Probing liver function test patterns in COVID-19 pneumonia: Implications for disease severity assessment.

OBJECTIVE: To explore the incidence of liver function test derangement, the precise patterns of derangement, and their relationship with coronavirus disease-2019 pneumonia severity. METHODS: The retrospective study was conducted at the Dow University Hospital and the Ojha Institute of Chest Diseases, Karachi, and comprised consecutive data from December 16, 2020, to March 16, 2021, of adults of either gender who had nasal swabs positive for coronavirus disease-2019 on real-time reverse transcriptase-polymerase chain reaction. Data regarding patients' demographics, co-morbidities, addictions, laboratory results, and standard information was retrieved from electronic and manual records. The severity of the disease was determined based on World Health Organisation protocols. Data was analysed using SPSS 23. RESULTS: Of the 344 patients, 235(68.3%) were males and 109(31.7%) were females. The overall mean age was 54.58±14.75 years, 187(54.4%) had severe coronavirus disease-2019 pneumonia and 157(45.6%) had non-severe disease at the time of admission. There was a significant prevalence of both mixed and cholestatic patterns of liver function test abnormality among the cases (p=0.046). The presence of a mixed pattern was linked to the disease severity (p<0.05). Advanced age and hypertension were significant risk factors for the development of severe coronavirus disease-2019 pneumonia (p<0.001 and p=0.002). CONCLUSIONS: Liver function test abnormality and coronavirus disease-2019 pneumonia severity were fund to have a significant relationship.

Fulminant Hepatic Failure in Glucose-6-Phosphate Dehydrogenase (G6PD) Deficient Patients Caused by Hepatitis E Infection: A Single Disease With Different Spectrums.

One of the major causes of acute viral hepatitis in Pakistan is the hepatitis E virus. Virus-induced liver inflammation within sight of glucose-6-phosphate dehydrogenase (G6PD) insufficiency might be related with intricacies, for example, extremely low hemoglobin, red blood cell (RBC) destruction, renal function collapse, a decline in brain function due to severe liver disease and even demise. Despite the two diseases being widespread, their effect on understanding patient ailment has not been studied in depth. Hemolytic anemia occurs as a complication of acute hepatitis. Nevertheless, the occurrence can ascend to a large percentage of patients harboring glucose-6-phosphate dehydrogenase (G6PD) insufficiency. Although being frequent in endemic countries, there is a lack of literature in understanding the synergistic effect of hepatitis E disease and G6PD inadequacy leading to fulminant hepatic failure and increased mortality in the absence of a liver transplant facility. Here we report a case of two brothers, both having G6PD deficiency. A 19-year-old male, the elder of the two brothers, came with three days of complaints of persistent vomiting and deep jaundice. On investigation, he was found to have acute hepatitis E. During his hospital stay, he became drowsy, comatose, and subsequently expired. The second patient, his younger brother, was a 15-year-old male who presented with similar history about one week after his demise. He was also managed conservatively and was subsequently discharged from the hospital.