risk individuals in a health check-up setting.

The fibrosis-4 index (FIB-4) and the NAFLD fibrosis score (NFS) have been used as noninvasive screening methods for advanced fibrosis in patients with NAFLD. However, their diagnostic performance has not been evaluated in at-risk individuals regardless of hepatic steatosis. This study evaluated the performance of the FIB-4 and NFS in at-risk groups of health check-up examinees at mass screening centers. This retrospective, cross-sectional study included 8545 participants who underwent voluntary magnetic resonance elastography at a discounted fee during their regular health check-ups at 13 mass screening centers nationwide. The at-risk group was defined as those with any of the following conditions: NAFLD, 2 or more metabolic abnormalities, diabetes mellitus, or abnormal aminotransferase levels. A magnetic resonance elastography cutoff of ≥3.6kPa was used to define conventional advanced fibrosis. According to the proposed criteria, the proportion of at-risk individuals was 67.4%-80.2% in the health check-up cohort without viral or alcohol-associated liver disease. The prevalence of individuals with advanced hepatic fibrosis in each at-risk group was ~2.3%-2.8% according to various criteria. It was higher in patients without NAFLD than in those with NAFLD. A total of 28.2%-39.6% of those in each at-risk group did not show hepatic steatosis on ultrasonography. The performance of FIB-4 for advanced fibrosis in the at-risk group was comparable with that in the NAFLD group. FIB-4 showed a better area under the receiver operating characteristic curve and sensitivity than NFS in the at-risk group. FIB-4 demonstrated superior performance compared with the NFS, and its performance in at-risk individuals was similar to that observed for patients with NAFLD.

A Cross-sectional Real-life Study of the Prevalence, Severity, and Determinants of Metabolic Dysfunction-associated Fatty Liver Disease in Type 2 Diabetes Patients.

Most data on liver assessment in type 2 diabetes mellitus (T2DM) patients are from retrospective cohorts with selection bias. We aimed at appraising the feasibility, results, and benefits of an outpatient systematic noninvasive screening for metabolic dysfunction-associated fatty liver disease (MAFLD) severity and determinants in T2DM patients. We conducted a 50-week cross-sectional study enrolling adult T2DM outpatients from a diabetes clinic. An algorithm based on guidelines was applied using simple bioclinical scores and, if applicable, ultrasound and/or elastometry. Two hundred and thirteen patients were included. Mean age and body mass index were 62 years and 31 kg/m2 and 29% of patients had abnormal transaminase levels. The acceptance rate of additional liver examinations was 92%. The prevalence of MAFLD, advanced fibrosis and cirrhosis was 87%, 11%, and 4%, respectively. More than half of the cases of advanced fibrosis had not been suspected and were detected by this screening. MAFLD was associated with poor glycemic control, elevated transaminases, low HDL-C and the absence of peripheral arterial disease. Advanced fibrosis was linked to high waist circumference and excessive alcohol consumption, which should be interpreted with caution owing to the small number of patients reporting excessive consumption. Simple bioclinical tools allowed routine triage of T2DM patients for MAFLD severity, with high adherence of high-risk patients to subsequent noninvasive exams.

Lysosomal acid lipase deficiency manifestations in children and adults: Baseline data from an international registry.

Lysosomal acid lipase deficiency (LAL-D) is a rare, autosomal recessive disease involving lysosomal accumulation of cholesteryl esters and triglycerides. The International Lysosomal Acid Lipase Deficiency Registry (NCT01633489), established in 2013 to understand LAL-D natural history and long-term outcomes, is accessible to centres caring for patients diagnosed by deficient LAL activity and/or biallelic pathogenic LIPA variants. We describe the registry population enrolled through 2 May 2022. In this prospective observational study, we analysed demographic and baseline clinical characteristics of children (ages ≥6 months to <18 years) and adults diagnosed with LAL-D. Of 228 patients with confirmed disease, 61% were children; 202/220 (92%) with data on race were white. Median age was 5.5 years at sign/symptom onset and 10.5 years at diagnosis; median time from sign/symptom onset to diagnostic testing was 3.3 years. The most common manifestations raising suspicion of disease were elevated alanine (70%) and aspartate aminotransferase levels (67%) and hepatomegaly (63%). Among 157 with reported LIPA mutations, 70 were homozygous and 45 were compound heterozygous for the common exon 8 splice junction pathogenic variant (E8SJM-1). Seventy percent (159/228) of patients had dyslipidaemia. Among 118 with liver biopsies, 63% had microvesicular steatosis exclusively, 23% had mixed micro- and macrovesicular steatosis and 47% had lobular inflammation. Of 78 patients with fibrosis-stage data, 37% had bridging fibrosis and 14% had cirrhosis. Although LAL-D signs/symptoms occur early, diagnosis is often delayed. Abnormal transaminase levels associated with hepatomegaly and dyslipidaemia should raise suspicion and prompt earlier diagnosis of LAL-D. NCT01633489.

A Newly Developed Method-Based Xanthine Oxidoreductase Activities in Various Human Liver Diseases.

Studies evaluating xanthine oxidoreductase (XOR) activities in comprehensive liver diseases are scarce, and different etiologies have previously been combined in groups for comparison. To accurately evaluate XOR activities in liver diseases, the plasma XOR activities in etiology-based comprehensive liver diseases were measured using a novel, sensitive, and accurate assay that is a combination of liquid chromatography and triple quadrupole mass spectrometry to detect [13C2, 15N2]uric acid using [13C2, 15N2]xanthine as a substrate. We also mainly evaluated the association between the plasma XOR activities and parameters of liver tests, purine metabolism-associated markers, oxidative stress markers, and an inflammation marker. In total, 329 patients and 32 controls were enrolled in our study. Plasma XOR activities were generally increased in liver diseases, especially in the active phase, such as in patients with hepatitis C virus RNA positivity, those with abnormal alanine transaminase (ALT) levels in autoimmune liver diseases, and uncured hepatocellular carcinoma patients. Plasma XOR activities were numerically highest in patients with acute hepatitis B. Plasma XOR activities were closely correlated with parameters of liver tests, especially serum ALT levels, regardless of etiology and plasma xanthine levels. Our results indicated that plasma XOR activity might reflect the active phase in various liver diseases.

The aspartate aminotransferase platelet count ratio index as an ideal predictor of dengue severity

Background: Now a days, majority of dengue patients with an abnormal aspartate aminotransferase level, and a decreased blood platelet count is linked to the severity of dengue fever. However, just a few researchers, assessed its predictive relevance for determining the severity of dengue. Hence, we aimed to assess the diagnostic value of aspartate aminotransferase platelet count ratio index for predicting dengue severity. Methods: A prospective study done among 115 patients with confirmed dengue fever (based NS1 antigen/IgM antibody positive report) who were admitted in tertiary care hospital from June 2021 to December 2021. All patients were clinically assessed and investigated for Serum transaminases and platelet count on day 1, day 4 and day 7 or on the day of discharge/death. Data was analysed using Microsoft excel and SPSS version 21.Results: A total of 115 patients, 76 (66.1%) males and 39 (33.9%) females, with the median age of the patients was 27 years (range from 15-45). Most of the patients (65, 56.5%) had dengue fever without warning signs and 20 patients (17.4%) had severe dengue disease. The aspartate aminotransferase (AST), leukocyte count, platelet count (PLT), aspartate aminotransferase/platelet count ratio index (APRI) showed a significant association with severe dengue (p&lt;0.05). With the observed 2.5 cut off value, we found the sensitivity and specificity of APRI for prediction of dengue severity as 80.0% and 76.8% respectively.Conclusions: Our study revealed that Aspartate aminotransferase/platelet count ratio index (APRI), can be useful for clinicians to predict the severity of dengue fever infection during the onset of symptoms and course of treatment for better outcome.

P37 A rare cause of autoimmune hepatitis secondary to a biological therapy

P37 A rare cause of autoimmune hepatitis secondary to a biological therapy

Undiagnosed abnormal alanine transaminase levels in vulnerable populations: Impact of sex, race/ethnicity, and body mass.

Liver disease is a leading cause of death in the United States and is often initially detected incidentally on lab tests ordered by general practitioners. Alanine transaminase (ALT), a marker of liver inflammation, is commonly ordered and may be abnormal in the setting of elevated body mass index, diabetes and dyslipidemia. Data regarding ALT testing within vulnerable populations are limited. Therefore, the prevalence of ALT testing and abnormal ALT in the absence of known chronic liver disease (CLD) among a safety-net population were assessed and factors associated with these outcomes were identified. In this retrospective longitudinal study of 92,997 patients seen between 01/2017-01/2019 within San Francisco's Safety-Net Healthcare System, electronic medical records were used to abstract data back to 04/1997. Descriptive analyses and multivariable modeling were performed. Overall, 59,323 (69%) without known CLD received an ALT test. Age, Black race, Latinx ethnicity, and metabolic factors were associated with higher odds of ALT testing, (p<0.01). Among those with an abnormal ALT (44%) without known CLD: median age 53years, 41% male, 19% White, 11% Black, 40% Latinx, 29% Asian/Pacific Islander (API), and 84% overweight/obese. On multivariable analysis, female sex (OR 2.7), Latinx ethnicity (OR 2.6), API race (OR 1.3), overweight/obesity (OR 1.8, OR 2.6), and dyslipidemia (OR 1.3) were associated with abnormal ALT, (p≤0.001). In the absence of known CLD, women, Latinx, API and persons with excess body weight were associated with greater odds of abnormal ALT. Future longitudinal studies are needed to confirm these differences and to determine if adequate work up for CLD is performed for abnormal ALT levels among at-risk populations.

Fatty Liver Change in Korean Adults in a Systematic Social Distancing System Amid the COVID-19 Pandemic: A Multicenter Analysis.

In response to the COVID-19 pandemic, the Korean government implemented policies including the systematic social distancing (SSD) system which started on 28 June 2020. The present study investigated the development and aggravation of fatty liver measured using ultrasonography during the transition period (from pre-SSD to SSD) compared to the fatty liver changes during the pre-SSD period. Changes in fatty liver and liver enzymes were assessed in different groups stratified by alcohol consumption. Our retrospective cohort analysis included 5668 participants who underwent health checkups at 13 university hospitals during the SSD period and two or more checkups before the SSD period. Fatty liver developed and aggravated more in the transition period (13.6% development and 12.0% aggravation) than in the pre-SSD period (10.8% development and 10.1% aggravation) in the alcohol consumption group. This finding was more prominent in women than in men. Abnormal alanine transaminase levels were more often developed in the transition period than in the pre-SSD period, especially in men (11.1% vs. 8.6% in each period). In conclusion, the SSD system may contribute to fatty liver changes in individuals who regularly consume alcohol. Further research of the post-pandemic period is needed to assess long-term changes in fatty liver disease.

An Observational Study to Determine Severity and Complications Associated with Non-Alcoholic Fatty Liver Disease with Special Emphasis on Riskfactors

Introduction: The clinical spectrum of NAFLD is wide extending and ranges from NAFL to NASH, advanced fibrosis, cirrhosis, HCC. It has emerged as the most prevalent chronic liver disease worldwide in adults and children's. NAFLD is commonly linked with MS such as obesity, DM, H0TN, hypercholesterolemia. Methods: This is an observational study conducted to determine risk factor, severity and complication associated with NAFLD. Data was collected from outpatient and inpatients of gastroenterology department and also through patient or care taker interview. Result: A total of 112 cases of liver disease were observed among them 61 cases were found with NAFLD. Majority of cases were examined with Grade I fatty liver. Males were more prone to develop NAFLD and the most highest prevalence was found in the age group 51-70yrs. DM is the main RF and PHTN is the common complication observed. Beta blocker, ARB, statins, are frequently observed prescribed drugs to manage risk factors and complication. Hepatoprotective drugs like ursodeoxycholic acid, SAMe are given. Conclusion: The study concluded that the prevalence of Grade I fatty liver was high followed by CLD. Further, patients with NAFLD were predominantly middle aged men, most of whom were overweight and obese. Prevalence of NAFLD appears to be substantially higher than that predicted on basis of elevated ALT levels. Male sex, BMI, abnormal transaminase level, and MS were independently associated with ultrasonographic severe fatty change. Early detection, as well as steps to prevent the condition through lifestyle modification may halt the progression of a benign disease to advanced illness. Sedentary behavior or physical inactivity is a developing issue quietly putting individuals at elevated risk.

Who Should Return for an Oral Glucose Tolerance Test? A Proposed Clinical Pathway Based on Retrospective Analysis of 332 Children

Purpose: Fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT) is the traditional diagnostic tool for type 2 diabetes (T2DM). Primary barrier to performing FPG or OGTT in asymptomatic patients is the requirement of fasting, and thus the need for another scheduled visit. For OGTT, at least 2 blood draws would be needed, making the test inconvenient and labour-intensive. These barriers may lead to lower testing rate and possibly under-diagnosis. In a busy clinic setting with increasing number of referrals for children with obesity, a more practical and simpler clinical pathway to stratify those at higher risk of having abnormal OGTT results from the lower risk ones is needed. This study thus aimed to identify simple non-fasting parameters which can be used to formulate a clinical pahtway to stratify subjects according to their risk of abnormal OGTT. Methods: This retrospective study included subjects with overweight or obesity who had undergone OGTT in tertiary paediatric unit from 2012–2018. The optimal haemoglobin A1c (HbA1c) cutoff that predicts abnormal OGTT was evaluated. Other non-fasting parameters, in combination with this HbA1c cutoff, were also explored as predictors of abnormal OGTT. Results: Three hundred and thirty-two subjects (boys: 54.2%, Chinese: 97.3%) were included for analysis, of which, 272 (81.9%) subjects had normal OGTT while 60 (18.0%) subjects had abnormal OGTT (prediabetes or T2DM). The mean age was 15.4 ± 2.3 years and the mean BMI z-score was 2.7 ± 0.6. The mean HbA1c level was significantly higher in the abnormal OGTT group than normal OGTT group (5.6% vs 5.3%, P<0.001). In our cohort, using the ADA criteria for prediabetes with a HbA1c cutoff of ≥ 5.7% only yielded a sensitivity of 41.7% and a specificity of 86% in identifying abnormal OGTT (prediabetes or T2DM), meaning that a substantial proportion of subjects with prediabetes or diabetes will be missed. From Receivers operating characteristic (ROC) curves analysis, optimal HbA1c predicting abnormal OGTT was 5.5% (AUC 0.71; sensitivity of 66.7% and specificity of 71%). When HbA1c ≥ 5.5% was combined with positive family history and abnormal alanine transaminase (ALT) level, the positive predictive value for abnormal OGTT was increased from 33.6% to 61.6%. Conclusion: In our cohort, over 97% were Chinese and close to 60% had family history of T2DM, thus fulfilling the ‘high-risk’ group criteria as suggested by American Diabetes Association to have FPG or OGTT screening. Nevertheless, only 18% of subjects had prediabetes or diabetes based on OGTT results. Our study showed that HbA1c, family history of T2DM and ALT level could be used to derive a clinical pathway to stratify children who have high risk of abnormal OGTT. These high risk individuals can go for further diagnostic tests, while those at lower risk of prediabetes/T2DM can avoid unnecessary tests and additional clinic visits.

Who should return for an oral glucose tolerance test? A proposed clinical pathway based on retrospective analysis of 332 children.

Fasting plasma glucose or oral glucose tolerance test (OGTT) is the traditional diagnostic tool for type 2 diabetes (T2DM). However, fasting is required and implementation in all overweight/obese subjects is not practical. This study aimed to formulate a clinical pathway to stratify subjects according to their risk of abnormal OGTT. This retrospective study included patients with overweight or obesity who had undergone OGTT in a tertiary paediatric unit from 2012 to 2018. The optimal haemoglobin A1c (HbA1c) cutoff that predicts abnormal OGTT was evaluated. Other non-fasting parameters, in combination with this HbA1c cutoff, were also explored as predictors of abnormal OGTT. Three hundred and thirty-two patients (boys: 54.2%, Chinese: 97.3%) were included for analysis, of which, 272 (81.9%) patients had normal OGTT while 60 (18.0%) patients had abnormal OGTT (prediabetes or T2DM). Optimal HbA1c predicting abnormal OGTT was 5.5% (AUC 0.71; sensitivity of 66.7% and specificity of 71%). When HbA1c≥5.5% was combined with positive family history and abnormal alanine transaminase (ALT) level, the positive predictive value for abnormal OGTT was increased from 33.6 to 61.6%. HbA1c, family history of T2DM and ALT level could be used to derive a clinical pathway to stratify children who have high risk of abnormal OGTT.

Multicenter Analysis of Clinical Features and Prognosis of COVID-19 Patients with Hepatic Impairment.

Background/AimsRecent data indicate the presence of liver enzyme abnormalities in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the clinical features and treatment outcomes of COVID-19 patients with abnormal liver enzymes.MethodsWe performed a retrospective, multicenter study of 874 COVID-19 patients admitted to five tertiary hospitals from February 20 to April 14, 2020. Data on clinical features, laboratory parameters, medications, and treatment outcomes were collected until April 30, 2020, and compared between patients with normal and abnormal aminotransferases.ResultsAbnormal aminotransferase levels were observed in 362 patients (41.1%), of which 94 out of 130 (72.3%) and 268 out of 744 (36.0%) belonged to the severe and non-severe COVID-19 categories, respectively. The odds ratios (95% confidence interval) for male patients, patients with a higher body mass index, patients with severe COVID-19 status, and patients with lower platelet counts were 1.500 (1.029 to 2.184, p=0.035), 1.097 (1.012 to 1.189, p=0.024), 2.377 (1.458 to 3.875, p=0.001), and 0.995 (0.993 to 0.998, p>0.001), respectively, indicating an independent association of these variables with elevated aminotransferase levels. Lopinavir/ritonavir and antibiotic use increased the odds ratio of abnormal aminotransferase levels after admission (1.832 and 2.646, respectively, both p<0.05). The median time to release from quarantine was longer (22 days vs 26 days, p=0.001) and the mortality rate was higher (13.0% vs 2.9%, p<0.001) in patients with abnormal aminotransferase levels.ConclusionsAbnormal aminotransferase levels are common in COVID-19 patients and are associated with poor clinical outcomes. Multivariate analysis of patients with normal aminotransferase levels on admission showed that the use of lopinavir/ritonavir and antibiotics was associated with abnormal aminotransferase levels; thus, careful monitoring is needed.

Role of Elevated Liver Enzymes in the Diagnosis of Liver Injury in Bluntabdominal Trauma

The liver is the second most commonly injured organ following blunt abdominal trauma. The stable patient with minimal physical findings with a history of blunt abdominal trauma presents a challenge for diagnosis of liver injury. This study was conducted to determine the usefulness of hepatic transaminases in predicting the presence of liver injury and its severity following blunt abdominal trauma. In this study we included all patients who had sustained blunt abdominal injury and were treated in hospitals attached to bmcri between November 2018 to October 2020. The grading of the liver injury was verified using CT scans or surgical findings. All patiens with blunt abdominal trauma underwent the required blood tests and were included in the study. In patients with blunt abdominal trauma, abnormal hepatic transaminase levels are associated with liver injuries. Patients with ALT &gt;57 U/l and AST &gt;113 U/l are strongly associated with liver injury and require further imaging studies and close management. Key words: Liver injury; Blunt trauma; Transaminase; Computed tomography; Retrospective study.

Clinical and Laboratory Factors Associated with Symptom Development in Asymptomatic COVID-19 Patients at the Time of Diagnosis.

In preparation for the surge of coronavirus disease 2019 (COVID-19), it is crucial to allocate medical resources efficiently for distinguishing people who remain asymptomatic until the end of the disease. Between January 27, 2020, and April 21, 2020, 517 COVID-19 cases from 13 healthcare facilities in Gyeonggi province, Korea, were identified out of which the epidemiologic and clinical information of 66 asymptomatic patients at the time of diagnosis were analyzed retrospectively. An exposure-diagnosis interval within 7 days and abnormal aspartate aminotransferase levels were identified as characteristic symptom development in asymptomatic COVID-19 patients. If asymptomatic patients without these characteristics at the time of diagnosis could be differentiated early, more medical resources could be secured for mild or moderate cases in this COVID-19 surge.

VP45.03: COVID‐19 causing HELLP‐like syndrome in pregnancy and the role of angiogenic factors for differential diagnosis

In this series, we aimed to describe the prevalence of HELLP-like syndrome and the performance of sFlt-1/PlGF ratio to rule out true pre-eclampsia. A case series was created of consecutive pregnant women of more than 20 weeks of gestation presenting with symptomatic COVID-19 between 21 March and 7 April 2020 at two hospitals in Barcelona, with symptomatic and confirmed COVID-19 infection by quantitative RT-PCR on nasopharyngeal swabs. Symptomatic disease was defined by the presence of acute respiratory tract infection with no other etiology that fully explained the clinical presentation. sFlt1/PlGF ratio was considered abnormal if it was above 85 before 34 weeks of gestation or above 110 after 34 weeks of gestation. A total of 27 pregnant women were included. Overall, 7 patients (25.9%) presented at least one sign of suspected HELLP syndrome, of which 2 (7.4%) were diagnosed clinically with pre-eclampsia because of hypertension and proteinuria or elevated transaminases; 3 (11.1%) had significant proteinuria plus elevated transaminases; and 2 had isolated abnormal transaminase levels. sFlt-1/PlGF ratio was elevated over the cut-off for pre-eclampsia in 1 of 7. Of note, magnesium sulfate was initiated in 2 patients, and discontinued in those with normal levels. There were no other obstetrical complications. This preliminary series suggest that the performance of angiogenic factors is high in women with COVID-19 infection, and thus measuring angiogenic factors seems critical in COVID-19 pregnancies with PE-like analytical signs to rule out true pre-eclampsia, avoiding needless interventions and iatrogenic preterm delivery. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Manifestations of digestive system of hospitalized patients with coronavirus disease 2019 in Wuhan, China: a single-center descriptive study

Objective To study the manifestations of digestive system of hospitalized patients with coronavirus disease 2019 (COVID-19) in Wuhan, China, and to provide a reference for disease control and treatment. Methods The data of hospitalized patients with COVID-19 in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 27 to February 14, 2020 were retrospectively analyzed, which included general information, positive rate of nucleic acid test, severity of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected Chi-square test and independent sample median Chi-square test were used for statistical analysis. Results Among the 305 patients, there were 146 males (47.9%) and 159 females (52.1%), and the median age was 57 years old. Nucleic acid assay of nasopharyngeal swabs or pharyngeal swabs were positive in 84.1% (228/271) patients including 46 patients (15.1%) of critical group and 259 patients (84.9%) of non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms were mainly fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, with a median time of 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. After excluding possible drug-related diarrhea, the incidence of diarrhea was still 22.2%. Only 6.9% (4/58) of patients had positive fecal leukocytes or fecal occult blood test. Alanine aminotrans ferase (ALT), aspartate aminotransferase (AST), or total bilirubin (TBil) increased in 39.1% (119/304) of patients on admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased TBil level, and the average level was (37.4±21.1) μmol/L. The median age of critical group was older than that of non-critical group (65 years vs. 56 years), the proportion of patients with abnormal liver function and slightly increased AST (40- 0.05). Conclusions The manifestation of digestive system of hospitalized COVID-19 patients in Wuhan is significant, the proportion of patients with diarrhea and abnormal aminotransferase level is high. And on admission the proportion of patients with abnormal liver function of critical group is higher than that of non-critical group, which will provide reference for the prevention and treatment of COVID-19. Key words: 2019-nCoV; COVID-19; Diarrhea; Liver function; Gastrointestinal tract