Liver injury in the era of COVID-19

Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)has undoubtedly revolutionized the whole globe and given a new point of view on respiratory tract infections.Nevertheless,coronavirus disease 2019(COVID-19)cannot be perceived as a disease limited only to pneumonia with diverse severity.More and more reports have demonstrated a wide range of possible systemic symptoms,including hepatic complications.Liver injury has been observed in a significant proportion of patients,especially in those with a severe or critical illness.COVID-19 might provoke a deterioration of liver function in patients with already diagnosed chronic liver diseases and without pre-existing liver disorders.The deterioration of liver function worsens the prognosis,increases the risk of a severe course of SARS-CoV-2 infection and prolongs the hospital stay.In general,patients who develop liver dysfunction in COVID-19 are mainly males,elderly people,and those with higher body mass index.The underlying mechanisms for hepatic failure in patients infected with SARS-CoV-2 are still unclear,nevertheless liver damage appears to be directly connected with virus-induced cytopathic effects.A liver injury observed during hospitalization might be simultaneously caused by the use of potentially hepatotoxic drugs,mainly antiviral agents.This minireview focuses on a possible relationship between COVID-19 and the liver,potential molecular mechanisms of liver damage,the characteristics of liver injury and suggested factors predisposing to hepatic manifestations in COVID-19 patients.

Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease

BACKGROUND Looking for undiscovered blood markers of liver fibrosis and steatosis still remains an issue worth exploring.There are still plenty of unresolved issues related to the actual role of hematological indices as potential markers of liver function.AIM To study red blood cell distribution width(RDW),RDW-to-platelet ratio(RPR)and RDW-to-lymphocyte ratio(RLR) in alcohol-related liver cirrhosis(ALC) and metabolic-associated fatty liver disease(MAFLD).METHODS The study group was composed of 302 people:142 patients with ALC and 92 with MAFLD;68 persons were included as controls.RDW,RPR and RLR were measured in each person.Indirect and direct parameters of liver fibrosis were also assessed [aspartate transaminase to alkaline transaminase ratio,aspartate transaminase to platelet ratio index(APRI),fibrosis-4(FIB-4),gamma-glutamyl transpeptidase to platelet ratio(GPR),procollagen I carboxyterminal propeptide,procollagen Ⅲ aminoterminal propeptide,transforming growth factor-α,plateletderived growth factor AB,laminin].MELD score in ALC patients and nonalcoholic fatty liver disease(NAFLD) fibrosis score together with BARD score were obtained in the MAFLD group.The achieved results were compared to controls.Then a correlation between assessed markers was done.Diagnostic value of each investigated parameter and its suggested cut-off in the research group RESULTS RDW,RPR and RLR values turned out to be significantly higher in ALC and MAFLD groups compared to controls(ALC:P<0.0001;NAFLD:P<0.05,P<0.0001 and P<0.0001,respectively).RPR correlated positively with MELD score(P<0.01) and indirect indices of liver fibrosis(FIB-4 and GPR;P<0.0001) in ALC patients;negative correlations were found between PDGF-AB and both:RDW and RPR(P<0.01 and P<0.0001,respectively).RPR correlated positively with NAFLD fibrosis score and APRI(P<0.0001) in the MAFLD group;a positive relationship was observed between RDW and FIB-4,too(P<0.05).AUC values and suggested cut-offs for RDW,RPR and RLR in ALC patients were:0.912(>14.2%),0.965(>0.075) and 0.914(>8.684),respectively.AUC values and suggested cut-offs for RDW,RPR and RLR in MAFLD patients were:0.606(>12.8%),0.724(>0.047) and 0.691(>6.25),respectively.CONCLUSION RDW with its derivatives appear to be valuable diagnostic markers in patients with ALC.They can also be associated with a deterioration of liver function in this group.