Liver Enzymes In Patients Research Articles

GLP-1 Receptor Agonist Effects on Lipid and Liver Profiles in Patients with Nonalcoholic Fatty Liver Disease: Systematic Review and Meta-Analysis.

Aims This meta-analysis of randomized placebo-controlled clinical trials assessed the effect of glucose-like peptide-1-receptor agonists (GLP-1RA) on the lipid profile and liver enzymes in patients with nonalcoholic fatty liver disease (NAFLD). Materials and Methods Randomized placebo-controlled trials investigating GLP-1RA on the lipid profile and liver enzymes in patients with NAFLD were searched in PubMed-Medline, Scopus, Web of Science, and Google Scholar databases (from inception to January 2020). A random-effects model and a generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted. Weighted random-effects meta-regression was performed on potential confounders on lipid profile and liver enzyme concentrations. Results 12 studies were identified (12 GLP-1RA arms; 677 subjects) that showed treatment with GLP-1RA reduced alanine transaminase (ALT) concentrations (WMD = −10.14, 95%CI = [−15.84, −0.44], P < 0.001), gamma-glutamyl transferase (GGT) (WMD = −11.53, 95%CI = [−15.21,−7.85], P < 0.001), and alaline phosphatase (ALP) (WMD = −8.29, 95%CI = [−11.34, −5.24], P < 0.001). Aspartate aminotransferase (AST) (WMD = −2.95, 95% CI = [−7.26, 1.37], P=0.18) was unchanged. GLP-1 therapy did not alter triglycerides (TC) (WMD = −7.07, 95%CI = [−17.51, 3.37], P=0.18), total cholesterol (TC) (WMD = −1.17 (−5.25, 2.91), P=0.57), high-density lipoprotein (HDL-C) (WMD = 0.97, 95%CI = [−1.63, 3.58], P=0.46), or low-density lipoprotein (LDL-C) (WMD = −1.67, 95%CI = [−10.08, 6.74], P=0.69) in comparison with controls. Conclusion The results of this meta-analysis suggest that GLP-1RA treatment significantly reduces liver enzymes in patients with NAFLD, but the lipid profile is unaffected.

Impact of Coronavirus Diseases on Liver Enzymes.

IntroductionCoronavirus disease 2019 (COVID-19) affects various organs including lungs, brain, and eyes. Very limited data is available related to the effect of COVID-19 on liver. This study is conducted to determine the impact of COVID-10 on liver by measuring the frequency of participants with deranged liver enzymes in patients diagnosed with COVID-19.MethodsThis cross-sectional study was conducted in a COVID-19 unit of a tertiary care hospital in Pakistan from February 2021 to June 2021. A total of 900 patients admitted with COVID-19 were enrolled in the study after seeking informed consent. After enrollment, taking history and vitals, 5 mL blood was drawn via phlebotomy and sent to the laboratory to test for C-reactive protein, lactate dehydrogenase, and liver enzymes.ResultsOverall 141 (28.2%) participants had a minimum of one deranged liver enzyme. The most commonly deranged liver enzyme found was alanine transaminase (ALT), both in males (19.9%) and females (21.3%), followed by aspartate transaminase (male: 18.3% and female: 20.3%). Serum total bilirubin was deranged in both males (8.4%) and females (8.3%). There was no significant difference in the gender-wise prevalence of deranged liver enzymes. ConclusionLiver enzymes are frequently deranged in patients admitted with COVID-19. Liver enzymes should be regularly monitored during the course of management of COVID-19, as various medications used in the treatment of COVID-19 may further deteriorate liver enzymes and may cause long-term damage.

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.

Effects of Sodium Valproate Monotherapy on Blood Liver Enzyme Levels in Patients with Epilepsy: A Meta-Analysis.

We conducted this meta-analysis to assess the effects of sodium valproate (VPA) monotherapy on blood liver enzymes in patients with epilepsy. PubMed, Web of Science, EBSCO, Cochrane Library, Wanfang, China national knowledge infrastructure databases were searched. Nine studies were included. Results showed: (1) The overall SMD for blood AST, ALT, and GGT levels of VPA monotherapy group versus control group were 0.70 (95% CI=0.31 to 1.09, Z=3.52, p=0.0004), 0.47 (95% CI=- 0.01 to 0.95, Z=1.91, p=0.06), 0.44 (95% CI=0.29 to 0.60, Z=5.55, p<0.00001), respectively. (2) In subgroup meta-analysis, increased blood AST and GGT levels were observed in epileptic minors (AST: total SMD=0.85, 95% CI=0.40 to 1.30, Z=3.69, p=0.0002; GGT: total SMD=0.46, 95% CI=0.29 to 0.63, Z=5.25, p<0.00001). Elevated blood ALT level was observed in Asian patients receiving VPA monotherapy (total SMD=0.70, 95% CI=0.51 to 0.90, Z=7.01, p<0.00001), and the early stage of VPA monotherapy (total SMD=0.93, 95% CI=0.57 to 1.29, Z=5.09, p<0.00001). Overall, our results indicated that blood AST and GGT were significantly increased in epileptic minors receiving VPA monotherapy. The elevation of blood ALT was observed in Asian patients and the early stage of VPA monotherapy. However, due to the small number of included studies, our results should be considered with caution.

Presence of fatty liver disease leads to unusual rise of liver enzymes in patients with common bile duct colic

This study compares liver enzymes, inflammatory markers and bilirubin levels in patients with and without fatty liver disease (FLD) presenting with common bile duct (CBD) obstruction. CBD colic was diagnosed based on clinical, radiological and biochemical criterion. Presence of FLD was diagnosed by ultra sound scan and the macroscopic appearance of liver during surgery. Liver enzymes, inflammatory markers and bilirubin levels were prospectively assessed and compared between the two groups. Out of 42, there were 22 (52.3%) patients with FLD. Median body mass index was 26.9 (24.1-30.8) in fatty liver group compared to 25.7 (23.5-26.2) in others. Individuals with FLD showed high aspartate transaminase (558.5 vs. 247.0, p = 0.005), alanine trasaminase (467 vs. 228.5, p = 0.005) and bilirubin (3.8 vs. 2.2, p = 0.015) levels compared to those without FLD. According to multiple linear regression models, high AST and ALT levels showed significant associations with FLD after adjusting for age, gender, body mass index, amylase and C reactive protein levels. The median enzyme level at two weeks did not show a difference among patients with and without FLD. Presence of FLD causes unusual rise of AST and ALT levels in patients with CBD stones. This rise is transient.

Cross talk of serum elements, cardiac and liver enzymes in patients with HCV chronic hepatitis and hepatocellular carcinoma in Pakistani population

HCV-associated hepatic pathologies are now the frequent inducer of cardiac abnormalities because of cardio-hepatic interaction. Studies are going on to elucidate and highlight the possible factors involved in this complex interaction, but this paradigm is still unclear. Here, we aimed to explore the interrelationship among electrolytes, cardiac, and liver enzymes in HCV-associated hepatic abnormalities, including chronic hepatitis and hepatocellular carcinoma in the Pakistani population. 100 Hepatitis C virus (HCV) infected patients with liver disorders and 50 healthy individuals were recruited in the present analysis. Trace elements, ions, and enzyme concentrations were quantified via an automatic analyzer, while HCV was confirmed by enzyme-linked immunosorbent assay (ELISA). Our results demonstrated that serum Ca++, Mg++, Fe++, Cl-, and PO4- levels were significantly increased in HCV patients with hepatic pathologies, including cirrhosis and carcinoma. Cardiac enzymes, including aspartate aminotransferase (AST), creatine kinase (CK2), and lactate dehydrogenase (LDH) concentration, were also elevated in HCV patients. Furthermore, serum cholesterol and triglyceride levels significantly differed in HCV patients than in normal individuals. Impaired alkaline transaminase (ALT) and alkaline phosphatase levels in HCV patients further validate the HCV patients' hepatic pathologies. Interestingly, all these impaired factors were positively correlated with the progression of hepatic disorders. In conclusion, altered ionic concentrations, cardiac enzymes, and liver dysfunction markers suggest their significant relationship to HCV leading liver pathologies in the Pakistani population.

The Effect of oral Administration of Cichorium Intybus on Reduction of Liver Enzymes in Patients with Major Thalassemia: Randomized Clinical Trial Study

Background: Beta-thalassemia is a common hematological disorder. The aim of this study was to determine the effect of oral administration of Cichorium intybus on reduction of liver enzymes in patients with major thalassemia. Materials and Methods: This study was randomized clinical trial study that was conducted on 100 patients with age over 2 years and major thalassemia referred to Mohammad Kermanshahi Hospital of Kermanshah city (Iran) in 2019-2020. Eligible patients were randomly divided into two intervention (n=50), and control (n=50)groups.The intervention group received 0.028mg/kg/day Cichorium intybus as a medicinal supplement and control group received placebo for 3 months. All patients were evaluated and followed up for 6 months. The Liver enzymes levels (AST and ALT) were measured at four time periods (baseline, 1.5, 3 and 6 months after intervention). Ferritin was also measured at three time periods (baseline, 3, and 6 months after the intervention).The SPSS software version 24.0 was used to data analysis. Results: The results of Repeated Measure ANOVA test showed that therewere significant statistical differencebetween the two groups of intervention and control in term of ALT and AST at different time periods, so that the means of ALT and AST after the interventionwere lower in intervention group than control group(p 0.05). Conclusion: Oral administration of Cichorium intybus can reduce liver enzyme levels (ALT and AST) in patients with thalassemia major. Therefore, Chicory administration in patients with major thalassemia is suggested.

Persistent liver inflammation in chronic hepatitis C patients with advanced fibrosis after direct-acting antivirals induced sustained virological response.

Direct-acting antivirals (DAA) improve sustained virological response (SVR) rates with normalization of liver enzymes in patients with hepatitis C. However, liver inflammation may persist despite virus eradication. We aimed to investigate the rate and risk factors for persistent elevated aminotransferase levels in patients with advanced fibrosis after DAA-induced SVR. From January 2017 to April 2018, chronic hepatitis C patients with advanced fibrosis and SVR after DAA treatment at the Taipei Veterans General Hospital were prospectively enrolled. Persistent liver inflammation after SVR was defined as an increase in levels of alanine aminotransferase (ALT) (>40 U/L) at SVR12. A total of 461 patients were included (57.9% females, mean age 64 years, 69.6% genotype 1b, 46.4% cirrhosis). At SVR12, there was a decline in ALT levels (90.5 ± 80.8 U/L to 25.3 ± 26.5 U/L) from baseline levels. Persistent liver inflammation at SVR12 was detected in 45 patients (9.8%). The presence of cirrhosis, markers of impaired liver functions, history of interferon-based therapy, steatosis, and elevated ALT levels at baseline was associated with persistent liver inflammation after SVR12. Results of multivariate analysis indicated that levels of baseline serum total bilirubin (odds ratio [OR]: 2.605, 95% CI: 1.158-5.858), international normalized ratio (OR: 14.389, 95% CI: 1.754-118.049), ALT (OR: 1.006, 95% CI: 1.003-1.009), and the presence of steatosis (OR: 3.635, 95% CI: 1.716-7.698) were independent predictors of persistent liver inflammation at SVR12. Persistent liver inflammation is not uncommon in chronic hepatitis C patients with advanced fibrosis after DAA-induced SVR. It is associated with impaired baseline liver function and steatosis. Long-term follow-up is required to assess the implication of liver inflammation on disease progression.

Molecular and Haematological Analysis of Dengue Virus-3 Among Children in Lahore, Pakistan

Background: Dengue virus (DENV) is an RNA virus belonging to the family Flaviviridae of the genus Flavivirus with worldwide distribution. Dengue fever is caused by any of four closely-related serotypes DENV, an emerging pandemic-prone viral disease in many regions of the world. Objectives: The present study aimed to determine the prevalence of dengue virus genotypes and serotypes in children aged below 15 years in Lahore, Pakistan. Methods: In this study, 112 serum samples were collected from clinically suspected dengue fever patients from March 2017 to December 2018 at different tertiary care hospitals in Lahore, Pakistan. Regarding the patients’ age, the samples were divided into four groups from A to D (i.e., 0 - 1, 1 - 5, 5 - 10, and 10 - 15 years of age). Rapid immuno-chromatography (ICT) test was conducted on the collected serum samples, followed by quantitative RT-PCR for serotype of dengue virus. Results: Out of 112 samples, 34 samples were diagnosed as DENV positive by the rapid ICT screening method. No virus was detected in groups A and B, while three samples were positive in group C (1 boy and two girls), and 31 samples (23 boys and 8 girls) were positive in group D. The results of quantitative RT-PCR exclusively showed DEN-3 serotype in all the ICT positive samples. The results indicated that the prevalence of DEN-3 serotype in children was 100%, indicating that DEN-3 serotype might cause severe epidemics in the future in Lahore, Pakistan. Hematological analysis revealed an increase in hematocrits in 41.1% dengue-positive cases. Leucopenia was prominent in 79.4% of the cases, while Thrombocytopenia was reported in 70.5% of the participants. The biochemical analysis also indicated an increase in liver enzymes in patients (ALT 88%, AST 79%), while the lower levels of cholesterol (69 %) and serum albumin (25%) were also observed. Conclusions: Dengue virus spreads and grows quickly worldwide over a highly short time interval. Dengue fever claims for a significant number of lives. This study would help individuals know about the status of laboratory parameters in dengue fever and detect how to overcome the prevalence of Dengue virus.

Retrospective analysis of T-lymphocyte subsets and cytokines in malignant obstructive jaundice before and after external and internal biliary drainage.

ObjectiveTo study changes in T lymphocyte subsets, cytokines, and liver enzymes in patients with malignant obstructive jaundice (MOJ) before and after external biliary drainage (percutaneous transhepatic cholangiography drainage, PTCD) and internal biliary drainage (percutaneous transhepatic insertion of biliary stents, PTIBS).MethodsMOJ patients undergoing PTCD (n = 44) and PTIBS (n = 38) at our hospital were enrolled in the study from January 2017 until December 2019. Peripheral blood total bilirubin (TBIL), direct bilirubin (DBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), CD3+%, CD4+%, CD4+/CD8+ ratio, interleukin (IL)-2, IL-6, and tumor necrosis factor (TNF)-α were measured before and 1 week after biliary drainage.ResultsThere was no significant difference in any parameter between the two groups before biliary drainage. TBIL, DBIL, AST and ALT following PTCD were significantly lower than before PTCD. By contrast, CD3+%, CD4+%, CD4+/CD8+ ratio, IL-2, IL-6 and TNF-α showed no significant difference before and 1 week after PTCD. TBIL, DBIL, AST, ALT, IL-6 and TNF-α were significantly lower following PTIBS than before PTIBS. CD3+%, CD4+%, CD4+/CD8+ ratio and IL-2 were significantly higher following PTIBS than before PTIBS.ConclusionBoth PTCD and PTIBS were effective for treatment of MOJ, but PTIBS was more beneficial for recovery of immune function.

Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury

BackgroundThe liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.MethodThe study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), the chi-squared test was used for categorical variables as appropriate, and the Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using the Kruskal-Wallis test. The receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT.ResultsAmong the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (< 0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89 (95% confidence interval 0.86–0.98) and of ALT was 0.92 (95% confidence interval 0.83–0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT, respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7%, a specificity of 90%, a positive predictive value of 86.8%, and a negative predictive value of 77.6%. The corresponding values for ALT ≥ 80 U/l were 77.8%, 94.1%, 92.1%, and 82.8%, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l, respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center.

Prevailing patterns of liver enzymes in patients with COVID-19 infection and association with clinical outcomes.

BackgroundCOVID-19 is now a critical threat to global public health. Although the majority of patients present with respiratory illness, several studies have described multiorgan involvement. This study evaluated the prevailing patterns of liver enzymes in COVID-19 patients on admission and their association with clinical outcomes.MethodsThis was a single-center retrospective analysis of all inpatients with COVID-19. Demographic and clinical factors, and liver enzyme tests, including aspartate aminotransferase (AST) and alanine aminotransferase (ALT), were noted on admission. The association of liver enzyme elevation with outcomes such as inpatient death, need for intubation, and vasopressor use was determined using the chi-square test and multivariate regression analysis.ResultsAmong 200 patients, AST and ALT elevation was seen in 55% and 20%, respectively. Alkaline phosphatase elevation was seen in 28%. AST elevation was associated with inpatient death (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05; P=0.035), need for vasopressors (OR 1.034, 95%CI 1.015-1.055; P=0.001), and intubation (OR 1.03, 95%CI 1.01-1.05; P=0.002). An AST/ALT ratio of 2 or more was seen in 34% of patients and was associated with need for intubation (OR 2.678, 95%CI 1.202-5.963; P=0.016), and need for vasopressors (OR 3.352, 95%CI 1.495-7.514; P=0.003).ConclusionSerum aminotransferase levels are useful markers of hepatocellular injury. Patients with elevated AST or AST/ALT ratio are at higher risk of severe disease, as evidenced by intubation, vasopressor use, and inpatient death. These patients should be monitored closely given their propensity for severe disease.

Sodium-glucose cotransporter-2 inhibitors improve liver enzymes in patients with co-existing non-alcoholic fatty liver disease: a systematic review and meta-analysis.

Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis, inflammation, and fibrosis. While sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been established to improve glycaemic control in type-2 diabetes mellitus (T2DM), evidence of the beneficial effects in diabetics with coexisting NAFLD has yet to be quantitatively summarized. We searched the PubMed, Medline, CINAHL, and Cochrane databases and ClinicalTrial.gov from database inception to July 2020. We included randomized controlled trials assessing the impact of SGLT2 inhibitors on liver enzymes among patients with NAFLD. Our primary outcome included liver inflammation as measured using liver transaminase. Secondary outcomes included drug efficacy on hepatic steatosis and body mass index. Risk differences were calculated using a random model. A total of 10,555 patients were included in this meta-analysis (SGLT2 inhibitor group: n = 7125; control group: n = 3430). The treatment duration ranged from 8 to 52 weeks. Patients with T2DM, who were treated with SGLT2 inhibitor had decrease in ALT (SMD = -0.22, 95% CI: -0.27 to -0.20) and AST levels (SMD = -0.20, 95% CI: -0.31 to -0.08). The SGLT-2 inhibitor did not cause statistically significant weight loss (SMD = -0.21, 95% CI: -0.47 to 0.06), fibrosis regression utilizing FIB-4 score (SMD = -0.12, 95% CI: -0.41 to 0.18), and hepatic steatosis by using MRI-PDFF (SMD = -0.31, 95% CI: -0.68 to 0.07), as compared to controls. The SGLT2 inhibitor treatment may improve liver function, as demonstrated in the statistically significant reduction in transaminase levels. There were also notable trends in improved liver fibrosis and steatosis across the study periods.

The effect of silymarin on liver enzymes and antioxidant status in trauma patients in the intensive care unit: a randomized double blinded placebo-controlled clinical trial.

Aim of the studyThis study was conducted to investigate the positive effect of silymarin on liver enzymes and antioxidant status in trauma patients with elevated liver enzymes due to trauma-induced liver injury, admitted to the intensive care unit.Material and methodsThis one-year, randomized, double-blinded, placebo-controlled clinical trial was conducted on 90 trauma patients. The participants were assigned to either receiving Livergol tablets containing 140 mg of silymarin or 140 mg of placebo three times daily for 14 days. Liver enzymes, including aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP), were measured at baseline and days 3, 7, 9 and 14 after intervention. Also, antioxidant markers were measured at baseline and day 14 after treatment.ResultsReceiving silymarin supplement significantly lowered the liver enzymes, compared to placebo (p < 0.05). The mean serum level of malondialdehyde (MDA) was significantly decreased and the mean serum levels of total antioxidant capacity (TAC) and thiol groups were significantly increased in the silymarin group from baseline to day 14. In the placebo group, mean serum levels of MDA and thiol groups were significantly increased, while serum level of TAC was not significantly changed at day 14, compared to baseline. Also, the mean serum level of MDA was significantly lower, while the serum levels of thiol groups and TAC were significantly higher in the silymarin group.ConclusionsSilymarin supplementation significantly improved some antioxidant markers (TAC and thiol) and decreased liver enzymes in patients with trauma-induced liver injury.

Impact of baseline body mass index on the efficacy and safety of tofacitinib in patients with psoriatic arthritis

ObjectivesThis post-hoc analysis explored the impact of body mass index (BMI) on tofacitinib efficacy/safety in patients with active psoriatic arthritis (PsA).MethodsData were pooled from two phase 3 studies (NCT01877668; NCT01882439)....

The Effects of Nigella sativa Supplementation on Liver Enzymes Levels: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

The present systematic review and meta-analysis aimed to investigate the effects of Nigella sativa (N. sativa) supplementation on liver enzymes levels including aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Relevant studies, published from inception up to January 2020, were searched through PubMed, Scopus and Google Scholar conducted on randomized controlled trials (RCTs) investigating the effect of N. sativa on serum AST and ALT levels. Meta-analysis was applied using a random-effects model. Eight studies met inclusion criteria (n=281 in the N. sativa and n = 279 in placebo group). This meta-analysis showed that N. sativa supplementation significantly reduced AST level (weighted mean difference [WMD], −8.11 IU/L; 95% confidence interval [CI], −13.6, −2.53; p = 0.004) with significant heterogeneity (I-squared, 95.9%; p < 0.001) while the decrease in ALT level was not statistically significant (WMD, −7.26 IU/L; 95% CI, −15.4, 0.04; p = 0.051) with significant heterogeneity (I-squared, 97.8%; p < 0.001). This meta-analysis suggests that N. sativa supplementation may improve AST levels and ALT levels, however more RCTs with larger sample size are needed to found effects of N. sativa on liver enzymes in patients with non-alcoholic fatty liver disease.

The Elevation of LIVER Enzymes in Patients with Atrial Fibrillation and COVID-19 Is a Marker of Bad Evolution and Mortality

Introduction: The COVID-19 pandemic reflects liver damage. A study carried out in China (Guan WJ et al. N Engl J Med. 2020) reported that in more than 21% of cases there was an elevation of liver enzymes (ELE), with only 2.1% of them having previous liver disease. ELE is frequent in anticoagulated patients and is associated with an increased cardiovascular risk and bleeding complications2,3. It is necessary to evaluate the impact of ELE in patients with atrial fibrillation (AF) and COVID-19 Methods: Multicenter, retrospective and observational study that consecutively included patients admitted with COVID-19 during the months of March and April 2020. The patients were followed were followed up until 30 days after discharge or death. termino en inglés ¿??Anticoagulation was chosen at the clinical discretion. The main variables investigated were the value of liver enzymes (AST, ALT, GGT) at admission, during the first week (peak value) and at hospital discharge. Patients who achieved a 3-fold higher level of ELE(> 120UI) were described as high-risk transaminasemia (HRT). The number of bleedings, thromboembolic events, as well as all-cause mortality were evaluated. Statistical analysis was performed with SPSS 21.0 (SPSS Inc., Chicago, IL). Results: A total of 235 patients were included. The mean age was 79 years [standard deviation (SD) 7.9. years]. The demographic characteristics of the patients with and without HRT are summarized in Table 1. The median follow-up was 59 days (SD 29 days). In AF patients, ELE values rose significantly on admission with respect to discharge p <0.05. No significant difference in the value of ELE was found between those who received LMWH versus ACODS. In patients with AF, there were 30 admissions to intensive care, these had higher ELE values at admission and at discharge, awith ALT at admission and ALT, AST and GGT at discharge being significant, p <0.05. They also presented 24 (10%) bleeding events, which had a significantly higher AST level in the first week (42-60UI). There were 45 (19.1%) patients who died during de follow-up, ELE values were significantly higher on admission. Finally, if we analyze the events in the 48 HRTpatients (21%) compared to the non-TAR 187 patients (79%), they had significantly more hemorrhagic events, and death from all causes, p <0.05, events was resume in Table 2. If we perform a logistic regresión for TAR as a predictor variable of bleddings events, TAR was a risk marker ,independly OR 3,6(1,39-9,33), table 3 Conclusion: In our cohort, AF patients who suffered events had a higher ELE than those who did not suffer significantly. Furthermore, the patients classified as HRT presented an increase in mortality, bleedings events compared to non-HRT (Table 2 and 3). No significant differences were observed in the elevation of the ELE according to the antithrombotic treatment, the patients treated with DOACs did not experience a significant increase in the ELE during the follow-up.DisclosuresOlivera:Daiichi Sankyo:Consultancy, Speakers Bureau;BAYER:Consultancy;Boehringer Ingelheim:Consultancy, Speakers Bureau;Pfizer:Consultancy, Speakers Bureau.Campoy Castaño:Boehringer Ingelheim:Consultancy;Daiichi Sankyo:Speakers Bureau.Sierra:Astellas:Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees;Novartis:Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau;Abbvie:Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals:Research Funding;Pfizer:Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau;Daiichi Sankyo:Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau;Roche:Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees;Gilead-Kite:Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees.

S3247 Prevailing Patterns of Liver Enzymes in Patients With COVID-19 Infection and Association With Clinical Outcomes

INTRODUCTION: Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is now a critical threat to global public health. Although, the majority of patients present with respiratory illness, several studies have described multi-organ involvement. The purpose of this study was to report liver enzyme test results in COVID-19 patients on admission and their association with clinical outcomes. METHODS: This study was a single-center retrospective analysis of all in-patients with a confirmed diagnosis of COVID-19. Demographic, clinical factors, and liver enzyme tests including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were noted from the time of admission. Association of liver enzyme elevation with clinical outcomes such as inpatient death need for intubation and vasopressor use was determined using chi-square test and multivariate regression analysis. RESULTS: Among 200 patients, AST elevation was seen in 55% and ALT elevation in 20% of patients. AST elevation was associated with in-patient death OR 1.03 (95% CI 1.01–1.05) P = 0.035, need for vasopressors CI 1.034 (95% CI 1.015–1.055) P = 0.001 and intubation OR 1.03 (95% CI 1.01–1.05) P = 0.002. AST/ALT ratio of 2 or more was seen in 34% of patients and was associated with the need for intubation OR 2.678 95% CI [1.202–5.963] P = 0.016 and need for vasopressors OR 3.352 95% CI [1.495–7.514]. CONCLUSION: Serum aminotransferase levels are useful markers of hepatocellular injury. Patients with elevated AST, AST/ALT ratio are at higher risk of severe disease as evidence by intubation, vasopressor use, and inpatient death. These patients should be monitored closely given the propensity for severe disease.

Epidemiological panorama of dengue in the 2019 season of the HCG Juan I. Menchaca

Abstract Introduction Dengue fever is a viral infection transmitted by female mosquitoes of the Aedes aegypti and Aedes albopictus species. vector-borne diseases represent an impact on public health in Mexico and the world, so it has tried to contain and mitigate them. Objectives Analyze the epidemiological panorama of dengue in the 2019 season of the Guadalajara Civil Hospital 'Juan I. Menchaca'. Material and Methods A cross-sectional, analytical study was designed. The data search was carried out through the platform of the National Epidemiological Surveillance System (SINAVE), of all the cases notified as arbovirosis during the year 2019. The analysis was carried out with the EPI Info 7 statistical package, frequency measures were calculated and association. Results 1496 probable cases of dengue were reported, of which: non-serious dengue 108 (7.22%), dengue with alarm signs 197 (13.17%) and severe dengue 183 (14.9%), positivity of 488 cases (70%). Municipality of residence: Guadalajara 287 (58.81%), Tonalá 73 (14.95%), Tlaquepaque 60 (12.29%). Housewife represented 39.96% (OR 1.40, 95% CI 0.99-1.97, p 0.053), age (mean 30.78), male 60.83% (OR 0.77, 95% CI 0.54-1.09, p 0.14). Liver enzymes in patients with dengue fever: ALT 830.42 (mean difference 795.08, 95% CI 683.00-907.17, p &amp;lt; 0.0001), AST (mean difference 2368.83, 95% CI 1980.65-2757.01, p &amp;lt; 0.0001). Conclusions The high positivity reflects a high incidence of the disease during the 2019 season. Home occupation was highly prevalent, although it was not possible to demonstrate statistical significance as a risk factor for the disease, however, it opens the possibility of future research. Our study highlights the importance of including liver function tests as an initial evaluation since it was an important predictor of mortality. Key messages Dengue. Fever.

Lubiprostone in patients with non-alcoholic fatty liver disease: a randomised, double-blind, placebo-controlled, phase 2a trial

The laxative drug lubiprostone improves intestinal permeability in healthy volunteers. We aimed to assess efficacy and safety of lubiprostone in patients with non-alcoholic fatty liver disease (NAFLD) with constipation via attenuation of intestinal permeability. This randomised, double-blind, placebo-controlled, phase 2a study in Yokohama City University Hospital, Japan, recruited patients (aged 20-85 years) with NAFLD and constipation, alanine aminotransferase (ALT) at least 40 U/L, liver stiffness (≤6·7 kPa), and hepatic fat fraction at least 5·2% when assessed by MRI-proton density fat fraction. Eligible patients were randomly assigned (11:10:9) by a computer-based system and stratified by age and sex to receive 24 μg lubiprostone, 12 μg lubiprostone, or placebo, orally, once per day for 12 weeks. The primary endpoint was the absolute changes in ALT at 12 weeks. Efficacy analysis was done by intention to treat. Safety was assessed in all treated patients. This trial was registered with University Hospital Medical Information Network Clinical Trials Registry (UMIN000026635). Between March 24, 2017, and April 3, 2018, we screened 288 patients, of whom 150 (52%) were randomly assigned to treatment: 55 patients were assigned to receive 24 μg lubiprostone, 50 to receive 12 μg lubiprostone, and 45 to receive placebo. A greater decrease in the absolute ALT levels from baseline to 12 weeks was seen in the 24 μg lubiprostone group (mean -13 U/L [SD 19]) than in the placebo group (1 U/L [24]; mean difference -15 U/L [95% CI -23 to -6], p=0·0007) and in the 12 μg lubiprostone group (-12 U/L [21]) than in the placebo group (mean difference -13 U/L [-22 to -5], p=0·0023). 18 (33%) of 55 patients in the 24 μg group had at least one adverse event, as did three (6%) of 47 patients in the 12 μg group and three (7%) of 43 in the placebo group. The most common adverse event was diarrhoea (17 [31%] of patients in the 24 μg group, three [6%] in the 12 μg group, none in the placebo group). No life-threatening events or treatment-related deaths occurred. Lubiprostone was well tolerated and reduced the levels of liver enzymes in patients with NAFLD and constipation. Further studies are necessary to better define the efficacy and tolerability of lubiprostone in patients with NAFLD without constipation. Mylan EPD G.K.