Risk Factors For Liver Dysfunction Research Articles

Risk factors for liver dysfunction and their clinical importance after gastric cancer surgery

Postoperative hepatobiliary enzyme abnormalities often present as postoperative liver dysfunction in patients with gastric cancer (GC). This study aimed to identify the risk factors for postoperative liver dysfunction and their clinical impact after GC surgery. We retrospectively analyzed the data of 124 patients with GC who underwent laparoscopic or robotic surgery at Kyoto Prefectural University of Medicine between 2017 and 2019. Twenty (16.1%) patients with GC developed postoperative liver dysfunction (Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 ≥ Grade 3). Univariate analyses identified robotic surgery as a risk factor for postoperative liver dysfunction (P = 0.005). There was no correlation between the postoperative liver dysfunction status and postoperative complications or postoperative hospital stays. Patients with postoperative liver dysfunction did not have significantly worse overall survival (P = 0.296) or recurrence-free survival (P = 0.565) than those without postoperative liver dysfunction. Robotic surgery is a risk factor for postoperative liver dysfunction; however, postoperative liver dysfunction does not affect short or long-term outcomes.

Perbandingan Perlindungan Minyak Jintan Hitam, Minyak Argan dan Minyak Zaitun terhadap Enzim Hati Tikus Akibat Diet Tinggi Lemak

High-fat diet has become one of the risk factors of liver dysfunction due to accumulation of fat in the liver cells. This disorder might be triggered by increased reactive oxygen species (ROS) activity with high-fat consumption. This study aimed to compare protective effect of natural antioxidants black cumin oil, argan oil and olive oil on liver function in wistar rats fed with high-fat diet. Male wistar rats (n = 24) were divided into four treatment groups. Group 1 (negative control) was not given any oil treatment (0,5 ml/g bw), group 2 was given black cumin oil (0,4 ml/g bw), group 3 was given argan oil (0,5 ml/g bw) and group 4 was given olive oil (0,5 ml/g bw). All rats were fed a high-fat diet of 10 gr/day for 2 months. The analysis of liver function tests was performed before and after treatment. With high-fat diet, the negative controls had SGOT of 93.05 ± 47.91 UI/I and SGPT of 43.10 ± 14.64 UI/l.  Administration of black cumin oil markedly reduced SGOT (62.05 ± 30.67 UI/l) and SGPT levels (28.81 ± 10.60 UI/l) (P0.05). Argan oil can not reduce SGOT levels (97.92 ± 35.07 UI/l) but can reduce SGPT levels (51.67 ± 15.84 UI/l). Olive oil can not reduce SGOT levels (67.38 ± 29.31 UI/l) but can reduce SGPT levels (50.19 ± 9.70 UI/l). It was concluded that administration of black cumin is more effective to reduce SGOT and SGPT levels in rats with high-fat diet compared to argan oil and olive oil treatments.

Postoperative liver dysfunction is associated with poor long-term outcomes in patients with colorectal cancer: a retrospective cohort study

BackgroundPostoperative hepatobiliary enzyme abnormalities often present as postoperative liver dysfunction in patients with colorectal cancer. This study aimed to clarify the risk factors of postoperative liver dysfunction and its prognostic impact following colorectal cancer surgery.MethodsWe retrospectively analyzed data from 360 consecutive patients who underwent radical resection for Stage I–IV colorectal cancer between 2015 and 2019. A subset of 249 patients with Stage III colorectal cancer were examined to assess the prognostic impact of liver dysfunction.ResultsForty-eight (13.3%) colorectal cancer patients (Stages I–IV) developed postoperative liver dysfunction (Common Terminology Criteria for Adverse Events version 5.0 CTCAE v5.0 ≥ Grade 2). Univariate and multivariate analyses identified the liver-to-spleen ratio on preoperative plain computed tomography (L/S ratio; P = 0.002, Odds ratio 2.66) as an independent risk factor for liver dysfunction. Patients with postoperative liver dysfunction showed significantly poorer disease-free survival than patients without liver dysfunction (P < 0.001). Univariate and multivariate analyses using Cox’s proportional hazards model revealed that postoperative liver dysfunction independently was a poor prognostic factor (P = 0.001, Hazard ratio 2.75, 95% CI: 1.54–4.73).ConclusionsPostoperative liver dysfunction was associated with poor long-term outcomes in patients with Stage III colorectal cancer. A low liver-to-spleen ratio on preoperative plain computed tomography images was an independent risk factor of postoperative liver dysfunction.

Weight Loss Improves Liver Dysfunction and Dipstick Proteinuria in Obesity: The Japan Specific Health Checkups Study.

Obesity and inappropriate lifestyle is the major risk factors for liver dysfunction and proteinuria. Nevertheless, previous studies have not described the differential impacts of body weight changes and lifestyle modification on already developed liver dysfunction and proteinuria. The original cohort was 933,490 individuals from the Japanese general population. In this investigation, we included 36,256 obese individuals with elevated levels of aspartate aminotransferase and/or alanine aminotransferase (≥31 IU/L) or positive proteinuria (+/- or more) in both the first and second years. Outcomes were the first normalization of these data defined as improvement in liver dysfunction and proteinuria. Times to outcomes were assessed using the Cox proportional hazards modeling for -1 kg/m2/year change in body mass index (BMI) changes in exercise and alcohol intake. The multivariable-adjusted hazard ratio (HR) for incident improvement in liver dysfunction with BMI change -1.0 kg/m2/year was 1.07 (95% confidence interval [CI] 1.05-1.09) in obesity and that with improved proteinuria was 1.04 (95%CI 1.02-1.07). Compared to subjects without exercise habits, subjects who gained exercise habits exhibited a higher rate of improvement in liver dysfunction (HR 1.08; 95%CI 1.01-1.15) but not in proteinuria (HR 0.98; 95%CI 0.88-1.08). Compared to subjects with continuous alcohol intake habits, subjects who quit alcohol intake also showed a higher rate of improvement in liver dysfunction (HR 1.20; 95%CI 1.09-1.32). This study suggested that weight loss greater than 1 kg/m2/year improves liver dysfunction and dipstick proteinuria in obesity. Particularly, liver dysfunction can be remedied by acquiring an exercise habit and quitting alcohol intake.

Correlation of low body mass index and albumin level with the presence of liver dysfunction in newly diagnosed tuberculosis patients

Tuberculosis (TB) patients often experience reduced appetite or nutritional malabsorption leading to malnutrition, which manifests in excessive loss of muscle mass and low body mass index (BMI). Patients with protein malnutrition is associated with increased risk of drug-induced liver injury and may require a close monitoring during the course of antituberculosis (AT) treatment. The purpose of this study was to determine the correlation of low body mass index and albumin level with liver dysfunction in patients newly diagnosed with TB prior to receiving AT drugs. This study is a nonexperimental observational study with consecutive sampling technique by following a descriptive analytic design (cohort study). The subjects were patients in the National Lung Health Center Makassar who are newly diagnosed with TB and have not received any AT drug. The BMI data and blood samples were collected and analyzed to obtain Alanine aminotransferase (ALT), Aspartat aminotransferase (AST), and Albumin levels. It was found that out of 22 total patients, 3 (14%) of the TB patients experienced liver dysfunction characterized by high level of ALT and AST levels. Both patients had normal levels of albumin despite one of them had a low BMI. The statistical showed no correlation between the low BMI or albumin level with the presence of liver dysfunction. It is concluded that the presence of liver dysfunction is not correlated with low BMI or albumin level in newly diagnosed TB patients, and hence, are not considered as independent risk factors of liver dysfunction in this population.

Clinical Characteristics and Risk Factors of Liver Dysfunction in COVID-19 Patients

ABSTRACTBackground:COVID-19 outbreak has spread around the world. Liver dysfunction (LD) was related with high mortality in COVID-19.Methods:Retrospective, single-center study case series of 425 consecutive hospitalized COVID-19 patients were enrolled. Demographic, clinical, laboratory, and treatment data were collected.Results:A total of 425 patients were included in this study, 145 of whom had LD. The overall mortality rate was 8.9%, while 17.9% in the LD group and 4.3% in the nonliver dysfunction (NLD) group. Age, sex, and hypertension were the independent risk factors of LD. LD was an independent risk factor for incidence of severe illness, acute respiratory distress syndrome, and death. The survival rate of patients in LD group was lower than that in NLD group (P < 0.001). A similar trend was observed by the multivariate regression analysis (adjusted hazard ratio, 3.52; 95% confidence interval [CI], 1.69–7.33; P = 0.001). Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers had effect to reduce LD (odds ratio of 0.48 [95% CI, 0.232–0.989; P = 0.045]).Conclusions:LD is one of the main features of hospitalized patients of COVID-19, with a worse prognosis. Patients of COVID-19 with LD on admission should be more cautions.

Prognostic value of baseline interleukin 6 levels in liver decompensation and survival in HCC patients undergoing radioembolization

BackgroundTo confirm the prognostic value of previously published baseline interleukin 6 (IL6) and IL8 cutoff values in survival and liver dysfunction in patients with advanced HCC undergoing 90Y radioembolization.MethodsA total of 83 patients (77 male) represented a subset of HCC patients undergoing 90Y radioembolization combined with sorafenib as part of the prospective multicenter phase II trial SORAMIC. IL6 and IL8 levels were determined in serum samples collected at baseline. In this post hoc analysis, we sought to confirm the prognostic value of baseline cutoff values of 6.53 pg/mL and 60.8 pg/mL for IL6 and IL8, respectively, in overall survival (OS) or liver dysfunction (grade 2 bilirubin increase) after treatment.ResultsMedian OS was 12.0 months. While low baseline albumin and high bilirubin values were associated with high IL6, liver cirrhosis, alcoholic liver disease, and portal vein infiltration were associated with high IL8.In univariate analysis, high baseline IL6 and IL8 were associated with significantly shorter overall survival (7.8 vs. 19.0 months for IL6 and 8.4 vs. 16.0 months for IL8). In addition to IL values, liver cirrhosis, Child–Pugh grade, baseline albumin (< 36 g/dL), and total bilirubin (≥ 17 µmol/L), and higher mALBI grade (2b &3) values were associated with OS. At multivariate analysis, high baseline IL6 was the only independent prognostic factor for OS (HR 2.35 [1.35–4.1], p = 0.002).Risk factors for liver dysfunction were high baseline IL6, albumin, and total bilirubin, and mALBI grade as found in univariate analysis. High baseline IL6 (HR 2.67 [1.21–5.94], p = 0.016) and total bilirubin ≥ 17 µmol/L (HR 3.73 [1.72–8.06], p < 0.001) were independently associated with liver dysfunction.ConclusionIn advanced HCC patients receiving 90Y radioembolization combined with sorafenib, baseline IL6 values proved to be prognostic, confirming previous findings in patients undergoing 90Yradioembolization. IL6 might be useful for patient selection or stratification in future trials.

Promotion effects of DEHP on hepatocellular carcinoma models: up-regulation of PD-L1 by activating the JAK2/STAT3 pathway.

Di(2-ethylhexyl) phthalate (DEHP), as an endocrine disruptor, is often used as a plasticizer in various polyvinyl chloride plastic products and medical consumables. Epidemiological studies have shown that long-term large intake of DEHP may be a risk factor for liver dysfunction. Long-term exposure to DEHP is associated with liver disease and aggravates the progression of chronic liver injury. However, the effects of DEHP on hepatocellular carcinoma (HCC) are rarely studied. In this study, we sought to determine the effects of DEHP on HCC induced by carbon tetrachloride combined with diethylnitrosamine, and further study its molecular mechanism. It was found that DEHP exposure significantly promotes tumor immune escape and activates signaling pathways involved in related protein expression of tumor immune escape, including PD-L1, JAK2, and STAT3. In addition, the trends observed in the HepG2 cells assay are consistent with vivo conditions. In summary, DEHP may play a tumor-promoting role in HCC mice and IFN-γ stimulated HepG2 cells, which may be related to the JAK2/STAT3 signaling pathway.

Di(2-ethylhexyl) phthalate promotes hepatic fibrosis by regulation of oxidative stress and inflammation responses in rats

Di(2-ethylhexyl) phthalate (DEHP) is an environmental pollutant that is widely used in medical and consumer products. An epidemiological study has suggested that a large daily intake of DEHP from phthalate-contaminated food may be a risk factor for liver dysfunction. Long-term exposure to DEHP is associated with liver disease and exacerbates the progression of chronic liver injury. However, the effect of DEHP on hepatic fibrosis is rarely studied. In the present study, we sought to determine the effect of DEHP on carbon tetrachloride (CCl4)-induced liver fibrosis, and to further examine the molecular mechanisms. We found that DEHP exposure remarkably promoted liver inflammation, necrosis and fibrosis, and increased expression of the protein associated with liver inflammation and fibrogenesis, including α-SMA, COL-Ⅰ, COL-Ⅲ, TGF-β1, P-Smad2, P-Smad3, P-p38 and P-p65. The similar trend was observed in the LX-2 cells. Furthermore, DEHP exposure induced oxidative stress and inflammatory cytokine production. Taken together, DEHP might play a fibrotic role in hepatic fibrosis rats and TGF-β1-stimulated LX-2 cells in vitro which was related to TGF-β1/Smad and p38MAPK/NF-κB signal pathway.

Risk factors of liver dysfunction for donor after extended right lobe graft donation

Introduction: Extended right lobe graft are often used in living donor liver transplantation(LDLT), in the donors with sufficient future liver remnant (FLR) volume. The aim of this study is to review retrospectively and to find risk factors of liver dysfunction for donor after extended right lobe graft donation. Method: From November 2005 to May 2018, a total of 52 living liver donors who underwent extended right lobectomy were included in this study.The subjects were divided into 2 groups.The hazard group was defined as the donors showing at least one of the following criteria:(1)postoperative serum peak bilirubin > 3.0mg/dL; (2) postoperative peak INR > 2.0, (3) posthepatectomy liver failure(PHLF) grade B or C of International Study Group of Liver Surgery(ISGLS), (4) ascites > 500cc on or after pod 5. Other donors with no criteria mentioned above were included in the safety group. Result: In hazard group, they had smaller volume of left lateral section(LLS) compared to safety group and the ratio of left liver volume(LLV) and left lateral section volume(LLSV) to total liver volume (TLV) in hazard group were smaller than in safety group. The mean and median values of the ratio of LLV to TLV(LLV/TLV); 38%, and the ratio of LLSV to TLV(LLSV/TLV); 20%, were used as the cut-off value. In hazard group, there were more patients whose LLV/TLV was less than 38% and whose LLSV/TLV was less than 20%. Using each cut-off values regarded as risk factors, three groups were categorized. This indicates that donors with smaller LLV/TLV or/and LLSV/TLV are more prone to liver dysfunction. Conclusion: The extent of donor hepatectomy must be contemplated based on a careful preoperative evaluation, including the volumetry. In this study, the LLV/TLV less than 38% and/or LLSV/TLV less than 20% were the major risk factors for postoperative liver dysfunction.

110P - HGCSG1401: A retrospective cohort study evaluating the safety and efficacy of regorafenib in patients with metastatic colorectal cancer: Analysis of risk factors for liver dysfunction

110P - HGCSG1401: A retrospective cohort study evaluating the safety and efficacy of regorafenib in patients with metastatic colorectal cancer: Analysis of risk factors for liver dysfunction

Study the Impact of Cytomegalovirus (CMV) Infection and the Risk Factor for Liver Dysfunction in Saudi Patients

Study the Impact of Cytomegalovirus (CMV) Infection and the Risk Factor for Liver Dysfunction in Saudi Patients

Prospective Association between Gestational Diabetes and Subsequent Abnormal Liver Function Scores 9 to 16 Years after Pregnancy

Chronic hyperglycemia is a risk factor for liver dysfunction. Women with gestational diabetes mellitus (GDM), glucose intolerance first recognized in pregnancy, may identify a population of individuals at an increased risk for liver complications. However, large prospective studies examining liver function following a GDM pregnancy are lacking. The Diabetes &amp; Women’s Health (DWH) Study (2012-2014) followed women with and without GDM in the Danish National Birth Cohort (DNBC). DNBC was a population-based cohort study of pregnant Danish women (1996-2002). At 9-16 years postpartum, the DWH Study conducted a clinical exam and collected bio-specimens on 607 of 1,274 women with GDM and 619 of a random sample of 1,457 women without GDM during the index DNBC pregnancy. Markers of liver function measured at follow-up included: alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT). Liver function scoring indices were used to assess liver capacity including: nonalcoholic fatty liver disease liver fat score (NAFLD-LFS), fatty liver index (FLI), hepatic steatosis index (HSI), and liver fat percentage. The mean (standard deviation) age (years) at follow-up for women without and with prior GDM was 43.4 (4.5) and 43.8 (4.6), respectively. Women with prior GDM had an increased risk at follow-up of elevated NAFLD-LFS (Adjusted Relative risk [RR], 2.34; 95% CI, 1.68-3.27), FLI (RR, 1.59; 95% CI, 1.27-1.99), and HSI (RR, 1.44; 95% CI, 1.21-1.71) adjusted for pre-pregnancy BMI and other relevant risk factors compared to women without prior GDM. Women with prior GDM also had a significantly higher fatty liver percentage (Adjusted difference (%), 1.93; 95% CI, 1.10-2.77). Women with GDM during pregnancy were at an increased risk for subsequent abnormal liver function 9-16 years postpartum. GDM may serve as another risk indicator for the early identification and prevention of liver dysfunction. Disclosure S. Donnelly: None. S. Hinkle: None. S. Rawal: None. L. Grunnet: None. J.E. Chavarro: None. A.A. Vaag: Employee; Self; AstraZeneca. J. Wu: None. P. Damm: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. M. Li: None. A.A. Bjerregaard: None. A. Thuesen: None. R.E. Gore-Langton: None. E.C. Francis: None. F. Hu: None. M.Y. Tsai: None. S.F. Olsen: None. C. Zhang: None.

P-264 - HGCSG1401: A retrospective cohort study evaluating the safety and efficacy of regorafenib in patients with metastatic colorectal cancer: Analysis of risk factors for liver dysfunction

Introduction: Regorafenib (REG) prolongs overall survival (OS) and progression-free survival (PFS) for patients (pts) with metastatic colorectal cancer (mCRC) in RCTs. However, there is a problem with REG-induced severe liver dysfunction (≥Grade 3) which occurs in 5-11% of treated Japanese pts. Therefore, we analyzed the incidence, therapeutic efficacy, and potential risk factors for REG-induced severe liver dysfunction in a community-based retrospective study (HGCSG1401) of pts treated with REG. Methods: 173 pts treated with REG were retrospectively registered from 22 centers in Japan. Survival analyses were performed with Kaplan-Meier method. Log-rank test and Cox-proportional hazard model were used to compare Grade 0-2 and 3-5. To identify risk factors for REG-induced severe liver dysfunction, a multivariate analysis was performed using the logistic regression analysis with backward elimination for variables with p < 0.10 in univariate analysis. Results: In 173 eligible pts, 24 (13.9%) experienced REG-induced severe liver dysfunction. The median PFS of Grade 0-2 and 3-5 were 2.2 and 1.6 months, respectively. The median OS of Grade 0-2 and 3-5 were 6.9 and 3.4 months, respectively. In the analysis of PFS and OS, there were significant difference between Grade 0-2 and 3-5 (PFS: HR 1.578, p = 0.045, OS: HR 1.799, p = 0.010). Univariate analyses showed that high AST, LDH, ALP, and GGT level at baseline were associated with REG-induced severe liver dysfunction. In multivariate analyses, high baseline AST level (≥ 50 U/L) was significantly associated with increased risk of REG-induced severe liver dysfunction (odds ratio=3.458, p = 0.032). Conclusion: Compared with previous reports, this analysis showed the slightly higher incidence of REG-induced severe liver dysfunction (13.9%). In multivariate analysis, it was inferred that high AST level (≥ 50 U/L) at baseline might be an independent risk factor. REG-induced severe liver dysfunction population significantly showed shorter OS than mild liver dysfunction. It is presumed that this patient population could not receive TAS-102 as post regorafenib therapy. Since this is an exploratory analysis, we consider it necessary to verify in large data set.

Hypercholesterolemia and hypertriglyceridemia as risk factors of liver dysfunction in children with inflammation receiving total parenteral nutrition

Hepatic dysfunction, due to parenteral nutrition, may become severe and lead to cirrhosis and hepatic failure, especially in newborns and infants. This study aimed to evaluate the association between the exclusive use of total parenteral nutrition (TPN) and changes in the hepatic profile, and to investigate the relationship between age, hypertriglyceridemia, and hypercholesterolemia, and the occurrence of laboratory liver dysfunction. A descriptive and historical cohort study was conducted, evaluating 195 pediatric patients (age: 1 month to 19 years) who received TPN. The following hepatic and lipid profiles were assessed: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, gamma-glutamyl transferase (GGT), bilirubin, triglycerides (TGs), cholesterol, high-density lipoprotein (HDL), albumin, and transthyretin. High C-reactive protein and/or low HDL were considered indicative of inflammatory process. The majority of patients presented normal values of AST (79.2%), ALT (74.9%), GGT (56.4%), and alkaline phosphatase (68.1%). Total bilirubin changed in 68.5% of patients, and transthyretin and albumin were low in 87.3% and 65.1% of the patients, respectively. Incidences of high GGT values were related to age (odds ratio [OR], 2.46; confidence interval [CI] 1.28-4.76; p=0.007), hypercholesterolemia (OR, 3.00; 95% CI, 1.24-7.25; p=0.015), and hypertriglyceridemia (OR, 2.39; 95% CI, 1.02-5.60; p=0.046). Incidences of elevated ALT values were associated with hypercholesterolemia (OR, 4.57; 95% CI, 2.03-10.30; p<0.001). Monitoring the hepatic profile from the early stage of TPN is necessary. Changes in the plasma lipid and hepatic profiles were frequently observed during the infusion of TPN, in patients with inflammation. Patients >2 years old and those with high TG and HDL levels were more likely to have elevated GGT levels. Hypercholesterolemia was associated with ALT alterations. Strategies to attenuate these issues should be considered in the early stages, in patients with TPN.

Risk Factors of Liver Dysfunction Induced by Microwave Ablation in Patients with Hepatocellular Carcinoma

To investigate the risk factors of the aggravation of liver function induced by microwave ablation (MWA) of patients with hepatocellular carcinoma (HCC). We retrospectively reviewed the liver function of 498 patients with HCC undergoing MWA treatment. The dynamic changes of liver enzymes and Child-Pugh scores were observed. The potential risk factors, including the relative position between the tumor and portal vein (PV), tumor numbers, ablation volumes, Child-Pugh classifications, platelet, APRI and MELD scores, were analyzed. Based on the relative position between the tumor and PV, the tumors of the patients were divided into four groups, (1) far away from PV; (2) close to the third branch of PV (< 5mm); (3) close to the second branch of PV (< 5mm); (4) close to the first branch of PV (< 5mm). Complete response was achieved in 409 (98.08%) of 417 patients with tumors far away from the PV and in 89 (95.70%) of 93 patients with tumors close to a branch of the PV. Large fluctuations in the levels of ALB, ALT, AST and TBIL were observed three days after treatment, while the concentrations of ALP and γ-GGT were relative stable. 13.86% (69/498) patients suffered from liver function damage, that is, having an increase of Child-Pugh score by two three days after MWA. The incidences of liver dysfunction of the patients with tumors close to PV, more than three tumors, ablation volumes lager than or equal to 22.5 cm3, Child-Pugh classification B, APRI > 1.6, MELD > 30 or PLT < 110 × 109/L were 53.85%, 46.15%, 20.60%, 24.24%, 31.53%, 22.55% or 18.92%, respectively, much higher than those of patients without above characteristics. MWA can cause a transient deterioration of liver function. Patients with tumors close to PV, large numbers of tumors or large ablation volumes may present a great fluctuation of liver enzymes and an aggravation of liver dysfunction. In addition, poor liver reserve function is a risk factor of liver function damage but not the elevations of liver enzymes after MWA.

Review of Pathophysiological Aspects and Risk Factors for Liver Dysfunction

The liver is accountable for many critical functions within the body and loss of those functions can cause significant damage to the body. Liver disease is a extensive term that covers all aspects that cause the liver to fail to perform its proper functions.

Baseline abnormal liver function tests are more important than age in the development of isoniazid-induced hepatoxicity for patients receiving preventive therapy for latent tuberculosis infection.

One of the cornerstones of Australia's public health programmes to eliminate tuberculosis (TB) is the identification and treatment of latent tuberculosis infection (LTBI). The main aim of this study is to determine the demographics, compliance, completion rates and adverse events of patients on preventive therapy (PT) for LTBI at our institution. The secondary aim is to determine the rates of isoniazid (INH) hepatotoxicity and identify any contributory factors. The method used was an audit using medical records of 100 consecutive patients (2010-2014) treated with PT for LTBI. Seventy-two patients with confirmed LTBI started 9 months of INH and 22 started 4 months of rifampicin (RIF). The median age was 30 years. Half the patients were born in high TB-prevalence countries. Fifty-six per cent were contacts of index cases with confirmed TB, and 26% were pre-immunosuppression. Seventy-seven per cent completed PT with adequate compliance. Thirty-three per cent on INH and 23% on RIF experienced some liver function test (LFT) abnormality while on treatment. INH was ceased in 3% due to asymptomatic hepatic dysfunction (transaminases >5x upper limit of normal). No patients had permanent liver damage. Significant risk factors for liver dysfunction during PT were risk factors for liver disease (χ(3)(2) = 8.7; P = 0.03) or abnormal pre-therapy LFT (χ(3)(2)= 22.4; P < 0.001). No patients developed active TB. The completion rate of 77% and rate of INH-induced hepatic dysfunction of 3% is comparable with the literature. We found no age association with the risk of INH-induced hepatic dysfunction; however, there was a significant and linear association with the degree of liver function abnormality during INH therapy and the presence of abnormal baseline LFT. Routine LFT monitoring allowed early cessation of INH in those with significant but asymptomatic hepatitis who did not meet criteria for ATS/CDC LFT monitoring.

A retrospective study: analyzing the risk factors of liver dysfunction in Graves' disease

Objective Liver dysfunction is a common complication of hyperthyroidism[mainly Graves' disease(GD)], that may restrict the choice as well as affect the ultimate outcome of treatment. The purpose of this study was to describe the clinical and biochemical patterns in patients suffering from Graves' disease and liver dysfunction and to determine influential factors. Methods A total of 1 928 patients received radioactive iodine, 131I treatment. Before 131I therapy, 24 h radioactive iodine uptake of thyroid(24 h RAIU), serum free triiodothyronine(FT3), free thyroxine(FT4), sensitive thyroid-stimulating hormone(sTSH), anti-thyrotrophin receptor antibody(TRAb), thyroglobulin antibody(TgAb), anti-thyroid peroxidase antibody(TPOAb), and serum hepatic function parameters etc were performed. Data were analyzed by the unpaired t-test, the independent samples t-test, the χ2 test, logistic regression, and Pearson bivariate correlation. Results Ages, the course of Graves' disease, the weight of thyroid, FT4, TPOAb, and TRAb in Graves' disease patients complicated with liver dysfunction were higher than those in patients with normal hepatic function, as shown in table 1. The influential factors including age, course of Graves' disease, heart rate, weight of thyroid, FT4, 24 h RAIU, TgAb, TPOAb, and TRAb. 24 h RAIU were the protecting factors. Age, course of Graves' disease, heart rate, weight of thyroid, FT4, TRAb, and TPOAb were the risk factors. Conclusion The risk of liver dysfunction in patients with Graves' disease was increased in the following cases: age over 45 years, heart rate above 90 bpm, weight of thyroid more than 35 g, course of Graves' disease longer than 3 years, FT4 greater than 70.5 pmol/L, TPOAb above 360 IU/ml, and TRAb above 15 IU/L. In these coses 131I therapy will be recommended. (Chin J Endocrinol Metab, 2015, 31: 501-505) Key words: Hyperthyroidism; Liver dysfunction; Radioiodine therapy(131I); Aminotransferase; Bilirubin; Risk factors

Liver Dysfunction Associated with Intravenous Methylprednisolone Pulse Therapy in Patients with Graves' Orbitopathy.

Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment for the active phase of moderate to severe Graves' orbitopathy (GO). However, acute and severe liver damage has been reported during and after IVMP therapy. In this retrospective study, we investigated risk factors for liver dysfunction during and after IVMP therapy based on 175 Japanese patients with moderate to severe GO and treated at our center between 2003 and 2011. The results showed that seven patients developed severe liver dysfunction with elevated serum alanine aminotransferase (ALT > 300 U/L). Mild (40–100 U/L) and moderate (100–300 U/L) increases of ALT occurred in 62 patients (35%) and 10 patients (6%), respectively. Liver dysfunction was more frequently observed in males, in patients receiving high-dose methylprednisolone, and patients aged over 50 years. Preexistent viral hepatitis was significantly associated with liver dysfunction (65% in patients positive for hepatitis B core antibody and patients positive for hepatitis C virus antibodies). Our study confirmed the association of liver dysfunction with IVMP during and after treatment. It suggests that, in patients with GO, evaluation of preexisting risk factors—including viral hepatitis—and careful weekly monitoring of liver function during IVMP therapy and monthly thereafter for 12 months are warranted.