Жамият ва инновациялар –
Общество и инновации –
Society and innovations
Journal home page:
https://inscience.uz/index.php/socinov/index
Patients with chronic liver disease and COVID-19 (literature
review and own data)
Yuldasheva D.H
1
Muxamedova Z.X.
2
Shadjanova N.S.
3
Bukhara state medical institute
ARTICLE INFO
ABSTRACT
Article history:
Received January 2021
Received in revised form
15 January 2021
Accepted 20 February 2021
Available online
7 March 2021
The pandemic of the new coronavirus COVID-19 has switched
medicine around the world on the primary fight against this
infection. Patients with chronic liver diseases require increased
attention of doctors during an epidemic, since against the
background of an exacerbation of their disease, not only the risk
of contracting the COVID-19 viral infection increases, but also its
more severe course. Patients with confirmed COVID-19 with
severe liver damage - high biochemical activity. According to
some reports, patients with a severe course of COVID-19 have an
increase in ALT levels, a decrease in the number of platelets, a
decrease in the level of albumin, and a connection (although not
all indicators) with a higher risk of mortality is possible.
2181-1415/© 2021 in Science LLC.
This is an open access article under the Attribution 4.0 International
(CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/deed.ru)
Keywords:
COVID 19
Liver damage
Prognosis
Chronic liver disease
Blood chemistry
The course of a new
coronavirus infection
Jigarning surunkali kasalligi va COVID-19 bilan kasallangan
bemorlar (adabiyotlarni ko'rib chiqish va o'z ma'lumotlari)
АННОТАЦИЯ
Калит сўзлар:
COVID 19
Jigar shikastlanishi
Prognoz
Jigarning surunkali kasalligi
Qon kimyosi
Yangi koronavirus
infektsiyasining borishi
COVID-19 yangi koronavirusining pandemiyasi butun
dunyoda tibbiyotni ushbu infektsiyaga qarshi asosiy kurashga
o'zgartirdi. Surunkali jigar kasalliklariga chalingan bemorlar
epidemiya paytida shifokorlarning diqqatini kuchaytirilishini
talab qiladi, chunki ularning kasalliklari kuchayishi fonida
nafaqat COVID-19 virusli infektsiyasini yuqtirish xavfi, balki
uning og'ir yo'li ham oshadi. Jigarning jiddiy shikastlanishi bilan
tasdiqlangan KOVID-19 bilan kasallangan bemorlar - yuqori
biokimyoviy faollik. Ba'zi xabarlarga ko'ra, KOVID-19 ning og'ir
kursi bilan og'rigan bemorlarda ALT darajasi oshadi,
1
Bukhara state medical institute. Bukhara. Uzbekistan
2
Bukhara state medical institute. Bukhara. Uzbekistan
3
Bukhara state medical institute. Bukhara. Uzbekistan
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trombotsitlar soni kamayadi, albuminlar miqdori kamayadi va
yuqori xavfga ega bo'lgan ulanish (barcha ko'rsatkichlar emas).
o'lim mumkin.
Пациенты с хроническим заболеванием печени и COVID-19
(обзор литературы и собственные данные)
АННОТАЦИЯ
Ключевые слова:
COVID 19
Поражение печени
Прогноз
Хроническое заболевание
печени
Химический анализ крови
Течение новой
коронавирусной
инфекции
Пандемия нового коронавируса COVID-19 переключила
медицину во всем мире на первичную борьбу с этой
инфекцией. Пациенты с хроническими заболеваниями
печени требуют повышенного внимания врачей во время
эпидемии, поскольку на фоне обострения их заболевания
увеличивается не только риск заражения вирусной
инфекцией COVID 19, но и более тяжелое ее течение.
Пациенты с подтвержденным COVID-19 с тяжелым
поражением печени - высокая биохимическая активность.
По некоторым данным, у пациентов с тяжелым течением
COVID-19 наблюдается повышение уровня АЛТ, снижение
количества тромбоцитов, снижение уровня альбумина и
связь (хотя и не все показатели) с более высоким риском
смертности возможна.
THE URGENCY OF THE PROBLEM
The global pandemic of the new coronavirus infection (COVID-19) caused by the
SARSCoV-2 coronavirus began in Wuhan, China in December 2019 and has since spread
around the world. Coronavirus infection (COVID-19) is an acute infectious disease caused
by a new strain of the SARS CoV-2 coronavirus with aerosol-capillary and contact-
mechanical transmission [2,4,17]. The pathogenetic COVID-19 is characterized by viremia,
local and systemic immune-inflammatory processes, hyperactivity of the coagulation
cascade, endothelial disease, hypoxia, which leads to the development of micro- and
macrothrombosis; proceeds from asymptomatic to clinically severe forms with
intoxication, fever, damage to the vascular endothelium, lungs, heart, kidneys,
gastrointestinal tract, central and peripheral nervous system, system at risk
[1,2,3,5,7,9,18,21].
The pandemic of the new coronavirus COVID-19 has switched medicine around the
world on the primary fight against this infection. However, the COVID-19 attack did not
cancel diseases that humanity suffered before the pandemic developed. And, as thanks to
the joint efforts of the medical community, the pandemic is stabilizing, and in a number of
countries are beginning to decline, the need is ripe to return attention to patients with
other diseases and assess their interaction with the new an unprecedented infection, the
features of which both per se and in combination with other pathological conditions, we
still know very little [3,4,6,18].
During the pandemic, it became clear that COVID - 19 is not just acute respiratory
infection, but a disease with multiple organ systemic damage, including number of such an
important organ as the liver. This issue was covered by us in special reviews [3,5,6,13,15]
based on a generalization of the data available at that time literature. The liver is a vital
Жамият ва инновациялар – Общество и инновации – Society and innovations
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organ with multiple functions. The protective function of the liver includes detoxification
of endogenous and exogenous factors. Liver cells are actively involved in the div's
immune defense. The liver contains T- and B-lymphocytes, endothelial cells produce
inflammatory mediators IL-1 and IL-6, Kupffer cells are specialized liver macrophages and
are necessary for effective capture of the virus and disruption of its replication. The latter
process includes an asset cation of Kupffer cells with interferon (IFN) -I and prevents the
spread of the virus to neighboring hepatocytes. In the absence of Kupffer cells, hepatocytes
are unable to suppress viral replication even in the presence of IFN-I, which leads to long-
term viral replication and even to possible severe T-cell immunopathology [4,18,20]. It has
been shown that the liver, along with the respiratory tract, is actively participates in the
pathological process, and the course and outcome of COVID-19 are closely related to the
frequency and extent of liver damage from this infection.
However, the problems of patients with chronic liver disease (ChLD) amid the
COVID-19 pandemic remain unresolved and require study. Chronic liver diseases are
among the most common in the world, and in an epidemic, effective follow-up and
continued treatment of patients with these pathologies is especially important to maintain
health, as well as to reduce the burden on health care and reduce the total number of
victims of coronavirus infection. To date, scientific data have confirmed that the risk group
with an increased likelihood of infection and a severe course of coronavirus infection
includes elderly patients and patients with chronic cardiovascular diseases, such as
hypertension, coronary heart disease and diabetes mellitus. Less is known about the
effects of other chronic diseases, in particular liver disease. However, it is already clear
that patients with severe fibrosis and cirrhosis of the liver, patients after liver
transplantation are also a vulnerable group with an increased risk of infection and severe
course of COVID-19. Therefore, they are strictly prescribed self-isolation and reduction of
social contacts [3,5,7].
The liver is a vital organ with multiple functions. The protective function of the liver
includes detoxification of endogenous and exogenous factors [1,5,7,26,27].
Analysis of clinical data the picture of the new coronavirus infection COVID-19
shows that liver dysfunction is common a phenomenon in hospitalized patients with
severe disease. Elevated levels alanine aminotransferase (ALT) and aspartate
aminotransferase (AST) were registered, according to different data, in 16–53% of
patients [4,8,10,17,22]. Liver dysfunction in COVID-19 is considered mild by most
researchers and is seen as a concomitant damage [4,10,20]. Some data indicate that 2-11%
of patients with COVID-19 had comorbidities liver, and in 14-53% of cases, there were
abnormal aminotransferase levels during disease progression. Patients with severe
COVID-19 appear to more often suffer from liver dysfunction. In a study conducted in New
York with the participation of 5700 patients, 58.4% had AST values above 40 U / L and
39.0% had ALT values above 60 U / L. In the same cohort, 56 (2.1%) patients developed
acute liver injury, defined as an increase in AST or ALT levels by more than 15 times
compared with the upper limit of normal. Of these 56 patients, 3 were 18–65 years old
(3/1 373; 0.2%) and were subsequently discharged, and 53 died: 25 were 18–65 years old
(25/134; 18.7%), and 28 were over 65 years old (28/469; 6.7%). Analysis of the data
shows that the incidence of liver dysfunction increases in proportion to the severity of
COVID-19. Apparently, in COVID-19, elevated ALT, hypoalbuminemia, and
thrombocytopenia are an unfavorable prognosis factor for the disease. Similar findings
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have been reported in pediatric practice. Few studies of infants with COVID-19 suggest
liver damage against the background of disease progression from the 7th to the 11th day
of the disease, along with multiple lesions other organs [4,14,18]. Investigations of the
hepatic ducts affected in patients with COVID-19, have shown their high susceptibility to
infection COVID-19 and maintaining robust viral replication. Virus SARS-CoV-2 impairs the
barrier and transport functions of bile acids in cholangiocytes [4,22]. This assumption is
supported by an increase in circulating serum gamma-glutamyl transferase (GGT) levels
in patients with COVID-19. Most patients with severe COVID-19 there is an abnormal
increase in serum proinflammatory cytokines. Overproduction proinflammatory
cytokines (tumor necrosis factor, IL-6, IL-2, IL-7, inducible interferon-γ protein 10,
monocytic chemoattractant protein 1, macrophage inflammatory protein 1-α and IL-11)
has been described as a cytokine storm leading to increased risk of vascular
hyperpermeability, multiple organ failure, and ultimately death when high cytokine
concentrations do not diminish over time [4,11]. Activation of blood clotting pathways
during the immune response to infection leads to excess production of pro-inflammatory
cytokines, which leads to multi-organ damage. During inflammation, the concentration of
anticoagulants decreased due to a decrease production and increased consumption. This
procoagulant-anticoagulant imbalance predisposes to the development of
microthrombosis, disseminated intravascular blood coagulation and multiple organ
failure [4,12,26]. Patients with chronic liver diseases require increased attention of
doctors during an epidemic, since against the background of an exacerbation of their
disease, not only the risk of contracting the COVID-19 viral infection increases, but also its
more severe course.
Current research has shown that the poor prognosis in COVID-19 patients was
related to gender (male), age (over 60 years), underlying medical conditions (diabetes,
cardiovascular disease), secondary ARDS, and other related factors. However, ALT, AST,
total bilirubin and other liver function indicators were significantly increased in patients
with severe COVID-19 compared with patients with mild COVID-19, and indicators of
function liver functions gradually returned to normal in the course of recovery. Liver
damage in patients with mild COVID-19 is often temporary and can be restored to normal
without any specific treatment. Hepatoprotective drugs have usually been given to
patients with severe liver damage. In addition, liver dysfunction in COVID-19 patients has
been associated with activation of coagulation and fibrinolysis, relatively low platelet
count, increased granulocyte count and neutrophil-to-lymphocyte ratio, and high ferritin
levels. Although these parameters were considered non-specific markers of inflammation,
they also corresponded to the dysregulation of innate immunity. It is worth noting that
these changes immune balance occurred with increasing age of the patient. So the situation
could be worse for elderly patients. The effect of glucocorticoids on the prognosis of
COVID-19 in patients with autoimmune hepatitis is unknown. Severe COVID-19 patients
require more intensive monitoring or individualized treatment, especially in older patients
with other osfalsehoods [19, 24, 25].
CONCLUSION
Patients with chronic liver diseases require increased attention of doctors during an
epidemic, since against the background of an exacerbation of their disease, not only the
risk of contracting the COVID-19 viral infection increases, but also its more severe course.
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Previous studies show that patients with coronavirus infection (COVID-19) often have
elevated liver enzyme levels, while other studies have shown that chronic liver disease is
a risk factor for severe infection and increased mortality.
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