Potential Beneficial Effects of Crab-Flavored Seafood Intake in Young Rats.

Background: Crab-flavored seafood is a well-known traditional Japanese product that is sold as "imitation crab" worldwide. Although it is a low-cost, low-fat, high-protein food, there are few data on its potential health benefits. Here, we have assessed the effects of crab-flavored seafood consumption on organ weight and serum biomarkers levels in rats. Methods: Sprague-Dawley rats (male; aged 6 weeks) were fed a normal diet (n = 8) or a normal diet with 5% dried crab-flavored seafood (n = 8) for 84 days. Food intake and overall body weight were measured every week; organ weight and blood biochemistry were evaluated at the end of the administration period. Results: After 84 days, there were no significant differences in food intake, overall body weight, or organ weight between the 2 groups; however, the muscle weight of rats fed crab-flavored seafood tended to be higher than that of rats fed the normal diet. Several serum biomarkers did not differ between the 2 groups, but serum high-density lipoprotein, total bilirubin, and indirect bilirubin levels were significantly raised in rats fed crab-flavored seafood. Moreover, blood urea nitrogen was significantly lower, and some liver function parameters tended to be lower in rats fed crab-flavored seafood. Conclusions: Consumption of crab-flavored seafood may be effective for promoting muscle protein synthesis and improving serum biomarkers associated with disorders such as cardiovascular disease and stroke. Thus, crab-flavored seafood may have application as a functional food for the global management of human health.

Liver function abnormality on admission predicts long COVID syndrome in digestive system.

Background: Clinical practice showed that many patients with SARS-CoV-2 infection presented with long COVID syndrome in digestive system. We sought to investigate the factor affecting the incidence of long COVID syndrome in digestive system. Methods and results: Patients with SARS-CoV-2 infection diagnosed at two centers of Zhongshan Hospital and one center of Shanghai Pudong Hospital from March 01, 2022 to May 31, 2022 were enrolled, collected in the hospital database, and followed up until March 30, 2023. The primary outcome of the study was the occurrence of post-acute sequelae of COVID-19 in the digestive system (long COVID syndrome). Modified Poisson regression was used to calculate the relative risk (RR). This cohort study included 494 patients with SARS-CoV-2 infection, 144 (29.1 %) patients developed liver function abnormality on admission. During the follow-up period, the primary study outcome occurred in 30 (20.8 %) of the group presenting with liver function abnormality on admission and in 20 (5.7 %) of the group without liver function abnormality on admission (adjusted, RR = 3.550, 95%CI: 2.099-6.006, P ≤ 0.001). Conclusion: Our study suggests that patients with COVID-19 who experience liver function abnormality on admission have an increased risk of developing long COVID syndrome in the digestive system.

Comparative Evaluation of 0.9% Normal Saline Versus Acetate-Gluconate-Based Balanced Solution on Acid-Base Status and Postoperative Liver Function in Donor Hepatectomy Patients.

Background Live donor liver transplantation, a widely practiced procedure, involves resecting a portion of a healthy donor's liver for transplantation. Despite advancements, it poses challenges like cardiovascular instability and electrolyte imbalances, with maintaining acid-base balance being critical. This study compares the effects of 0.9% normal saline and PlasmaLyte A® on acid-base status and postoperative liver function. Methodology This prospective observational study was conducted over one year among 40 healthy adults aged 18-60 years undergoing donor hepatectomy. Patients were alternately allocated to receive either 0.9% saline (Group 1; n = 20) or PlasmaLyte A® (Group 2; n = 20). Key parameters, including acid-base status, hemodynamic parameters, and postoperative liver function, were monitored at various intervals. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), with appropriate statistical tests. A p-value <0.05 was considered statistically significant. Results The study included 40 patients, with 20 in each group. No significant differences were observed between the groups concerning age, gender, weight, hemodynamic parameters, and urine output. However, significant differences were found in acid-base parameters. Group 2 showed better preservation of acid-base balance with higher pH and HCO3 levels. Patients in Group 1 exhibited a significant decrease in HCO3 levels during surgery, while those in Group 2 maintained a more stable metabolic profile. Furthermore, nine patients in Group 1 required sodium bicarbonate supplementation for metabolic acidosis, compared to only three in Group 2. Postoperative liver function tests revealed no significant differences between the two groups, although a trend toward better outcomes was observed in Group 2. Conclusions PlasmaLyte A® demonstrated superior preservation of acid-base balance compared to 0.9% normal saline, with less need for bicarbonate supplementation. While liver function outcomes were similar, the balanced solution showed a trend toward better metabolic stability, suggesting it may offer safer and more effective fluid management in liver transplantation surgery.

Prognostic role of albumin-bilirubin (ALBI) score and Child-Pugh classification in patients with advanced hepatocellular carcinoma under systemic treatment.

Hepatocellular carcinoma (HCC) is a lethal malignancy associated with cirrhosis and liver dysfunction. The aim of this study is to characterize a cohort of patients with advanced HCC according to liver function-related variables and evaluate the prognostic significance of Child-Pugh (CP) and albumin-bilirubin (ALBI) scores. A database of 406 HCC patients treated between 2009 and 2023 was retrospectively evaluated. Clinical and laboratory parameters were collected to classify patients into ALBI and CP scores. Survival was estimated using the Kaplan-Meier method and multivariate models were used to evaluate prognosis prediction. In this cohort, 337 (83%) patients were classified as CP-A, while 69 (17%) as CP-B. Additionally, according to ALBI score, 159 (39.2%) individuals were categorised as ALBI-1, 233 (57.4%) as ALBI-2 and 14 (3.4%) as ALBI-3. A statistically significant association between both classifications was observed (p < 0.001). CP and ALBI scores were independently associated with prognosis (Hazard ratio = 2.93 and 1.66, respectively), with better survival for patients with CP-A (versus B) and ALBI-1 (versus -2 and -3). ALBI score showed better predictive performance versus CP (c Harrell´s C index = 0.65 versus 0.62; p = 0.008) and ALBI evolution during the first month of treatment was associated with overall survival. Additionally, ALBI score was able to define distinct prognostic subgroups within CP-A patients. In conclusion, liver function scores, such as ALBI and CP, have a clinically relevant prognostic role in patients with advanced HCC under systemic treatment. ALBI score is a more granular scoring scale than CP, and enables a more precise evaluation of patients with CP-A.

Iron overload and liver function in patients with beta thalassemia major: A cross sectional study.

Objective: In thalassemia major, repeated blood transfusions result in iron overload causing organ damage. The objective of this study was assessment of liver enzymes in patients with Thalassemia major and to observe their association with ferritin. Method: A cross-sectional study was performed, at Islamabad Medical and Dental College and its affiliated Akbar Niazi Teaching Hospital from November 2021 till August 2022. Serum ferritin, AST, ALT, and total bilirubin levels were determined, in 135 patients of beta thalassemia major receiving transfusions. Data analysis was performed using SPSS Version 20. For categorical variables, calculation of frequencies and percentages was performed. Mean (± standard deviation) was determined for quantitative variables. ANOVA with post hoc Tukey's test was used for determining association between liver enzymes and serum ferritin. A p-value of <0.05 was considered significant. The correlation between ferritin and LFTs was determined by Pearson's correlation coefficient. Results: Patients had an age range of 7-30 years, and males constituted 51% of sample. Mean level of ferritin was 6062.61 + 3641.79 ng/ml, with an insignificant difference between the genders (p =0.366). The levels of AST, ALT and bilirubin were perceived to show a significant increase in patients with ferritin levels >5000ng/ml, when compared with patients having ferritin levels < 2,500 ng/ml. A significant positive correlation of increasing serum ferritin levels was observed with ALT (r= 0.682), to a lesser extent with AST (r = 0.532), and only a weak correlation with serum bilirubin (r = 0.350). Conclusion: Liver damage was caused by increased iron deposition. LFTs should be performed regularly to detect and reduce liver damage by increasing chelation therapy, thereby reducing morbidity and mortality due to thalassemia.

Intraoperatively measured prehepatectomy portal vein pressure as a useful predictor of posthepatectomy liver failure.

BACKGROUND: Predicting posthepatectomy liver failure (PHLF) may be a critical requirement for liver disease patients undergoing hepatectomy. This study retrospectively analyzed the impact of the intraoperatively measured portal vein pressure (PVP) prior to hepatectomy on the prediction of PHLF in hepatectomized patients. METHODS: A total of 334 hepatectomized patients in whom the PVP was intraoperatively measured before resection at our institution were enrolled in the present study. Outcomes were assessed according to the International Study Group of Liver Surgery definition and the severity of PHLF grading. RESULTS: Thirty-nine of the 334 patients (11.6%) developed grade B/C PHLF. The following factors were significantly associated with grade B/C PHLF in a univariate analysis: indocyanine green retention rate after 15 min, Child-Pugh score, prehepatectomy PVP, and transfusion (each P < 0.0001). A prehepatectomy PVP value of 19.5 cmH2O was the optimal cutoff value for predicting grade B/C PHLF. In a multivariate analysis, prehepatectomy PVP (≥ 19.5 cmH2O) was selected as the most relevant risk factor for grade B/C PHLF (P = 0.0003, hazard ratio: 5.96, 95% CI: 1.80-19.70). CONCLUSIONS: Prehepatectomy PVP can serve as a useful predictor of the risk of PHLF in patients who have undergone hepatectomy. The results emphasize the possibility of reducing the planned extent of hepatic resection when the prehepatectomy PVP value measured intraoperatively exceeds 19.5 cmH2O, and the importance of predicting the PVP before the operation.

Changes in the Liver Function and Hematological Parameters in Dengue Patients at a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Liver is most commonly affected in dengue often resulting in changes in the liver function test parameters. Alterations in hematological parameters are also reported which could serve as early prognostic markers especially in resource limited settings where serological tests for the diagnosis of dengue is not available. This study aims to analyze liver function test and hematological parameter changes in dengue infected patients. METHODS: A descriptive cross-sectional study was conducted from December 2022 to October 2023 in serologically dengue positive patients. Liver function parameters and blood parameters were analyzed from 220 patients. The purposive sampling technique was employed during the selection of participants. RESULTS: Out of 220 study participants, 113 (51.36%) were males and 107 (49.64%) were females. The median age of the participants was 35 years (IQR: 26 - 48 years). Elevated serum AST and ALT levels were present in 121 (55%) and 80 (36.36%) of the participants respectively. Thrombocytopenia and leukopenia were observed in 92 (41.82%) and 88 (40%) of the study participants respectively. The median hemoglobin level was 14.4 (IQR: 13-15.47) g/dl. Low hemoglobin level was found in 31 (14.09%) participants. The median red blood cell count was 4.91 (IQR: 4.49 - 5.28) millions/mm3 with decreased red blood cell count noted in 27 (12.27%) participants. CONCLUSIONS: Increased serum transaminases levels, thrombocytopenia and leukopenia are common laboratory findings in dengue patients.

Modified Albumin-Bilirubin Grade After Curative Treatment: Predicting the Risk of Late Intrahepatic Recurrence of Hepatocellular Carcinoma.

BACKGROUND: We aimed to identify the prognostic factors for late intrahepatic recurrence (IHR), defined as recurrence more than two years after curative treatment of newly diagnosed hepatocellular carcinoma (HCC). METHODS: This retrospective cohort study included patients with newly diagnosed, previously untreated, very early, or early HCC treated with initial curative treatment and followed up without recurrence for more than two years, excluding early IHR defined as recurrence within two years in single center. Late IHR-free survival (IHRFS) was defined as the time interval from initial curative treatment to the first IHR or death without IHR, whichever occurred first. RESULTS: Among all the enrolled 2,304 patients, 1,427 (61.9%) underwent curative intent hepatectomy and the remaining 877 (38.1%) underwent local ablative therapy (LAT). During the follow-up after curative treatment (median, 82.6 months; range, 24.1 to 195.7), late IHR was detected in 816 (35.4%) patients. In the multivariable analysis, age, male sex, cirrhotic liver at diagnosis, type of initial treatment, and modified albumin-bilirubin (mALBI) grade were significant prognostic baseline factors. Furthermore, mALBI grade at three (2a vs. 1, P = 0.02, hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04-1.70; 2b/3 vs. 1, P = 0.03; HR, 1.42; 95% CI, 1.03-1.94) and six months (2b/3 vs. 1; P = 0.006; HR, 1.61; 95% CI, 1.13-2.30) after initial curative treatment was also a significant prognostic factor for late IHR. CONCLUSION: After curative treatment for newly diagnosed early HCC, the mALBI grade at three and six months after initial curative treatment, as well as at baseline, was one of the most crucial prognostic factors for late IHR.

Re-evaluating the necessity of routine laboratory monitoring during isotretinoin therapy for acne.

In this letter, we discuss the topic of necessity of routine laboratory monitoring during isotretinoin treatment for acne. According to Park and colleagues, it is advisable to monitor the levels of triglycerides, alanine aminotransferase, and aspartate aminotransferase every 5 to 6 months. Additionally, the levels of total cholesterol and low-density lipoprotein should be checked within the first two months of treatment. Isotretinoin is a commonly prescribed agent mainly used to treat acne. Despite its high effectiveness, it necessitates regular monitoring of laboratory parameters due to its side effect profile. Currently, there remains a lack of consensus on the appropriate frequency for monitoring these parameters during treatment with isotretinoin. This letter will provide insight into this complex and controversial topic. Based on existing literature, we concluded that the incidence of changes in lipid and liver aminotransferase levels during isotretinoin treatment for acne was low and likely clinically insignificant. For generally healthy people, we recommend testing lipid and liver profiles once at baseline and a second time at the peak dosage. However, frequent testing might still be beneficial in certain populations of patients.

Association between Liver Damage and Disease Progression Markers with Mortality Risk and Mechanical Ventilation in Hospitalized COVID-19 Patients: A Nationwide Retrospective SARSTer Study.

(1) Background: Liver damage is an important component of acute COVID-19, and the advancement of preexisting liver disease is associated with a worse prognosis; (2) Methods: A nationwide retrospective study including 7444 patients aimed to evaluate levels of selected markers of liver damage and disease advancement and their association with mortality and mechanical ventilation (MV); (3) Results: Elevation of the following markers in multivariate models were associated with increased odds of mortality: Alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), lactate dehydrogenase (LDH), fibrosis-4 score (FIB-4), AST-to-platelet ratio index (APRI), and decreased levels of platelet count (PLT). Elevated levels of AST, LDH, APRI, FIB-4, and the AST/ALT ratio and decreased levels of PLT were associated with increased odds of MV in multivariate models. The best predictive accuracy against mortality was achieved with FIB-4 with AUC = 0.733 (95% CI, 0.718-0.749) at the optimal cut-off point of 2.764, while against MV was achieved with LDH with AUC = 0.753 (95% CI, 0.727-0.778) at the optimal cut-off point of 449.5 IU/L. (4) Conclusions: Our study confirms that the advancement of liver damage contributes to a worse prognosis in COVID-19 patients. Markers for liver damage and the advancement of liver disease can provide predictive value in clinical practice among COVID-19 patients.

Changes in interoception before and after treatment in patients with alcohol use disorder.

AIMS: To investigate the factors associated with interoception in patients with alcohol use disorder and determine whether treatment causes changes in their interoception. METHODS: The Body Perception Questionnaire-Body Awareness ultra-short version Japanese version (BPQ-BAVSF-J) was used to measure interoception in 50 alcohol-dependent participants (27 in the inpatient group and 23 in the outpatient group). The BPQ-BAVSF-J was administered and data on aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (γ-GTP), mean corpuscular volume, platelet count, and Fib-4 index were extracted at admission and immediately before discharge for the inpatient group and at the first outpatient visit and approximately 3 months after the visit for the outpatient group. RESULTS: The mean age of the 50 participants was 51.0 ± 12.3 years. Significant associations were found between the BPQ-BAVSF-J and Fib-4 index and AST. The BPQ-BAVSF-J score significantly decreased at discharge in the inpatient group. AST, ALT, γ-GTP, and Fib-4 index of liver function were also significantly lower at discharge. In contrast, in the outpatient group, there were no significant changes in the BPQ-BAVSF-J score, AST level, ALT level, γ-GTP level, and Fib-4 index between at the first outpatient visit and approximately 3 months after the visit. CONCLUSIONS: Interoception in patients with alcohol use disorder increased with worsening liver function and decreased with improvement in liver function owing to treatment. This suggests that the BPQ-BAVSF-J score, an easily accessible scale, may be used to detect early deterioration of liver function through regular administration.

LiMAx test and ultrasound elastography to measure biomarkers of declining liver function in patients with liver fibrosis: A correlation analysis.

BACKGROUND: Monitoring liver changes is crucial in the management of liver fibrosis. Current diagnostic methods include liver function tests such as the Liver Maximum Capacity (LiMAx) test and measurements of liver stiffness. While the LiMAx test quantifies liver function through 13C-methacetin metabolism, ultrasound (US) elastography noninvasively assesses liver stiffness. The relationship between the findings of these methods in patients with liver fibrosis is not fullyunderstood. OBJECTIVE: This study evaluated the correlation between LiMAx measurements of liver function and US elastography-based liver stiffness measurements to better understand the interplay between functional and structural liver parameters in fibrotic liver disease. Additionally, the relationship between body mass index (BMI) and these parameters isevaluated. METHODS: This retrospective study analysed data from 97 patients who underwent both LiMAx testing and real-time elastography, resulting in a total data set of 108 examinations. The correlations between the results of the LiMAx test and elastography and their relationships with body mass index (BMI) were analysed. RESULTS: There was a significant negative correlation (r = -0.25, p < 0.05) between LiMAx test values and liver stiffness measurements. BMI was significantly negatively correlated with LiMAx values (r = -0.29, p < 0.001) but not significantly correlated with liver stiffness values. CONCLUSIONS: This retrospective study confirms the results of previous studies showing a notable but weak association between liver function and liver stiffness. Our results highlight the potential value of both tests as complementary tools for the evaluation of liver health, reinforcing the necessity for a multimodal approach to liver assessment.

Liver and renal biochemical profiles of people with sickle cell disease in Africa: a systematic review and meta-analysis of case-control studies.

BACKGROUND: Sickle cell disease (SCD) is a genetic blood disorder characterized by a painful vaso-occlusive crisis due to the sickling of red blood cells in capillaries. Complications often lead to liver and renal dysfunctions, contributing to morbidity and mortality, particularly for children under 5. This systematic review and meta-analysis aimed to evaluate the liver and renal functions of people with SCD (HbSS) compared to those without it (HbAA) in Africa. METHODS: The protocol was registered with PROSPERO (CRD42022346771). We searched PubMed, Embase, Web of Science, and Google Scholar using the keywords "liver function", "renal function", "sickle cell disease", and "Africa" on 6th May 2023 for peer-reviewed articles with abstracts in English. We included case-control studies comparing SCD (HbSS) with controls without hemoglobinopathies (HbAA). We used the random-effect model to calculate the pooled average values for the blood tests of people with SCD in RStudio version 4.2.2. RESULTS: Overall, 17 articles were analyzed from five African countries involving 1312 people with SCD and 1558 controls. The pooled mean difference of liver enzymes aspartate transaminase (AST) was 8.62 (95% CI - 2.99-20.23, I2 = 97.0%, p < 0.01), alanine transaminase (ALT) 7.82 (95% CI - 0.16-15.80, I2 = 99%, p < 0.01) and alkaline phosphatase (ALP) - 2.54 (95% CI - 64.72 - 59.64, I2 = 99%, p < 0.01) compared to controls. The pooled mean difference for the renal biochemical profiles creatinine - 3.15 (95% CI - 15.02; 8.72, I2=99%, p < 0.01) with a funnel plot asymmetry of t = 1.09, df = 9, p = 0.3048 and sample estimates bias of 6.0409. The pooled mean difference for serum urea was - 0.57 (95% CI - 3.49; 2.36, I2 = 99%, p < 0.01), and the estimated glomerular filtration (eGFR) rate was 19.79 (95% CI 10.89-28.68 mL/min/1.73 m2, I2 = 87%, p < 0.01) compared to controls. CONCLUSION: People with SCD have slightly elevated liver enzymes and estimated glomerular filtration rates compared to controls in Africa. With all the heterogeneity (I2) > 50%, there was substantial variation in the reported articles' results. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022346771.

Effects of l-carnitine on frailty status in patients with liver cirrhosis: A randomized-controlled trial.

Background and Aims: Frailty is a common complication in patients with liver cirrhosis, which is linked with augmented rates of morbidity and mortality. In this regard, timely nutritional assessment and intervention have gained scientific attention. L-carnitine may be a promising candidate with its potential to enhance energy metabolism, reduce inflammation, and act as an antioxidant. Therefore, we aimed to assess the impact of l-carnitine supplementation on frailty status and liver function in adults with liver cirrhosis. Methods: This double-blinded, randomized, controlled clinical trial study enrolled 77 patients with liver cirrhosis. Patients were randomly allocated into two groups: the control group (n = 42) and the l-carnitine group (n = 35). The l-carnitine group received 500 mg of l-carnitine orally three times a day for 8 weeks, while the control group did not receive any intervention. Results: L-carnitine administration resulted in a significant decrease in alanine transaminase levels (p: 0.043) and partial thromboplastin time (p: 0.036). Furthermore, compared to the control group, l-carnitine treatment led to improvements in prothrombin time (p: 0.008) and international normalized ratio (p: 0.024). However, no significant improvement in the Liver Frailty Index, Freid Frailty Index, and Karnofsky Performance Status Scale (p > 0.05) was observed in the carnitine group after the 8-week intervention period. Conclusion: In conclusion, the administration of l-carnitine exhibited hepatoprotective properties and was correlated with lowered alanine transaminase levels with improvement in coagulation status in liver cirrhosis patients. Nevertheless, our study indicated that the short-term use of l-carnitine might not significantly improve frailty in these patients.

Insights into the accumulation and hepatobiliary transport of bisphenols (BPs) in liver and bile.

Bisphenols (BPs) are widely distributed in daily life as typical endocrine disruptors. In this study, we examined the distribution of bisphenol A (BPA) and BPA alternatives in liver (n = 149) and bile (n = 102) tissues from the patients with liver cancer, and calculated the hepatobiliary transport efficiency of BPs (TB-L). Seven BPs were detected in both liver (median: 0.859 ng/g; range: 0.0200-26.7 ng/g) and bile (median: 0.307 ng/mL; range: 0.0200-26.7 ng/mL), and BPA was the predominant in both liver (mean: 1.89 ng/g) and bile (mean: 1.65 ng/mL). The TB-L of BPs was reported for the first time and found to be negatively correlated with the molecular weight and Log Kow of BPs. Furthermore, BPA and ∑BPs in liver showed a significant negative correlation with age, and a significant difference was found in BPs in liver and bile in hepatocellular carcinoma patients with different genders (p < 0.05). For liver function indicators, levels of BPs showed significant positive correlation with γ-glutamyl transferase (GGT) and alanine aminotransferase (ALT), especially BPBP levels in bile. This suggests that BPs may have some correlation with hepatocellular carcinoma. This is the first report on distribution characteristics of BPs in the liver and bile of hepatocellular carcinoma patients, and is the first study to report the hepatobiliary transport efficiency of BPs. The results should contribute to the understanding of BPs accumulation in the liver and bile and further relationship with hepatocellular carcinoma.

Establishment of Reference Intervals for Common Renal and Liver Function Parameters in Healthy Adults in Mogadishu, Somalia: A Cross-Sectional Study.

Introduction: Reference intervals (RIs) are crucial for the accurate interpretating of laboratory test results in clinical settings, serving as benchmarks for evaluating individual health status. This study investigates the influence of sex and age on common liver function tests (LFTs) and renal function tests (RFTs) in healthy adults in Mogadishu, Somalia. Methods: A community-based cross-sectional study was carried out from October 2022 to January 2023 on a randomly selected sample of 255 healthy participants from Mogadishu, Somalia. Approximately 5 mL of whole blood was collected from each participant and processed screening of hepatitis B and C, and human immunodeficiency virus, and then biochemical analyses were conducted for common liver and kidney parameters. Results: The study found significant sex and age-related differences in the measured LFTs and RFTs parameters. For LFTs, males had higher levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) compared to females (ALT: 11.5 vs 7.5 U/L; AST: 25.5 vs 19.1 U/L; both p < 0.001). Age-related differences were also observed, with individuals aged 30 and above had higher levels of ALT and AST compared to those aged 18-29 (ALT: 10.9 vs 8.5 U/L; AST: 24.3 U/L vs 21.0 U/L, both p < 0.001). For RFTs, males had higher levels of creatinine (0.9 vs 0.7 mg/dL), urea (23.1 vs 16.1 mg/dL), and uric acid (5.2 vs 4.2 mg/dL) than females, all with p < 0.001. Conclusion: The study established population specific RIs for common liver and renal function parameters and revealed significant variations across sex and age groups. These findings underscore the importance of developing and using local RIs to ensure accurate clinical interpretation and effective patient management. Further research with larger sample sizes and in diverse regions of Somalia is highly recommended.

The Oral Cholate Challenge Test Quantifies Risk for Liver-Related Clinical Outcomes in Primary Sclerosing Cholangitis.

Background and Aims: We quantified hepatic functional impairment using quantitative function tests and linked severity of functional impairment to liver-related complications and outcome in primary sclerosing cholangitis. Methods: Forty-seven patients had baseline testing, and 40 were retested after 1 year. For each test, cholates labeled with cold, nonradioactive isotopes were administered orally (DuO, SHUNT tests) and intravenously (SHUNT test), and blood was analyzed at 20 and 60 minutes (DuO), or 0, 5, 20, 45, 60, and 90 minutes (SHUNT). Disease severity index (DSI), hepatic reserve (HR%), and portal-systemic shunting (SHUNT%) were calculated. Results: Three subgroups with low, moderate, and high disease severity were defined from the age-adjusted results for DSI, HR%, and SHUNT%. Standard laboratory tests, clinical scores, cytokine levels, and clinical outcome correlated with these subgroups. In univariate analysis of baseline tests, SHUNT% was a strong predictor of clinical outcome (n = 13 of 47; areas under the receiver operating characteristic curve, 0.84DuO, 0.90SHUNT). A model combining SHUNT%, DSI (or HR%), platelet count, and changes from baseline was most predictive of outcome (n = 10 of 40; areas under the receiver operating characteristic curve, 0.95DuO, 0.96SHUNT). Conclusion: DSI, HR%, and SHUNT% identified subgroups of primary sclerosing cholangitis based on the age-related severity of hepatic impairment that predicted risk for liver-related clinical outcome. Further study is warranted to confirm and validate these intriguing findings both in studies of natural progression of primary sclerosing cholangitis and in clinical trials. DuO enhances the utility of quantitative liver function testing.

Association of Liver Function Tests With the Severity and Outcome of Dengue Fever in Children.

Background Dengue is one of the most common vector-borne diseases in India, and it is transmitted by Aedes family mosquitoes. Hepatic injury is known to occur from dengue infection. Direct hepatotoxicity and deranged host immune responses to the virus are responsible for this hepatic dysfunction. Hence, the study was undertaken to understand the deranged hepatic enzymes using liver function tests (LFTs) and the severity and outcome of dengue fever in children. Methods This study is an observational-descriptive study conducted between June 2022 and May 2024. The study population includes children between the ages of one month and 16 years who have been diagnosed with dengue fever and admitted to pediatric wards and pediatric intensive care units (PICUs), with a sample size of 151. Informed consent from guardians and institutional ethical clearance were obtained. Results A total of 4.8% (N = 7) mortality was seen in this study with dengue patients. Hepatomegaly was seen in 34% (N = 49) of cases. There is a clear statistical significance that is seen among the non-survived and survived dengue patients with a 10-fold increase in serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels, respectively, along with total bilirubin, activated partial thromboplastin time (APTT), and prothrombin time (PT). Conclusions The current study shows that deranged LFTs are associated with more severe disease with more PICU admissions and mortality of the disease. The evidence clearly indicates the inclusion of LFTs as a routine investigation to understand the severity of the disease and the prognosis of the outcome.

Liver ultrasound evaluation of acutely increased liver function tests of COVID-19 hospitalized patients.

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.