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Volume 2024, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: The incidence of hepatic abnormalities has been notably higher following the coronavirus disease 2019 (COVID-19) infection, attributed to the virus’s entry into cells via angiotensin-converting enzyme 2 (ACE2) surface expression. The gastrointestinal tract’s significant ACE2 expression, alongside a lesser degree in the biliary epithelium, has been implicated in gastrointestinal symptoms and liver injury.

Purpose: The aim of this study was to determine whether specific ultrasonographic findings in the liver correlate with acute increases in liver function tests (LFTs) among hospitalized patients.

Methods: A retrospective analysis was conducted on hospitalized COVID-19 patients at Hazem Mebaireek General Hospital in Qatar, from March 1, 2020, to June 30, 2020. The study focused on patients who experienced acute increases in LFTs, excluding those with chronic liver disease. Ultrasound imaging and patient records were reviewed to gather data.

Results: Out of 223 ultrasound studies of COVID-19 patients, 158 met the inclusion criteria. The majority were male, with a mean age of 47.76 ± 13.76 years. Ultrasound results showed 43.7% normal liver parenchyma, while 56.3% exhibited nonspecific abnormalities such as diffuse liver hyperechogenicity (39.2%), enlargement with diffuse hyperechogenicity (12.7%), and other findings (4.4%). The biliary tree was predominantly normal (96.2%), with 3.8% showing abnormalities, including intrahepatic (2.5%) and extrahepatic (1.3%) dilatation. Gallbladder evaluations were normal in 60.1% of cases, with 39.9% showing abnormalities like stones (6.3%), stones with sludge (13.3%), polyps (6.3%), wall thickening (1.9%), and other conditions (12%). A significant correlation was found between abnormal liver parenchyma findings and elevated levels of bilirubin (total and direct) and alkaline phosphatase, with p-values < 0.05. Only aspartate aminotransferase levels showed a significant correlation with biliary tree abnormalities.

Conclusion: The most common ultrasonographic finding associated with acute increases in LFTs among hospitalized COVID-19 patients was diffuse liver hyperechogenicity, with or without enlargement. These findings suggest a nonspecific yet significant association with liver function anomalies in the context of COVID-19.

© 2024 Almughalles, Khojaly, Nashwan, Darweesh, Licensee HBKU Press.
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2024-09-16
2024-11-04
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References

  1. Sidhwani SK, Mirza T, Khatoon A, Shaikh F, Khan R, Shaikh OA, et al.. Inflammatory markers and COVID-19 disease progression. J Infect Public Health. 2023; 16:(9):1386-91. https://doi.org/10.1016/j.jiph.2023.06.018
     [Google Scholar]
  2. Safan AS, Imam Y, Khatib MY, Al Wraidat M, Altermanini MM, Al-Mughalles SA, et al.. COVID-19-associated neurological sequelae: A case series on cerebral microbleeds and encephalopathy. Qatar Med J. 2023; 2023:(4):29. https://doi.org/10.5339/qmj.2023.29
     [Google Scholar]
  3. Anjum MR, Chalmers J, Hamid R, Rajoriya N. COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future. World J Gastroenterol. 2021; 27:(44):7625-48. https://doi.org/10.3748/wjg.v27.i44.7625
     [Google Scholar]
  4. Shah MD, Sumeh AS, Sheraz M, Kavitha MS, Venmathi Maran BA, Rodrigues KF. A mini-review on the impact of COVID 19 on vital organs. Biomed Pharmacother. 2021; 143:112158. https://doi.org/10.1016/j.biopha.2021.112158
     [Google Scholar]
  5. Rismanbaf A, Zarei S. Liver and kidney injuries in COVID-19 and their effects on drug therapy; a letter to editor. Arch Acad Emerg Med. 2020; 8:(1):e17.
    [Google Scholar]
  6. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: Management and challenges. Lancet Gastroenterol Hepatol. 2020; 5:(5):428-30. https://doi.org/10.1016/S2468-1253(20)30057-1
     [Google Scholar]
  7. Sutherland F, Harris J. Claude Couinaud: A passion for the liver. Arch Surg. 2002; 137:(11):1305-10. https://doi.org/10.1001/archsurg.137.11.1305
     [Google Scholar]
  8. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al.. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020. https://doi.org/10.1101/2020.02.03.931766
     [Google Scholar]
  9. Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020; 158:(6):1831-3.e3. https://doi.org/10.1053/j.gastro.2020.02.055
     [Google Scholar]
  10. Li G, He X, Zhang L, Ran Q, Wang J, Xiong A, et al.. Assessing ACE2 expression patterns in lung tissues in the pathogenesis of COVID-19. J Autoimmun. 2020; 112:112:102463. https://doi.org/10.1016/j.jaut.2020.102463
     [Google Scholar]
  11. Sidhwani SK, Mirza T, Khatoon A, Shaikh F, Khan R, Shaikh OA, et al.. Angiotensin-converting enzyme 2 (ACE2) polymorphisms and susceptibility of severe SARS-CoV-2 in a subset of Pakistani population. Virol J. 2023; 20:(1):120. https://doi.org/10.1186/s12985-023-02091-2
     [Google Scholar]
  12. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al.. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020; 395:(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7
     [Google Scholar]
  13. Yan J, Xie W, Ou WN, Zhao H, Wang SY, Wang JH, et al.. Epidemiological survey and risk factor analysis of fatty liver disease of adult residents, Beijing, China. J Gastroenterol Hepatol. 2013; 28:(10):1654-9. https://doi.org/10.1111/jgh.12290
     [Google Scholar]
  14. Guo H, Zhang Z, Zhang Y, Liu Y, Wang J, Qian Z, et al.. Analysis of liver injury factors in 332 patients with COVID-19 in Shanghai, China. Aging (Albany NY). 2020; 12:(19):18844-52. https://doi.org/10.18632/aging.103860
     [Google Scholar]
  15. Chen F, Chen W, Chen J, Xu D, Xie W, Wang X, et al.. Clinical features and risk factors of COVID-19-associated liver injury and function: A retrospective analysis of 830 cases. Ann Hepatol. 2021; 21:100267. https://doi.org/10.1016/j.aohep.2020.09.011
     [Google Scholar]
  16. Zampino R, Mele F, Florio LL, Bertolino L, Andini R, Galdo M, et al.. Liver injury in remdesivir-treated COVID-19 patients. Hepatol Int. 2020; 14:(5):881-3. https://doi.org/10.1007/s12072-020-10077-3
     [Google Scholar]
  17. Abdelmohsen MA, Alkandari BM, Gupta VK, ElBeheiry AA. Diagnostic value of abdominal sonography in confirmed COVID-19 intensive care patients. Egypt J Radiol Nuclear Med. 2020; 51:198. https://doi.org/10.1186/s43055-020-00317-9
     [Google Scholar]
  18. Ippolito D, Maino C, Vernuccio F, Cannella R, Inchingolo R, Dezio M, et al.. Liver involvement in patients with COVID-19 infection: A comprehensive overview of diagnostic imaging features. World J Gastroenterol. 2023; 29:(5):834-50. https://doi.org/10.3748/wjg.v29.i5.834
     [Google Scholar]
  19. Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, et al.. Abdominal imaging findings in COVID-19: Preliminary observations. Radiology. 2020; 297:(1):E207-15. https://doi.org/10.1148/radiol.2020201908
     [Google Scholar]
  20. Ji D, Qin E, Xu J, Zhang D, Cheng G, Wang Y, et al.. Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study. J Hepatol. 2020; 73:(2):451-3. https://doi.org/10.1016/j.jhep.2020.03.044
     [Google Scholar]
  21. Spogis J, Hagen F, Thaiss WM, Hoffmann T, Malek N, Nikolaou K, et al.. Sonographic findings in coronavirus disease-19 associated liver damage. PLoS One. 2021; 16:(2):e0244781. https://doi.org/10.1371/journal.pone.0244781
     [Google Scholar]
  22. Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, et al.. COVID-19: Abnormal liver function tests. J Hepatol. 2020; 73:(3):566-74. https://doi.org/10.1016/j.jhep.2020.04.006
     [Google Scholar]
/content/journals/10.5339/qmj.2024.46
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Liver ultrasound evaluation of acutely increased liver function tests of COVID-19 hospitalized patients
Qatar Medical Journal 2024, 46 (2024); https://doi.org/10.5339/qmj.2024.46
/content/journals/10.5339/qmj.2024.46
/content/journals/10.5339/qmj.2024.46
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  • Article Type: Research Article
Keyword(s): ACE2 expression, COVID-19, hepatic abnormalities, liver function tests and ultrasonography

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