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The American Journal of the Medical... Feb 2022The current coronavirus disease outbreak of 2019 (COVID-19) has led to a global pandemic. The principal cause of mortality in COVID-19 is represented lung injury with... (Review)
Review
The current coronavirus disease outbreak of 2019 (COVID-19) has led to a global pandemic. The principal cause of mortality in COVID-19 is represented lung injury with the development of acute respiratory distress syndrome (ARDS). In patients with COVID-19 infection, liver injury or liver dysfunction has been reported. It may be associated with the general severity of the disease and serve as a prognostic factor for ARDS development. In COVID-19, the spectrum of liver damage may range from direct SARS-CoV-2 viral proteins, inflammatory processes, hypoxemia, the antiviral drugs induced hepatic injury and the presence of the preexisting liver disease. We highlight in this review important topics such as the epidemiological features, potential causes of liver injury, and the strategies for management and prevention of hepatic injury in COVID-19 patients.
Topics: COVID-19; Humans; Liver Diseases; Pandemics; Respiratory Distress Syndrome; SARS-CoV-2
PubMed: 34752738
DOI: 10.1016/j.amjms.2021.11.001 -
Taiwanese Journal of Obstetrics &... Oct 2015Deranged liver function tests are encountered in 3% of pregnancies. The potential causes are classified as those unique to and those just incidental to pregnancy.... (Review)
Review
Deranged liver function tests are encountered in 3% of pregnancies. The potential causes are classified as those unique to and those just incidental to pregnancy. Pregnancy-related diseases are the most frequent causes of liver dysfunction during pregnancy and exhibit a trimester-specific occurrence during pregnancy. Differentiation of liver dysfunction as that related to and just incidental to pregnancy is the key to management, especially when liver dysfunction is encountered after 28 weeks of pregnancy. It can be judged from the fact that delivery remains the cornerstone of management of pregnancy-related diseases except hyperemesis gravidarum. This is an overview of the causes of liver dysfunction during pregnancy; an update on the underlying mechanisms of their occurrence, especially liver diseases unique to pregnancy; and a methodological approach to their diagnosis and management.
Topics: Disease Management; Female; Global Health; Humans; Incidence; Liver Diseases; Liver Function Tests; Pregnancy; Pregnancy Complications; Prognosis
PubMed: 26522095
DOI: 10.1016/j.tjog.2015.01.004 -
Clinical Medicine (London, England) Sep 2021Liver disease in pregnancy can be related to a pre-existing condition (such as autoimmune liver disease) or arise as a consequence of pregnancy. In women with...
Liver disease in pregnancy can be related to a pre-existing condition (such as autoimmune liver disease) or arise as a consequence of pregnancy. In women with pre-existing disease, pre-pregnancy counselling is important to discuss the potential complications that may occur during pregnancy and how best to manage these. Acute fatty liver of pregnancy and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome are pregnancy-related liver diseases and are considered obstetric emergencies. Women with liver dysfunction need appropriate investigations, including blood tests and imaging. They should be managed as part of a multidisciplinary team with obstetricians, obstetric anaesthetists, specialist midwives, gastroenterologists and obstetric physicians.
Topics: Female; HELLP Syndrome; Humans; Liver; Liver Diseases; Pregnancy; Pregnancy Complications
PubMed: 34507927
DOI: 10.7861/clinmed.2021-0497 -
Anesthesia and Analgesia Jul 2021Liver and biliary disease complicates pregnancy in varying degrees of severity to the mother and fetus, and anesthesiologists may be asked to assist in caring for these... (Review)
Review
Liver and biliary disease complicates pregnancy in varying degrees of severity to the mother and fetus, and anesthesiologists may be asked to assist in caring for these patients before, during, and after birth of the fetus. Therefore, it is important to be familiar with how different liver diseases impact the pregnancy state. In addition, knowing symptoms, signs, and laboratory markers in the context of a pregnant patient will lead to faster diagnosis and treatment of such patients. This review article discusses changes in physiology of parturients, patients with liver disease, and parturients with liver disease. Next, general treatment of parturients with acute and chronic liver dysfunction is presented. The article progresses to specific liver diseases with treatments as they relate to pregnancy. And finally, important aspects to consider when anesthetizing parturients with liver disease are discussed.
Topics: Anesthesia, Obstetrical; Bile Duct Diseases; Female; Humans; Liver Diseases; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 33687174
DOI: 10.1213/ANE.0000000000005433 -
World Journal of Gastroenterology Jul 2023The global spread of severe acute respiratory syndrome coronavirus 2, responsible for coronavirus disease 2019 (COVID-19), poses a significant risk to public health.... (Review)
Review
BACKGROUND
The global spread of severe acute respiratory syndrome coronavirus 2, responsible for coronavirus disease 2019 (COVID-19), poses a significant risk to public health. Beyond the respiratory issues initially associated with the condition, severe cases of COVID-19 can also lead to complications in other organs, including the liver. Patients with severe COVID-19 may exhibit various clinical signs of liver dysfunction, ranging from minor elevations in liver enzymes without symptoms to more serious cases of impaired liver function. Liver damage is more commonly observed in patients with severe or critical forms of the disease.
AIM
To present the research landscape on COVID-19 and liver dysfunction while also offering valuable insights into the prominent areas of interest within this particular domain.
METHODS
On 18 February 2023, Scopus was utilised to conduct a comprehensive exploration of the relationship between COVID-19 and the liver dysfunction. The investigation encompassed the period from 1 January 2020 to 31 December 2022. Primary sources were meticulously examined and organised in a Microsoft Excel 2013 spreadsheet, categorised by journal, institution, funding agency, country and citation type. VOSviewer version 1.6.18 was employed to explore the prominent topics and knowledge network related to the subject.
RESULTS
There were 2336 publications on COVID-19 and liver dysfunction analysed in this study, of which 558 were published in 2020, 891 in 2021 and 887 in 2022. Researchers from 111 different countries participated in the retrieved documents. The United States contributed the most studies, with 497 documents, representing 21.28% of the total, followed by China with 393 documents (16.82%) and Italy with 255 documents (10.92%). In the context of research related to COVID-19 and the liver, co-occurrence analysis identified three distinct clusters of topics: (1) 'COVID-19 vaccines in liver transplant recipients'; (2) 'liver function tests as a predictor of the severity and clinical outcomes in hospitalised patients'; and (3) 'care of patients with liver disease during the COVID-19 pandemic'.
CONCLUSION
This bibliometric study provides a comprehensive overview of liver-related publications in COVID-19 research over the past 3 years. This study highlights the significant contributions of high-income nations, particularly the United States, China, and Italy, to the production of liver-related scholarly literature in this field. Most of the articles focused on liver dysfunction in patients with COVID-19 and the implications of the virus for gastroenterologists and hepatologists.
Topics: Humans; COVID-19; COVID-19 Vaccines; Pandemics; Liver Diseases; Bibliometrics
PubMed: 37545639
DOI: 10.3748/wjg.v29.i27.4356 -
Alcohol Research & Health : the Journal... 2003Hepatic encephalopathy (HE) is a brain disorder caused by chronic liver failure, particularly in alcoholics with cirrhosis, which results in cognitive, psychiatric, and... (Review)
Review
Hepatic encephalopathy (HE) is a brain disorder caused by chronic liver failure, particularly in alcoholics with cirrhosis, which results in cognitive, psychiatric, and motor impairments. In these patients, the number of functional liver cells is reduced, and some blood is diverted around the liver before toxins are removed. As a result, toxins such as ammonia and manganese can accumulate in the blood and enter the brain, where they can damage nerve cells and supporting cells called astrocytes. Positron emission tomography analyses have determined that ammonia levels are elevated in the brains of HE patients; ammonia accumulation can alter the expression of various important brain genes. Magnetic resonance images show that manganese is deposited in a brain area called the globus pallidus; manganese deposits may be responsible for structural changes in the astrocytes that are characteristic of HE. Treatment of patients with HE involves measures to lower ammonia levels in the blood, medications to counteract ammonia's effects on brain cell function, devices to compensate for liver dysfunction, and liver transplantation.
Topics: Brain; Hepatic Encephalopathy; Humans; Liver Diseases, Alcoholic
PubMed: 15535452
DOI: No ID Found -
PloS One 2022High-density lipoproteins (HDLs) are synthesized by the liver and display endothelioprotective properties, including anti-inflammatory, antiapoptotic, antithrombotic and... (Observational Study)
Observational Study
BACKGROUND
High-density lipoproteins (HDLs) are synthesized by the liver and display endothelioprotective properties, including anti-inflammatory, antiapoptotic, antithrombotic and antioxidant effects. In both septic and chronic liver failure patients, a low HDL cholesterol (HDL-C) concentration is associated with overmortality. Whereas sepsis-associated liver dysfunction is poorly defined, the aim of this study was to characterize the relationship between liver dysfunction, lipoprotein concentrations and mortality in septic patients in the intensive care unit (ICU).
METHODS
A prospective observational study was conducted in a university hospital ICU. All consecutive patients admitted for septic shock or sepsis were included. Total cholesterol, HDL-C, low-density lipoprotein-cholesterol (LDL-C), and triglyceride levels were assessed at admission. Sepsis-associated liver dysfunction was defined as a serum bilirubin≥ 2N or aspartate aminotransferase/alanine aminotransferase concentrations ≥ 2N. Short-term and one-year prognostic outcomes were prospectively assessed.
RESULTS
A total of 219 septic patients were included, and 15% of them presented with sepsis-associated liver dysfunction at admission. Low concentrations of lipoproteins were associated with mortality at Day 28 in the overall population. Sepsis-associated liver dysfunction at admission was associated with overmortality. In this subgroup, patients had a lower HDL-C concentration than patients without hepatic dysfunction (HDL-C = 0.31 [0.25, 0.55] mmol/L vs. 0.48 [0.29, 0.73] mmol/L, p = 0.0079) but there was no relationship with the outcome. Interestingly, no correlation was observed between lipoprotein concentrations and liver dysfunction markers.
CONCLUSION
Sepsis-associated liver dysfunction at ICU admission is strongly associated with overmortality and is associated with a lower HDL-C concentration. However, in this subgroup of patients, HDL-C concentration had no relationship with mortality. Further exploratory studies are needed to better understand the interaction between lipoproteins and liver dysfunction during sepsis.
Topics: Cholesterol, HDL; Cholesterol, LDL; Humans; Lipoproteins; Liver Diseases; Sepsis; Shock, Septic
PubMed: 35994439
DOI: 10.1371/journal.pone.0272352 -
World Journal of Gastroenterology Oct 2022Coronavirus disease 2019 (COVID-19) is a highly infectious disease which emerged into a global pandemic. Although it primarily causes respiratory symptoms for affected... (Review)
Review
Coronavirus disease 2019 (COVID-19) is a highly infectious disease which emerged into a global pandemic. Although it primarily causes respiratory symptoms for affected patients, COVID-19 was shown to have multi-organ manifestations. Elevated liver enzymes appear to be commonly observed during the course of COVID-19, and there have been numerous reports of liver injury secondary to COVID-19 infection. It has been established that patients with pre-existing chronic liver disease (CLD) are more likely to have poorer outcomes following COVID-19 infection compared to those without CLD. Co-morbidities such as diabetes, hypertension, obesity, cardiovascular and chronic kidney disease frequently co-exist in individuals living with CLD, and a substantial population may also live with some degree of frailty. The mechanisms of how COVID-19 induces liver injury have been postulated. Hepatorenal syndrome (HRS) is the occurrence of kidney dysfunction in patients with severe CLD/fulminant liver failure in the absence of another identifiable cause, and is usually a marker of severe decompensated liver disease. Select reports of HRS following acute COVID-19 infection have been presented, although the risk factors and pathophysiological mechanisms leading to HRS in COVID-19 infection or following COVID-19 treatment remain largely unestablished due to the relative lack and novelty of published data. Evidence discussing the management of HRS in high-dependency care and intensive care contexts is only emerging. In this article, we provide an overview on the speculative pathophysiological mechanisms of COVID-19 induced HRS and propose strategies for clinical diagnosis and management to optimize outcomes in this scenario.
Topics: Humans; Hepatorenal Syndrome; COVID-19; Pandemics; Liver Diseases; COVID-19 Drug Treatment
PubMed: 36338894
DOI: 10.3748/wjg.v28.i39.5666 -
BioMed Research International 2015Liver ischemia-reperfusion (I-R) injury occurs during liver resection, liver transplantation, and hemorrhagic shock. The main mode of liver cell death after warm and/or... (Review)
Review
Liver ischemia-reperfusion (I-R) injury occurs during liver resection, liver transplantation, and hemorrhagic shock. The main mode of liver cell death after warm and/or cold liver I-R is necrosis, but other modes of cell death, as apoptosis and autophagy, are also involved. Autophagy is an intracellular self-digesting pathway responsible for removal of long-lived proteins, damaged organelles, and malformed proteins during biosynthesis by lysosomes. Autophagy is found in normal and diseased liver. Although depending on the type of ischemia, warm and/or cold, the dynamic process of liver I-R results mainly in adenosine triphosphate depletion and in production of reactive oxygen species (ROS), leads to both, a local ischemic insult and an acute inflammatory-mediated reperfusion injury, and results finally in cell death. This process can induce liver dysfunction and can increase patient morbidity and mortality after liver surgery and hemorrhagic shock. Whether autophagy protects from or promotes liver injury following warm and/or cold I-R remains to be elucidated. The present review aims to summarize the current knowledge in liver I-R injury focusing on both the beneficial and the detrimental effects of liver autophagy following warm and/or cold liver I-R.
Topics: Animals; Autophagy; Humans; Liver; Liver Diseases; Reperfusion Injury
PubMed: 25861623
DOI: 10.1155/2015/417590 -
Anesthesia and Analgesia Dec 2020Despite substantial advances in anesthesia safety within the past decades, perioperative mortality remains a prevalent problem and can be considered among the top causes... (Review)
Review
Despite substantial advances in anesthesia safety within the past decades, perioperative mortality remains a prevalent problem and can be considered among the top causes of death worldwide. Acute organ failure is a major risk factor of morbidity and mortality in surgical patients and develops primarily as a consequence of a dysregulated inflammatory response and insufficient tissue perfusion. Neurological dysfunction, myocardial ischemia, acute kidney injury, respiratory failure, intestinal dysfunction, and hepatic impairment are among the most serious complications impacting patient outcome and recovery. Pre-, intra-, and postoperative arrangements, such as enhanced recovery after surgery programs, can contribute to lowering the occurrence of organ dysfunction, and mortality rates have improved with the advent of specialized intensive care units and advances in procedures relating to extracorporeal organ support. However, no specific pharmacological therapies have proven effective in the prevention or reversal of perioperative organ injury. Therefore, understanding the underlying mechanisms of organ dysfunction is essential to identify novel treatment strategies to improve perioperative care and outcomes for surgical patients. This review focuses on recent knowledge of pathophysiological and molecular pathways leading to perioperative organ injury. Additionally, we highlight potential therapeutic targets relevant to the network of events that occur in clinical settings with organ failure.
Topics: Acute Kidney Injury; Heart Diseases; Humans; Liver Diseases; Multiple Organ Failure; Perioperative Care; Postoperative Complications; Risk Factors
PubMed: 33186161
DOI: 10.1213/ANE.0000000000005191