R-ORANI, COVID-19 TEDAVİSİNDE AKUT KARACİĞER HASARININ BİR GÖSTERGESİ OLABİLİR Mİ?

Year 2021, Volume: 84 Issue: 3, 311 - 317, 31.07.2021

Yıldırım Kayacan , Hayrullah Yazar , Mehmet Özdin

https://doi.org/10.26650/IUITFD.2021.824074

Abstract

Amaç: Çalışmanın amacı, COVID-19 hastalarında R oranının bir gösterge olup olamayacağını belirlemektir. Gereç ve Yöntem: Tüm hastaların (n=314) ilk kan serumunda alkalen fosfataz (ALP) ve alanin aminotransferaz (ALT) ölçülerek R değerleri belirlendi ve gruplandı. Daha sonra tespit edilen parametreler arasındaki korelasyonlar incelenerek ve farklılıklar cinsiyete göre analiz edildi. Ayrıca hastalar referans aralığın ALT ve ALP üst değerlerine göre karşılaştırıldı. Alfa değeri <0,05 olarak kabul edildi. Bulgular: Tüm hastalarda, ALT ve ALP normal referans aralıklarının oldukça üzerinde tespit edildi (p=0,000). R-değeri oranı, ALT ve ALP ile önemli ölçüde ilişkiliydi (p<0,001). R grupları istatistiksel olarak anlamlı ve yaşla ters orantılıydı (p=0,049). Kadınlarda ≥5 R oranının erkeklere göre daha yüksek olduğu tespit edildi. Sonuç: Bulgularımıza göre COVID-19 tanısı alan hastalarda ölçülen ALT ve ALP normalden çok daha yüksekti. Araştırmamızın bir başka ilginç sonucu da hastalarımızın çoğunda R-oranının ≤2 olarak bulunmasıydı. Akut karaciğer hasarının bir göstergesi olarak kabul edilen R≤2 bulgusu, COVID-19 için bu değerin izlenmesinin önemli bir gösterge olabileceğini düşündürmektedir.

Keywords

SARS-CoV-2, COVID-19, R-Oranı, ALT, ALP

COULD THE R-RATIO BE AN INDICATOR OF ACUTE LIVER INJURY FOR THE TREATMENT OF COVID-19?

Abstract

Objective: The aim of the study was to determine whether the R-ratio could be an indicator in COVID-19 patients. Material and Method: Alkaline phosphatase (ALP) and alanine aminotransferase (ALT) were measured in the first blood serum of all patients (n=314), and R-values were determined and grouped. Then, the correlations between the detected parameters were examined and the differences were analyzed by gender. Patients were compared according to the ALT and ALP upper values of the reference interval. Alpha value was accepted as <0.05. Results: In all patients, ALT and ALP were detected well above normal reference ranges (p=0.000). The R-value ratio was significantly associated with ALT and ALP (p<0.001). R-groups were statistically significant and inversely proportional to age (p=0.049). It was detected that the R-ratio of ≥5 was higher in women than in men. Conclusion: According to our findings, ALT and ALP measurements in patients diagnosed with COVID-19 were much higher than normal. Another interesting result of our research was that the R-ratio was found to be ≤2 in the majority of our patients. The R≤2 finding, which is accepted as an indicator of acute liver injury, suggested that tracking of this value for COVID-19 could be an important indicator.

Keywords

SARS-CoV-2, COVID-19, R-Ratio, ALT, ALP

References

• 1. Wang Y, Chen J, Chen Y, Wu XT. Improvement of nonalcoholic fatty liver disease in ALT at >/=12 months after Roux-en-Y gastric bypass and sleeve gastrectomy, no effect in ALT and AST at <12 months after SG and in AST at >12 and </=24 months after RYGB. Surg Obes Relat Dis 2020;16(3):447-50. [CrossRef]
• 2. Moss DW, Henderson RA. Clinical Enzymology In: Burtis CA, Ashwood ER, eds Tietz textbook of clinical chemistry Philadelphia: WB Saunders Company, 1999; 676-84.
• 3. Friedman L. S, Chopra S, Travis A. C. Approach to the patient with abnormal liver biochemical and function tests. Up to Date, 2014. 4. Yao WH, Wei XL, Guo H, Cheng D, Li H, Sun LM, et al. Tributyltin reduces bone mineral density by reprograming bone marrow mesenchymal stem cells in rat. Environ Toxicol Phar 2020;73:103271. [CrossRef]
• 5. Thomas L. Alkaline phosphatase (ALP) In: Thomas L, ed Clinical laboratory diagnostics Use and assessment of clinical laboratory results Frankfurt/Main: TH-Books Verlagsgesellschaft, 1998:36-46.
• 6. Qian ZP, Mei X, Zhang YY, Zou Y, Zhang ZG, Zhu H, et al. Analysis of baseline liver biochemical parameters in 324 cases with novel coronavirus pneumonia in Shanghai area. Zhonghua Gan Zang Bing Za Zhi 2020;28(3):229-33.
• 7. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020:5(5):428-30. [CrossRef]
• 8. Han Y, Zhang H, Mu S, Wei W, Jin C, Tong C, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study. Aging (Albany NY) 2020;12(12):11245-58. [CrossRef]
• 9. Zimmerman HJ, Ishak KG. General aspects of drug-induced liver disease. Gastroenterol Clin North Am 1995;24(4):739- 57. [CrossRef]
• 10. Norris W, Paredes AH, Lewis JH. Drug-induced liver injury in 2007. Curr Opin Gastroenterol. 2008;24(3):287-97. [CrossRef]
• 11. Andrade RJ, Lucena MI, Kaplowitz N, Garcia-Munoz B, Borraz Y, Pachkoria K, et al. Outcome of acute idiosyncratic drug-induced liver injury: Long-term follow-up in a hepatotoxicity registry. Hepatology 2006:44(6):1581-88. [CrossRef]
• 12. Wroblewski F, Ladue JS. Serum glutamic pyruvic transaminase in cardiac with hepatic disease. Proc Soc Exp Biol Med 1956:91(4):569-71. [CrossRef]
• 13. Bergmeyer HU, Horder M. International federation of clinical chemistry. Scientific committee. Expert panel on enzymes. IFCC document stage 2, draft 1; 1979-11-19 with a view to an IFCC recommendation. IFCC methods for the measurement of catalytic concentration of enzymes. Part 3. IFCC method for alanine aminotransferase. J Clin Chem Clin Biochem 1980:18(8):521-34.
• 14. Bowers GN, Jr., McComb RB. Measurement of total alkaline phosphatase activity in human serum. Clin Chem 1975:21(13):1988-95. [CrossRef]
• 15. Tietz NW. Textbook of Clinical Chemistry, W.B. Saunders, (ed). 1986.
• 16. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J 2020;55(5):2000524. [CrossRef]
• 17. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect 2020;81(1):30208-5. [CrossRef]
• 18. Sarin SK, Choudhury A, Lau GK, Zheng MH, Ji D, Abd- Elsalam S, et al. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Hepatol Int 2020;14(5):690-700. [CrossRef]
• 19. 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. [CrossRef]
• 20. Zhao X-Y, Xu X-X, Yin H-S, Hu Q-M, Xiong T, Tang Y-Y, et al. Clinical characteristics of patients with 2019 coronavirus disease in a non-Wuhan area of Hubei Province, China: a retrospective study. BMC Infect Dis 2020;20:311. [CrossRef]
• 21. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62. [CrossRef]
• 22. Boettler T, Newsome PN, Mondelli MU, Maticic M, Cordero E, Cornberg M, et al. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep 2020;2(3):100113. [CrossRef]
• 23. Barrasa H, Rello J, Tejada S, Martín A, Balziskueta G, Vinuesa C, et al. COVID19 Study Investigators SARSCov- 2 in Spanish Intensive Care: Early Experience with 15-day Survival in Vitoria. Anaesth Crit Care Pain Med 2020;39(5):553-61. [CrossRef]
• 24. Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, et al. Characteristics of Liver Tests in COVID-19 Patients. J Hepatol 2020;73(3):566- 74. [CrossRef]
• 25. Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med 2006;354(7):731-39. [CrossRef]
• 26. Watkins PB. Idiosyncratic drug-induced liver injury in patients: Detection, severity assessment and, regulatory implications. Adv Pharmacol 2019;85:165-93. [CrossRef]
• 27. Whritenour J, Ko M, Zong Q, Wang J, Tartaro K, Schneider P, et al. Development of a modified lymphocyte transformation test for diagnosing drug-induced liver injury associated with an adaptive immune response. J Immunotoxicol 2017;14(1):31-8 [CrossRef]
• 28. Singh S, Khan A. Clinical characteristics and outcomes of coronavirus disease 2019 among patients with preexisting liver disease in the United States: a multicenter research network study. Gastroenterology 2020;159(2):768-71. [CrossRef]
• 29. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy 2021;76(2):428-55. [CrossRef]
• 30. Ali N. Relationship Between COVID-19 Infection and Liver Injury: A Review of Recent Data. Front Med-Lausanne 2020, 7. [CrossRef]