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E.
Gadour, FRCP1, K.J. Shrwani, MSc2, Z Hassan MBBS3
1-Consultant
Gastroenterologist, Department of Gastroenterology, Blackpool Teaching
Hospital, Blackpool, UK
2-Department
of Clinical Infection, Institute of Infection and Global Health, school of
Medicine and Life Sciences, University of Liverpool, Liverpool, UK.
3-Department
of public health and Community medicine, Faculty of Medicine, National Ribat
University, Khartoum, Sudan
*Corresponding
author: Dr
Eyad Gadour, FRCP (Glasg), Consultant Gastroenterologist, Department of
Gastroenterology, Blackpool Teaching Hospital, Blackpool, UK. E-mail: eyadgadour@doctors.org.uk
Citation: E. Gadour (2020) COVID-19
Induced Hepatitis (CIH), Definition and Diagnostic Criteria of a Poorly
Understood New Clinical Syndrome. World J Gastroenterol Hepatol Endosc, 3(3),1-6.
Copyright: © 2020, E. Gadour, et al.
This is an open-access article distributed under the terms of the Creative
Commons Attribution 4.0 International License, which permits unrestricted use,
distribution and reproduction in any medium, provided the original author and
source are credited.
ABSTRACT
Background:
Covid-19 Induced Hepatitis (CIH), is a novel terminology which is used in this
article for the first time in the medical liter¬ature. However, SARS-Cov-2
(Severe Acute Respiratory Syndrome Coronavirus 2) is a coronavirus that
out-broke in December 2019 in China.
Objective: To study the pattern of
liver impairment in patients with Covid-19 as well as to find acceptable and
practical diagnostic criteria of Covid-19 Induced Hepatitis (CIH). This review
article gives new insight and guidance about the diagnosis of Covid-19 Induced
Hepatitis (CIH), possible causes of liver damage and review of recently
published data about the impairment of liver function in Covid-19 patients.
Methodology: Extensive literature
review of newly published data and study in PubMed cited journals and other
international publisher journals. Research of all studies that reviewed liver
derangement in COVID-19 were mainly reviewed. Statistical analysis of submitted
data were checked using SPSS. PubMed Chinese language versions were also used.
Results: 60% of patients with SARS
can have abnormal liver functions. Aspartate Aminotransferase (AST) and Alanine
Aminotransferase (ALT) have noticeably been abnormal in around 14-53% of
patients with Covid-19 (7/114, 6.14%) (P > .05). Impairment in liver
enzymes, mainly ALT/AST, in severe Covid-19 pneumonia was significantly higher
than patients with mild disease, with mean average (37.87±32.17 vs 21.22±
12.67;38.87 ± 22.55 vs 24.39 ± 9.79, P < .001). Patients with Community
Acquired Pneumonia (CAP) had significantly less impaired liver synthetic function
(32/114, 28.07%) compared to Covid-19 pneumonia (60/115, 52.17%), which has
been demonstrated with high INR (P<0.01). Mild sinusoidal dilatation with
lymphocyte infiltration, minimal, has been displayed in the liver tissue of 114
deceased with Covid-19 and liver impairment, which was obtained in one hour
after their death. Fatality among Covid-19 and CLD with Child T-P score A was
23.9%, and Child T-P score B 43.3% with 63.0% fatality among patients with
Child T-P score C, Moon AL. Acute liver failure in Covid-19 has been re¬ported
only in 2 occasions, one adult, and infant who had recent liver transplant.
Conclusion: Covid-19 Induced
Hepatitis (CIH) is a new clinical syndrome, which can be defined as a “benign
new transient hepatitis in a SARS-CoV-2 patients which is characterized by the
following; Gradual onset, elevated AST and ALT, Dilated sinusoidal with
lymphocytic infil¬tration of liver parenchyma, non-Obstructive jaundice, stable
Underlying liver disease and no Radiological new hepatobiliary changes.†Using
GADOUR criteria may support the diagnosis, however, sensitivity and specificity
are yet to be established. Meticulous statistical studies need to be done
before establishing overly sensitive scoring system can be reach.
KEYWORDS: Covid-19 Induced Hepatitis, GADOUR criteria
DOI: http://dx.doi.org/10.47690/WJGHE.2020.3301
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