Preview

Experimental and Clinical Gastroenterology

Advanced search

Cytolytic syndrome in patients with COVID-19

https://doi.org/10.31146/1682-8658-ecg-203-7-115-122

Abstract

. Identify cytolysis syndrome among patients with COVID-19 and explore the potential relationship between the course of COVID-19 and liver damage. Materials and methods. 450 people with a diagnosis of "U07.1 - Coronavirus infection COVID-19, virus identified" were examined, undergoing and inpatient and outpatient treatment at Tuymazinskaya Central District Hospital. CT scan of the chest organs, biochemical blood test with calculation of ALT, AST, total protein, glucose, total bilirubin, APTT, PTI, INR, fibrinogen were evaluated. Results. The presence of cytolytic syndrome was detected in 217 (48.2%) patients. The ALT level was 60 [23;72] U/L, and the AST level was 45 [22;57] U/L. Between the severity of the course and the ALT level, a direct, strong significant correlation was revealed (ρ=0.724, t=22.26, p>95%). A direct, significant correlation of moderate strength was found between the severity and percentage of lung parenchymal lesions (ρ=0.68, t=19.62, p>95%), AST level (ρ=0.68, t=19.53, p>95%), age of patients (ρ=0.51, t=12.55, p>95%), BMI (ρ=0.4, t=9.44, p>95%). Comparing the degree of damage to the lung parenchyma with the level of AST, a direct, significant correlation of moderate strength (ρ=0.5, t=12.38, p>95%) was revealed, as well as with the level of ALT (ρ=0,5, t=11.98, p>95%), total protein level (ρ=0.38, t=8.8, p>95%), age (ρ=0.35, t=7.85, p>95%. Conclusion. Clinical manifestations of COVID-19 are characterized by polysyndromicity, including a cytolytic syndrome. Changes in liver function parameters found in COVID-19 are associated with the severity of the infection, age and BMI. An important point in the post-COVID rehabilitation of patients is inclusion of hepatoprotectors.

About the Authors

Alisa M. Lukmanova
Bashkir State Medical University of the Ministry of Healthcare of the Russia
Russian Federation


Albina R. Isanbaeva
Bashkir State Medical University of the Ministry of Healthcare of the Russia
Russian Federation


Gulnar M. Sakhautdinova
Bashkir State Medical University of the Ministry of Healthcare of the Russia
Russian Federation


References

1. WHO Coronavirus Disease (COVID-19) Dashboard. Available from: https://covid19.who.int/ (accessed: 27.12.2021)

2. Tay M. Z., Poh C. M., Re nia L., et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20:363-374. doi:10.1038/s41577-020-0311-8

3. Xu L., Liu J., Lu M., Yang D., Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;5(40):998-1004. doi:10.1111/liv.14435

4. Mao R., et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5:667-678. doi:10.1016/S2468-1253(20)30126-6

5. Ponziani F. R., et al. Liver involvement is not associated with mortality: results from a large cohort of SARSCoV-2 positive patients. Aliment. Pharmacol. Ther. 2020;52:1060-1068. doi:10.1111/apt.15996

6. Zhang Y., Zheng L., Liu L., Zhao M., Xiao J., Zhao Q. Liver impairment in COVID-19 patients: a retrospective analysis of 115 cases from a single centre in Wuhan city. China. Liver Int: Official J Int Assoc Study Liver. 2020;40(9):2095-2103. doi:10.1111/liv.14455

7. Fu Y., Zhu R., Bai T., Han P., He Q., Jing M., et al. Clinical features of patients infected with coronavirus disease 2019 with elevated liver biochemistries: A multicenter, retrospective study. Hepatology. 2021;73:1509-1520. doi:10.1002/hep.31446

8. Makarova M. A., Baranova I. A. Main hepatic syndromes in practice of internist. Consilium Medicum. 2017;19(8): 69-74. (In Russ.) doi:10.26442/2075-1753_19.8.69-74 @@Макарова М. А., Баранова И. А. Основные гепатологические синдромы в практике врача-интерниста. Consilium Medicum. 2017;19(8):69-74. doi:10.26442/2075-1753_19.8.69-74

9. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5

10. 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;2020.02.03.931766. doi:10.1101/2020.02.03.931766

11. Cai Q., Huang D., Yu H., Zhu Z., Xia Z., Su Y., Li Z., Zhou G., Gou J., Qu J., Sun Y., Liu Y., He Q., Chen J., Liu L., Xu L. COVID-19: Abnormal liver function tests. J Hepatol. 2020 Sep;73(3):566-574. doi:10.1016/j.jhep.2020.04.006

12. Suleyman G., Fadel R. A., Malette K. M., et al. Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Netw Open. 2020;3(6): e2012270. doi:10.1001/jamanetworkopen.2020.12270

13. Instructions for medical use of the drug hydroxychloroquine. Vidal handbook. Moscow. 2020. @@Инструкция по медицинскому применению лекарственного препарата гидроксихлорохин https://www.vidal.ru/drugs/hydroxychloroquine__21476, Описание препарата в справочнике Видаль

14. Wei C. H., Penunuri A., Karpouzas G. Troxis necrosis, a novel mechanism for drug induced hepatitis secondary to immunomodulatory therapy. Exp. Mol. Pathol. 2015;99(2):341-3. doi:10.1016/j.yexmp.2015.08.006

15. Instructions for medical use of the drug favipiravir. Vidal handbook. Moscow. 2020. @@Инструкция по медицинскому применению лекарственного препарата https://www.vidal.ru/drugs/molecule/2975, Описание препарата в справочнике Видаль

16. Yang X., Yu Y., Xu J., et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5

17. Dillon J. F., Miller M. H. Gamma glutamyl transferase ‘To be or not to be’ a liver function test? Ann Clin Biochem. 2016;53(6):629-631. doi:10.1177/0004563216659887

18. Fernandez N. J., Kidney B. A. Alkaline phosphatase: beyond the liver. Vet Clin Pathol. 2007;36:223-233. doi:10.1111/j.1939-165X.2007.tb00216.x

19. Falcão M. B., Pamplona de Góes Cavalcanti L., Filgueiras Filho N. M., Antunes de Brito C. A. Case Report: Hepatotoxicity Associated with the Use of Hydroxychloroquine in a Patient with COVID-19. Am J Trop Med Hyg. 2020;102(6):1214-1216. doi:10.4269/ajtmh.20-0276

20. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5

21. Templin C., Ghadri J. R., Diekmann J., et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373:929-938. doi:10.1056/NEJMoa1406761

22. Mehta P., McAuley D.F., Brown M., et al. HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033-1034. doi:10.1016/s0140-6736(20)30628-0

23. Sarzi-Puttini P., Giorgi V., Sirotti S., et al. COVID-19, cytokines and immunosuppression: what can we learn from severe acute respiratory syndrome? Clin Exp Rheumatol. 2020;38:337-342

24. Li X., Geng M., Peng Y., et al. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;10:102-108. doi:10.1016/j.jpha.2020.03.001

25. Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831-1833.e3. doi:10.1053/j.gastro.2020.02.055

26. Ministerio de Sanidad. Enfermedad por coronavirus, COVID-19. Madrid: Ministerio de Sanidad; 2020 [actualizado 3 Jul 2020] [citado 12 Jul 2020]. Disponible en: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCovChina/documentos/ITCoronavirus.pdf

27. Cohen J. The immunopathogenesis of sepsis. Nature. 2002;420:885-891. doi:10.1038/nature01326

28. Sun J., Aghemo A., Forner A., Valenti L. COVID-19 and liver disease. Liver Int. 2020;40(6):1278-1281. doi:10.1111/liv.14470

29. Lightsey J. M., Rockey D. C. Current concepts in ischemic hepatitis. Curr Opin Gastroenterol. 2020;33:158-163. doi:10.1097/mog.0000000000000355

30. Waseem N., Chen P. H. Hypoxic hepatitis: a review and clinical update. J Clin Transl Hepatol. 2016;4:263-268. doi:10.14218/jcth.2016.00022

31. Han H., Yang L., Liu R., Liu F., Wu K.-L., Li J. Prominent changes in blood coagulation of patients with SARSCoV- 2 infection. Clin Chem Lab Med. 2020;58:1116-1120. doi:10.1515/cclm-2020-0188

32. Li J., Li R. J., Lv G. Y., Liu H. Q. The mechanisms and strategies to protect from hepatic ischemia-reperfusion injury. Eur Rev Med Pharmacol Sci. 2015;19:2036-2047

33. Hundt M. A., Deng Y., Ciarleglio M. M., Nathanson M. H., Lim J. K. Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U. S. Hospital Network. Hepatology. 2020;72(4):1169-1176. doi:10.1002/hep.31487

34. Centers for Disease Control and Prevention. People who are at higher risk for severe illness https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html Accessed on April 1, 2020


Review

For citations:


Lukmanova A.M., Isanbaeva A.R., Sakhautdinova G.M. Cytolytic syndrome in patients with COVID-19. Experimental and Clinical Gastroenterology. 2022;(7):115-122. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-203-7-115-122

Views: 477


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1682-8658 (Print)