Transaminase Levels In Patients Research Articles

Risks and benefits of anti-TNF therapy for ulcerative colitis in a patient with autoimmune hepatitis-related cirrhosis: Case report.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized by continuous inflammation of the colonic mucosa. Autoimmune hepatitis (AIH) is a chronic liver disease characterized by hypergammaglobulinemia, circulating autoantibodies, interface hepatitis, and favorable response to immunosuppression. An association between IBD and AIH is uncommon, and experts have suggested that in patients with overlapping IBD and AIH, the anti-tumor necrosis factor agents can be used. Therefore, this study reports a rare case of a patient with liver cirrhosis due to AIH and UC refractory to conventional treatment and discusses the risks and benefits of using anti-tumor necrosis factor in both conditions. A 28-year-old female presented with symptoms of diarrhea, abdominal pain, asthenia, and inappetence, accompanied by abdominal collateral circulation, anemia, alteration of liver enzymes, and elevation of C-reactive protein levels. The patient underwent a liver biopsy, which was consistent with liver cirrhosis due to AIH. Colonoscopy showed an inflammatory process throughout the colon, compatible with moderately active UC. The patient received mesalazine, azathioprine, and corticotherapy, with no control of the inflammatory process. Faced with refractoriness to drug treatment and side effects of corticosteroids with an increased risk of severe infection due to cirrhosis, we opted to use infliximab for the treatment of UC. The patient presented with a clinical response and infliximab therapy was maintained. Eight months after starting infliximab therapy, the patient developed pneumonia with complications from disseminated intravascular coagulation and died. AIH is a rare cause of elevated transaminase levels in patients with UC. The best treatment to control the 2 conditions should be evaluated with vigilance for the side effects of medications, mainly infections, especially in patients with cirrhosis.

Effects of silymarin use on liver enzymes and metabolic factors in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis.

Fatty liver disease comprises a wide range of related liver disorders affecting mainly people who drink no or minimal amounts of alcohol. Silymarin is a member of the Carduus marianum family that has been used for centuries to treat different diseases. There is little evidence supporting its efficacy in humans. To evaluate the effects of Silymarin in patients with non alcoholic fatty liver disease (NAFLD) or recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD). We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant clinical trials assessing the use of silymarin in patients with NAFLD. A risk of bias assessment was performed using Cochrane's risk of bias tool. We included the following outcomes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transferase (GGT), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) (mg/dL), degree of fibrosis resolution, low-density lipoprotein (LDL), and HOMA-IR. We analyzed continuous data using mean difference (MD) and relative 95% confidence interval (CI). We included nine clinical trials. We found that silymarin significantly reduced the levels of ALT (MD= -17.12 [-28.81, -4.43]), (P < 0.004), AST (MD= -12.56 [-19.02, -6.10]), (P < 0.0001) and TG (MD = -22.60 [-23.83, -21.38]) (p < 0.00001). It also improved HDL (MD= 2.13 [1.60, 2.66]), (P < 0.01)). There was no significant difference regarding GGT (P=o.07), TC (P= 0.52), LDL (P= 0.06), HOMA-IR (P= 0.06) and BMI (p=0.1).One study reported significant improvement in the degree of fibrosis (P = 0.023). Silymarin treatment significantly reduces biochemical and transaminase levels in patients with MASLD.

STAT3-Dependent Effects of Polymeric Immunoglobulin Receptor in Regulating Interleukin-17 Signaling and Preventing Autoimmune Hepatitis

One-third of patients with autoimmune hepatitis (AIH) have cirrhosis at the time of diagnosis. The relevance of these variables, although unknown, is believed to be critical in AIH because of suspected interactions between the gut microbiome and genetic factors. Dysbiosis of the gut flora and elevated polymeric immunoglobulin receptor (pIgR) levels have been observed in both patients and mouse models. Moreover, there is a direct relationship between pIgR expression and transaminase levels in patients with AIH. In this study, we aimed to explore how pIgR influences the secretion of regenerating islet-derived 3 beta (Reg3b) and the flora composition in AIH using in vivo experiments involving patients with AIH and a concanavalin A-induced mouse model of AIH. Reg3b expression was reduced in pIgR gene (Pigr)-knockout mice compared to that in wild-type mice, leading to increased microbiota disruption. Conversely, exogenous pIgR supplementation increased Reg3b expression and maintained microbiota homeostasis. RNA sequencing revealed the participation of the interleukin (IL)-17 signaling pathway in the regulation of Reg3b through pIgR. Furthermore, the introduction of external pIgR could not restore the imbalance in gut microbiota in AIH, and the decrease in Reg3b expression was not apparent following the inhibition of signal transducer and activator of transcription 3 (STAT3). In this study, pIgR facilitated the upregulation of Reg3b via the STAT3 pathway, which plays a crucial role in preserving the balance of the intestinal microbiota in AIH. Through this research, we discovered new molecular targets that can be used for the diagnosis and treatment of AIH.

Network meta-analysis of different liver protective drugs in the treatment of drug-induced liver injury.

Currently, drug-induced liver injury (DILI) has become one of those public issues in society, which has added a huge burden to both the individuals and the society. In the current clinical stage, there are numerous drugs developed to treat this disease, and different drug treatment measures have been proven to achieve certain clinical efficacy in the corresponding randomized controlled trials. However, there are still many therapeutic drugs that have not been directly compared and studied. Therefore, it is difficult to directly compare the effectiveness and safety of various strategies for the treatment of DILI. In this regard, the present study collected the therapeutic efficacy of diverse treatments in DILI in recent years through network meta-analysis, evaluated and screened the existing optimal clinical therapeutic plan, and helped physicians formulate clinical therapeutic plans. Databases, including the Chinese Journal Full-text Database, Wanfang Data Journal Paper Resources (Wangfang), VIP Chinese Science and Technology Journal Full-text Database, The Cochrane Library, PubMed, and EMBASE, were searched using keywords from inception to January 2023. Eligible randomized controlled trials were selected in line with eligibility criteria, and mesh meta-analysis of binary variables was carried out using Stata 16 software. In combination with alanine aminotransferase, aspartate aminotransferase, and total bilirubin, MI may be the intervention measure for minimizing alanine aminotransferase levels in patients after treatment. Besides, compound glycyrrhizin may be the intervention for minimizing aspartate aminotransferase levels in patients after treatment, and polyene phosphatidylcholine may be the intervention for minimizing total bilirubin levels in patients after treatment. Placebo is the potential intervention that has the least adverse reactions post-treatment, and RT has the second least adverse reactions. Moreover, hepatocyte growth-promoting factors may be the most effective intervention after treatment. To sum up, the present work compared the clinical effects of 13 liver protective drugs through meta-analysis and provided a systematic understanding of commonly used drugs for the treatment of DILI in clinical practice.

The Effect of Vitamin E Supplementation on Serum Aminotransferases in Non-Alcoholic Fatty Liver Disease (NAFLD): A Systematic Review and Meta-Analysis.

Νon-alcoholic fatty liver disease (NAFLD) is a common cause of end-stage liver disease in developed countries. Oxidative stress plays a key role during the course of the disease and vitamin E supplementation has shown to be beneficial due to its antioxidative properties. We aim to investigate the effect of vitamin E supplementation on serum aminotransferase levels in patients with NAFLD. Three electronic databases (MEDLINE, CENTRAL, and Embase) were reviewed for randomized trials that tested vitamin E supplementation versus placebo or no intervention in patients with NAFLD, published until April 2023. A total of 794 patients from 12 randomized trials were included in this meta-analysis. Notwithstanding the studies' heterogeneity and moderate internal validity in certain cases, among studies testing vitamin E supplementation at 400 IU/day and above, the values of alanine aminotransferase (ALT) were reduced compared with placebo or no intervention [ALT Mean Difference (MD) = -6.99 IU/L, 95% CI (-9.63, -4.35), for studies conducted in Asian countries and MD = -9.57 IU/L, 95% CI (-12.20, -6.95) in non-Asian countries]. Regarding aspartate aminotransferase (AST), patients in the experimental group experienced a reduction in serum levels, though smaller in absolute values [AST MD = -4.65 IU/L, 95% CI (-7.44, -1.86) in studies conducted in Asian populations] and of lower precision in non-Asian studies [MD = -5.60 IU/L, 95% CI (-11.48, 0.28)].

A serial analysis of serum aspartate aminotransferase levels in patients with acute encephalopathy with biphasic seizures and late reduced diffusion and prolonged febrile seizure

BackgroundThere are no established biomarkers for diagnosing acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) in the early acute phase, called “the 1st seizure phase”. Based on our clinical experience, we hypothesized that serial examinations of blood levels of aspartate aminotransferase (AST) in children with febrile convulsive status epilepticus (FCSE) revealed higher levels in patients with AESD in the 1st seizure phase than in those with prolonged febrile seizures (PFs). MethodsTo test our presented hypothesis, we retrospectively investigated changes in serum AST in patients with FCSE due to AESD (n = 11) or PFs (n = 27) who were serially examined within 48 h of the onset of convulsions. ResultsThe rate of increase in AST was significantly higher in patients with AESD than in those with PFs. The rate of increase in AST correlated with previously reported scoring systems, i.e., Yokochi and Tottori scores, for the prediction of AESD. A positive correlation between the rate of increase in AST and creatinine levels in the first examination were observed; however, creatinine levels did not significantly differ between the AESD and PFs groups in the first or second examination. Blood levels of pH, ammonia, and sugar in the first examination and C-reactive protein in the second examination were significantly higher in the AESD group than in the PFs group. ConclusionsThe present study revealed that the rate of increase in AST was significantly higher in patients with AESD than in those with PFs. A novel predictive scoring system needs to be established in combination with the rate of increase in AST and reported clinical parameters, which will improve the prognosis of patients with FCSE.

Effectiveness of One-Year Pemafibrate Therapy on Non-Alcoholic Fatty Liver Disease Refractory to Long-Term Sodium Glucose Cotransporter-2 Inhibitor Therapy: A Pilot Study.

Background: Both pemafibrate and sodium glucose cotransporter-2 (SGLT2) inhibitor can decrease serum transaminase levels in patients with non-alcoholic fatty liver disease (NAFLD) complicated with dyslipidemia and type 2 diabetes mellitus (T2DM), respectively. However, the effectiveness of combined therapy has been rarely reported. Methods: This is a two-center retrospective observational study. NAFLD patients complicated with T2DM treated with pemafibrate for >1 year were included, in whom prior treatment with SGLT2 inhibitor > 1 year failed to normalize serum alanine aminotransferase (ALT) levels. Hepatic inflammation, function, and fibrosis were assessed by ALT, albumin-bilirubin (ALBI) score, and Mac-2 binding protein glycosylation isomer (M2BPGi) levels, respectively. Results: Seven patients were included. The median duration of prior treatment with SGLT2 inhibitors was 2.3 years. During the one year before starting pemafibrate therapy, the therapy did not significantly change hepatic enzymes. All patients received pemafibrate 0.1 mg twice daily without dose escalations. During one year of pemafibrate therapy, triglyceride, aspartate aminotransferase, ALT, γ-glutamyl transpeptidase, ALBI score, and M2BPGi levels significantly improved (p < 0.05), although weight or hemoglobin A1c did not significantly change. Conclusions: One year of pemafibrate therapy improves markers of hepatic inflammation, function, and fibrosis in NAFLD patients in whom long-term SGLT2 inhibitor therapy failed to normalize serum ALT.

Abnormal alanine aminotransferase levels in patients with moderate or severe ovarian hyperstimulation result in an increased risk of obstetric complications.

To explore the effect of abnormally elevated serum alanine aminotransferase (ALT) on pregnancy outcomes in patients with moderate and severe ovarian hyperstimulation syndrome (OHSS) at disease onset. This was a single-center retrospective cohort study conducted between January 1, 2014 and October 31, 2021. A total of 3550 fresh in vitro fertilization/intracytoplasmic sperm injection embryo transfer cycles were included, using Golan's three-degree, five-level classification to diagnose patients with OHSS. According to the patient's ALT level after diagnosis of OHSS, 123 (3.46%) patients with moderate-to-severe OHSS were divided into two groups. A control group included 3427 (96.54%) non-OHSS patients, and 91 (2.56%) abnormal ALT patients were matched with the control group for propensity scores. There was no difference in baseline data between the abnormal ALT and matched control groups. The incidence of obstetric complications was significantly higher in the abnormal ALT group than in the matched control group (P< 0.05). After adjusting for confounding factors, the incidence of obstetric complications in the abnormal ALT group was still higher than that in the normal ALT group (P< 0.05). In patients with moderate and severe OHSS, higher ALT levels resulted in an increased risk of obstetric and neonatal complications.

Effect of illness uncertainty on alanine transaminase levels and aspartate aminotransferase levels in patients with nonalcoholic fatty liver disease.

Patients with nonalcoholic fatty liver disease (NAFLD) have illness uncertainty. The purpose of this longitudinal study was to investigate the effect of the degree of illness uncertainty in patients with NAFLD on liver function values. We conducted a questionnaire survey and collected blood samples from outpatients with NAFLD. The items in the questionnaire were measured for illness uncertainty using the Japanese version of the Mishel Uncertainty in Illness Scale-Community (MUIS-C). Blood samples were collected at baseline and after 1 year. We divided the patients into two groups: one with high illness uncertainty and the other with low illness uncertainty. We then compared changes in alanine transaminase (ALT) and aspartate aminotransferase (AST) levels over time from baseline using multiple regression analysis. This study analyzed 148 patients with NAFLD; 75 were male and 73 were female, with a mean age of 58.4 ± 12.3 years. The group with higher illness uncertainty had significantly higher ALT and AST levels at 1 year (β = .185 and .183, respectively) than the group with lower illness uncertainty. High illness uncertainty in patients with NAFLD can lead to higher ALT and AST levels. Healthcare providers must focus on reducing illness uncertainty in patients with NAFLD.

Dabigatran in patients with atrial fibrillation after COVID-19 hospitalization: an update of the ANIBAL protocol.

COVID-19 increases the risk of atrial fibrillation (AF) and thrombotic complications, particularly in severe cases, leading to higher mortality rates. Anticoagulation is the cornerstone to reduce thromboembolic risk in patients with AF. Considering the risk of hepatotoxicity in patients with severe COVID-19 as well as the risk of drug–drug interactions, drug-induced hepatotoxicity and bleeding, the ANIBAL protocol was developed to facilitate the anticoagulation approach at discharge after COVID-19 hospitalization. However, since the publication of the original algorithm, relevant changes have occurred. First, treatment of COVID-19 pneumonia has been modified with the use of dexamethasone or remdesivir during the first week in patients that require oxygen therapy, and of dexamethasone and/or tocilizumab or baricitinib during the second week in patients that necessitate supplementary oxygen or with a high inflammation state, respectively. On the other hand, metabolic syndrome is common in patients with AF as well as metabolic-associated fatty liver disease, and this could negatively impact the prognosis of patients with COVID-19, including high transaminase levels in patients treated with immunomodulators. The EHRA guidelines update also introduce some interesting changes in drug–drug interaction patterns with the reduction of the level of the interaction with dexamethasone, which is of paramount importance in this clinical context. Considering the new information, the protocol, named ANIBAL II, has been updated. In this new protocol, the anticoagulant of choice in patients with AF after COVID-19 hospitalization is provided according to three scenarios: with/without dexamethasone treatment at discharge and normal hepatic function, transaminases ≤2 times the upper limit of normal, or transaminases >2 times the upper limit of normal.

Normal or near normal aminotransferase levels in patients with alcoholic cirrhosis

BackgroundAlcoholic liver disease is caused by excessive alcohol consumption that results in an inflammatory response and fibrosis. We have recognized that patients with alcoholic cirrhosis often have unremarkable liver enzyme values. MethodsIn this retrospective cohort analysis, we identified consecutive patients with documented alcoholic cirrhosis at an academic medical center who were admitted between January 1 2016 and December 1 2018. We examined clinical outcomes of patients as a function of whether the aspartate transaminase (AST) or alanine aminotransferase (ALT) was normal or abnormal. Likelihood chi-square analyses were utilized for group comparisons and t-tests were used for numerical data. ResultsIn the cohort of 78 patients with alcoholic cirrhosis (age 55, 26–75; 58% male) 70 had a normal ALT and 12 had a normal AST. The average AST for all patients was 59 ± 34 U/L (ULN = 35 U/L), and the average ALT was 27 ± 13 U/L (ULN = 45 U/L). The average INR was 1.5 ± 0.5 and total bilirubin was 3.7 ± 4.9 mg/dL, and 20 patients had a normal bilirubin level, including only one with an abnormal ALT level. The average model for end-stage liver disease (MELD) score was 19 ± 8 and 32% of patients died during the follow-up time period of 5 months. Decompensating events were identified in 78 (100%) patients. There was no correlation between complications or death and aminotransferase levels. ConclusionsAminotransferase levels are often unremarkable in patients with alcohol related cirrhosis and bear no relationship to clinical events or outcomes. Clinicians should be cautious when interpreting aminotransferases in patients with alcoholic cirrhosis.

Alanine Transaminase levels in Patients of Dengue Fever in the Suburbs of Islamabad

Introduction: Hepatic dysfunction is a highly varied condition that can show up as minor damage with elevated levels of transaminases, or appear as extensive damage and failure of liver cells. Thus, in order to reduce associated morbidity and mortality, this ailment should be diagnosed at the earliest possible so that appropriate therapy can be instituted. Our study was carried out to observe hepatic damage in patients with dengue fever (DF) by measuring alanine transaminase levels. Materials and Methods: A cross-sectional study of three months duration was carried out in the Department of Medicine, Dr. Akbar Niazi Teaching Hospital affiliated with Islamabad Medical &amp; Dental College, Pakistan. The sampling technique was Non-Random consecutive sampling and 118 patients were included in our study. Serum Alanine Transaminase (ALT) (normal = 7-56 IU/L), serum Aspartate Transaminase (AST) (normal = 10-40 IU/L) were determined and ultra-sound abdomen was performed. Statistical analysis was done using SPSS Version 24. The Chi-square test was used to observe the relationship between categorical variables. Phi, Cramer’s V, Pearson’s, and Spearman’s Correlation tests were used to study the association of age and gender with ALT levels. Results: There were 72% males (n=85) and 28% females (n=33). Patients were grouped according to age and mean ALT (95+86 IU/L) and AST (134.7+ 98 IU/L) levels were calculated in the different age groups. These levels were found to be significantly raised (P=0.00) in the age groups of 9-18 years and 19-25 years as compared to the other age groups. Moreover, males had high ALT levels as compared to females, however, a significant difference was not observed. There was also no association seen of gender with raised ALT levels (P=0.564), Phi &amp; Cramer’s V=0.56, and Spearman’s correlation coefficient=0.320.Conclusions: ALT and AST levels were elevated above the normal in our sample indicating hepatic involvement.

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.

Experience with the use of HIPEC in advanced serous ovarian cancer after complete and optimal cytoreduction.

Ovarian cancer (OC) is one of the most demanding unresolved issues in oncogynecology. In Ukraine, there are over 3000new cases of the disease annually. 24.6% of patients die within the first year after diagnosis. It indicates the relevance of developing new and optimizing existing OC treatment programs. To analyze the short-term results of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with primary (non-recurrent) advanced serous OC, in comparison with the group of patients after standard cytoreductive surgery (CRS) of high and medium complexity, according to the following indicators: the effect on metabolism, postoperative complications, length of stay in intensive care unit and hospital, timing of adjuvant chemotherapy initiation. Cases of 35patients with advanced serous OC who underwent the treatment at the Oncogynecology Department of the National Cancer Institute from December 2018to April 2020were analyzed. For the assessment of surgical procedures volumes, a surgical complexity scoring system was used. HIPEC was performed in 20patients (57.1%), while 15patients (42.9%) underwent standard CRS. At the beginning and end of the HIPEC procedure, a shift in acid-base state and the development of hyperthermia were evident. At the end of the 1st day of the postoperative period, statistically significant changes (p< 0.05) were revealed in pH, base excess, body temperature, alanine transaminase and aspartate transaminase levels in patients from HIPEC group indicating the development of metabolic acidosis and toxic liver damage. The negative effects of HIPEC developed at the end of the procedure may persist at the end of the first postoperative day. While metabolic acidosis diminishes, the signs of hepatotoxicity persist. Toxic liver damage is the most frequent complication of the postoperative period detected more often (p< 0.05) after HIPEC in comparison with standard CRS. Standard adjuvant chemotherapy began on average in 31.9± 4.4days in HIPEC group and 18.6± 1.6days in CRS group (p< 0.05). The data obtained indicate that HIPEC negatively affects metabolism and aggravates the severity of disorders that develop during the CRS phase. The use of HIPEC postpones the initiation of adjuvant chemotherapy, which is probably associated with a longer period of restoration of the functions of organs and systems of patients (in particular, liver function). The feasibility of HIPEC in advanced serous OC treatment requires further research.

Acute liver injury and survival in patients with SARS-Cov-2 from the Hospital Central Militar

Background and aim: Recent studies on SARS-CoV-2 have shown that the incidence of liver injury varies between 14.8% and 53%, mainly demonstrable by abnormal ALT / AST levels accompanied by slightly elevated bilirubin levels. Reports of autopsies around the word of patients that death from COVID-19 shows severe liver damage ranging from 58.06% to 78% of the cases. There is evidence that the elevation of transaminases (ALT / AST) translates into a more serious clinical profile. Besides, the elevation of AST is related with a high risk of mortality, so it must be monitored during hospitalization. Thus, it is important to know the behavior of liver injury and mortality in our population. Aim(s): To determine transaminase levels in patients with SARS-Cov-2 and its relationship with mortality. Methods. All the patients admitted with a positive SARS-Cov-2 PCR test were analyzed, the mean and standard deviation of AST, ALT, and other variables of the liver biochemistry, hemoglobin, leukocyte, fibrinogen, and TP were obtained. A Kapplan Meier curve was made for survival to compare patients with and without transaminases elevation. Result(s): We studied a total of 92 patients: 79 (86%) were male, age 56.62 +/- 13.70 years, weight 72.5 +/- 14.30 kg, height 1.63 +/- 0.10 m, BMI 27.09 +/- 5.04 kg / m2. Of the 92 patients, 68 (73%) had an elevation of transaminases at admission. Patient's whit elevation of transaminases (68): 63 (93%) were males, the mean values at admission of AST and ALT were 74.91 +/- 5.83 and 72.75 +/- 5.74, respectively. The average hospital stay was 6.1 +/- 4.1 days in de group with no elevation of transaminases and 7.25 +/- 5.3 days for the group with elevation. Other variables of liver biochemistry, hemoglobin, leukocyte, fibrinogen, and TP are presented in Table 1. The data referring to the probability of requiring ICU income. And probability of requiring mechanical ventilation are presented in Table 2. The group without and with elevated transaminases were compared to observe if elevation of transaminases could influence mortality, obtaining a non-statistically significant p. (x2 = 0.087, p = 0.782). Conclusion(s): In the studied population, the predominant gender was male, the population with elevated transaminases had a 3.82 risk of entering the ICU and 2.02 times more of requiring mechanical ventilation. The elevation of transaminases does not influence survival. The analysis of the entire database will have to be done, since this is a preliminary study (Fig. 1). Conflicts of interest: The authors have no conflicts of interest to declare. Copyright © 2020

Clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.

BACKGROUNDCoronavirus disease 2019 (COVID-19) has become a worldwide pandemic. We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing the epidemiological, clinical, and laboratory data for 218 COVID-19 patients and identifying the risk factors for liver injury by multivariate analysis.AIMTo investigate the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.METHODSThe 218 patients included 94 males (43.1%), aged 22 to 94 (50.1 ± 18.4) years. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were present in 42 (53.2%) and 36 (45.6%) cases, respectively, and 79 (36.2%) patients had abnormally elevated transaminase levels at admission. Patients with liver injury were older than those with normal liver function by a median of 12 years, with a significantly higher frequency of males (68.4% vs 28.8%, P < 0.001) and more coexisting illnesses (48.1% vs 27.3%, P = 0.002). Significantly more patients had fever and shortness of breath (87.3% vs 69.8% and 29.1% vs 14.4%, respectively) in the liver injury group. Only 12 (15.2%) patients had elevated total bilirubin. ALT and AST levels were mildly elevated [1-3 × upper limit of normal (ULN)] in 86.1% and 92.9% of cases, respectively. Only two (2.5%) patients had an ALT or AST level > 5 × ULN. Elevated γ-glutamyl transpeptidase was present in 45 (57.0%) patients, and 86.7% of these had a γ-glutamyl-transpeptidase level < 135 U/L (3 × ULN). Serum alkaline phosphatase levels were almost normal in all patients. Patients with severe liver injury had a significantly higher frequency of abnormal transaminases than non-severe patients, but only one case had very high levels of aminotransferases.RESULTSMultivariate analysis revealed that male sex, high D-dimer level, and high neutrophil percentage were linked to a higher risk of liver injury. The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels in patients in Wuhan. Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.CONCLUSIONMale sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.

Liver stiffness by transient elastography accompanies illness severity in COVID-19

ObjectiveSevere liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with...

Correlations Between METAVIR Staging, the Viral Load and Alanine Aminotransferase Levels in Patients with Chronic Hepatitis C, Before and after 12 Weeks of Antiviral Treatment

The World Health Organization (WHO) estimates that 170 million individuals worldwide are infected with hepatitis C virus (HCV). The aim of study was to evaluate possible correlations between METAVIR staging, the viral loads and alanine aminotransferase (ALT) levels in patients with chronic hepatitis C, before and after 12 weeks of treatment with PegInterferon a2a/a2b and Ribavirin. 93 consecutive patients with hepatitis C, were included in this study. The parameters followed were age, sex, Metavir histologic staging at the start of the treatment, hepatitis C virus ribonucleic acid (HCV-RNA) and ALT at start and after 12 weeks of treatment, as well as alcohol intake. The study group was composed by 58 women and 35 men, with a mean age of 44.47 � 11.17 years. At the beginning of the treatment, the mean value of HCV-RNA was 1327163 � 145001 UI/mL, with a CI95%=1327163 � 287986.36 UI/mL, and the mean value for ALT was 112.7124 � 68.7403 U/l. After 12 weeks of therapy, significant differences were found concerning both HCV-RNA and ALT values. HCV-RNA lowered to a mean value of 457.3978 � 402.653 (p[0.0001), while ALT lowered to a mean value of 37.90 � 16.43U/l (p[0.0001). Neither the initial HCV-RNA nor ALT values had any correlations with the METAVIR histological staging of the fibrosis. Initial ALT was higher in those with alcohol intake (p=0.000048). The ALT values instead, after 3 months of treatment, decreased significantly (p[0.0001), did correlate with the METAVIR groups (p=0.0019). The evolutionary stage of fibrosis didn�t correlate with gender of the patients or initial values of the HCV-RNA or ALT. There was no correlation between the age/gender of the patients and the determined METAVIR score.

MON-300 EFFICACY AND SAFETY OF CANAGLIFLOZIN, A SODIUM GLUCOSE COTRANSPORTER 2 (SGLT2) INHIBITOR, IN DIABETIC KIDNEY DISEASE: A RANDOMIZED OPEN-LABEL PROSPECTIVE TRIAL

Sodium glucose cotransporter 2 (SGLT2) inhibitors are expected to have, renoprotective effects based on the possible mechanism that SGLT2 inhibitors reduce hyperfiltration by blocking proximal tubule sodium reabsorption and activating tubuloglomerular feedback (TGF) and may decrease inflammatory, fibrotic, and hyperplastic response of proximal tubular cells by blocking glucose reabsorption into proximal tubular cells. Although SGLT2 inhibition is associated with an acute reduction in estimated glomerular filtration rate (eGFR) by about 4-6 mL/min per 1.73m2, eGFR typically has a tendency to return to baseline and remains stable thereafter. Furthermore, a 30 to 40% reduction in albuminuria was found. However, the effects of SGLT2 inhibition are unclear with regard to other kidney related biomarkers, such as those associated with tubulointerstitial damage. In the present study, we aimed to examine precisely the renoprotective effects of the SGLT2 inhibitor canagliflozin by measuring albuminuria, tubulointerstitial biomarkers, eGFR, and other metabolic parameters in patients with diabetic kidney disease (DKD) who are treated with renin-angiotensin system (RAS) inhibitors. In this prospective, open-label, parallel-group study, Japanese diabetes patients were randomized to receive either oral canagliflozin (100 mg/day) or usual care (control group) for 52 weeks. Before randomization, patients received fixed doses of conventional antidiabetic drugs (oral drugs and/or insulin) and RAS inhibitors for 8 weeks; these drugs were continued during the study. A total of 44 patients were randomly assigned to the canagliflozin group (n = 22) or the control group (n = 22). Endpoints included changes in urinary albumin-to-creatinine ratio (UACR), other urinary biomarkers, laboratory and vital parameters, and adverse events. Both groups included 22 patients in the analysis. Mean change in UACR was -221 g/gCr and 81 mg/gCr in the canagliflozin and control groups, respectively (P=0.004). Percent reduction in UACR was significantly greater in the canagliflozin group than in the control group (-49 ± 26% vs. 24 ± 47 %; P<0.0001). Urinary liver-type fatty acid binding protein (L-FABP), N-acetyl-β-D-glucosaminidase (NAG), and β2-microglobulin levels were also significantly decreased in the canagliflozin group, but not in the control group. Mean change in eGFR at the end of the study was 0.7 and -3.4 mL/min/1.73m2 in the canagliflozin and control group, respectively (P=0.024). A significant decrease in body mass index (BMI), systolic, diastolic blood pressure (BP), and mean arterial pressure was observed in the canagliflozin group. In addition, canagliflozin was associated with a significant increase in hemoglobin concentrations and hematocrit levels. Canagliflozin treatment leads to a reduction in albuminuria, urinary L-FABP, NAG, and β2-microglobulin levels in patients with DKD, regardless of simultaneous RAS inhibition. Furthermore, after 52 weeks, canagliflozin, in contrast to the control treatment, significantly reduced HbA1c and was associated with reductions in body weight, BPs, and liver transaminase levels in patients with DKD. The effect of canagliflozin on UACR appeared to be, in large part, beyond the effects on glycemic control. These findings suggest that canagliflozin may be an appropriate treatment option for patients with DKD.

Does turmeric/curcumin supplementation improve serum alanine aminotransferase and aspartate aminotransferase levels in patients with nonalcoholic fatty liver disease? A systematic review and meta-analysis of randomized controlled trials.

We performed a meta-analysis to evaluate the efficacy of turmeric/curcumin supplementation on serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with nonalcoholic fatty liver disease (NAFLD). We searched PubMed, Scopus, Cochrane Library, ISI Web of Science, and Google Scholar up to November 20, 2018. Studies that examined the effect of turmeric/curcumin on serum concentrations of ALT and AST among patients with NAFLD were included. The mean difference and standard deviation (SD) of changes in ALT and AST between intervention and control groups were used as effect size for the meta-analysis. A total of six randomized controlled trials (RCTs) were eligible for meta-analysis. Results from pooled analysis revealed that turmeric/curcumin supplementation reduced ALT (MD: -7.31 UL/L, 95% CI [-13.16, -1.47], p=0.014) and AST (MD: -4.68 UL/L, 95% CI [-8.75 -0.60], p=0.026). When RCTs stratified on the basis of their treatment duration, the significant reduction in serum concentrations of ALT and AST was observed only in studies lasting less than 12weeks. This review suggests that turmeric/curcumin might have a favorable effect on serum concentrations of ALT and AST in patients with NAFLD. However, further clinical trials are needed to confirm these findings.