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Introduction and Objectives: As of January 2021, over 88 million people have been infected with COVID-19. Almost two million people have died of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A high SOFA score and a D-Dimer >1 µg/mL identifies patients with high risk of mortality. High lactate dehydrogenase (LDH) levels on admission are associated with severity and mortality. Different degrees of alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) abnormalities have been reported in these patients, its association with a mortality risk remains controversial. The aim of this study was to explore the correlation between LDH and in-hospital mortality in Mexican patients admitted with COVID-19. Materials & Methods: We performed a retrospective multi-centre cohort study with 377 hospitalized patients with confirmed SARS-CoV-2 in three centres in Mexico City, Mexico, who were ≥18 years old and died or were discharged between April 1 and May 31, 2020. Results: A total of 377 patients were evaluated, 298 (79.1%) patients were discharged, and 79 (20.9%) patients died during hospitalization. Non-survivors were older, with a median age of 46.7 ± 25.7 years old, most patients were male. An ALT > 61 U/l (OR 3.45, 95% CI 1.27−9.37; p = 0.015), C-reactive protein (CRP) > 231 mg/l (OR 4.71, 95% CI 2.35−9.46; p = 0.000), LDH > 561 U/l (OR 3.03, 95% CI 1.40−6.55; p = 0.005) were associated with higher odds for in-hospital death. Conclusions: Our results indicate that higher levels of LDH, CRP, and ALT are associated with higher in-hospital mortality risk in Mexican patients admitted with COVID-19.

Introduction and Objectives: Alcoholic hepatitis (AH) is an acute liver inflammation associated with excessive alcohol consumption. The pharmacological treatment for AH is corticosteroids. There is a study that has proposed calculating the Lille model on day 4 (Lille-4), which apparently has comparable accuracy to the Lille model calculated on day 7 (Lille-7). However, this finding has not been validated. Therefore our objective is to determine if Lille-4 is equivalent to Lille-7 in predicting 28-day mortality in patients with probable severe alcoholic hepatitis (AH) as defined by the 2016 consortium criteria sponsored by NIAAA. Materials and Patients: Observational, prospective, ambidirectional, analytical cohort study conducted from January 2010 to April 2023. We collected clinical and biochemical variables upon admission, calculated Lille models, assessed response and 28-day mortality. Comparative analyses were performed based on survival versus mortality. Sensitivity, specificity, PPV, NPV, and accuracy of the models were calculated. Results: A total of 327 patients were included, 297 (90.8%) being male. Mean age was 43.4±9.3 years. The 50th percentile for alcohol consumption was 320 g/day (5th-95th percentile: 100.8-662). At day 28, 207 patients (63.3%) died. Upon admission, the patients who died showed a significant difference compared to survivors in: Maddrey (90 [95%CI: 81-99] vs. 70 [95%CI:65-75]; p0.45 had a sensitivity (S) of 78% and specificity (E) of 45% in predicting early mortality. Lille-4 model had an AUROC of 0.68 [0.63-0.74], where a value >0.45 had an S of 81% and E of 54% (Figure 1). Conclusions: Lille-7 is the model with the highest accuracy, according to the obtained AUROC, for predicting early mortality in severe alcoholic hepatitis (AH). Therefore, the determination of total bilirubin should not be done prematurely (before day 7), and steroid therapy should be provided to patients for up to 7 days to classify treatment response.

Introduction and Objectives: Severe alcoholic hepatitis (AH) has a high mortality rate, and currently, it is still a challenge to be able to establish the prognosis of these patients and their risk of death at admission in order to be able to offer better therapeutic alternatives that save a life in a timely manner. This study aimed to compare several prognostic scores to verify which of them has the best performance in predicting 28-day mortality at admission in patients with AH. Materials and Methods: Observational, cohort study. Data were collected from patients with severe AH who were hospitalized between January 2010 to May 2022. MELD, MELDNa, MELD3.0, ABIC, Maddrey, Glasgow scale for AH were calculated with admission parameters, and their outcome was verified at 28 days. ROC curves were constructed to compare the different prognostic scales. Results: 144 patients were included, 129 (89.6%) men, mean age 43.3±9.3 years, median grams of alcohol consumed/day were 320 (range: 60-1526). 65 (45.1%) died. The mean of MELD, MELDNa and MELD3.0 were higher among the deceased vs. survivors (33.5±7.5 vs. 27.1±6.2; 34.6±5.7 vs. 29.1±5.7; and 35.8±6.0 vs. 30.1±5.5 respectively; p

Introduction and Objectives: Diabetes is a high-risk condition for the progression of metabolic fatty liver disease (MAFLD). The FAST® index combines the result of transition elastography (Fibroscan®) and AST levels and is used to predict the risk of suffering from non-alcoholic steatohepatitis (NASH) with a high risk of progression (NAS >4, F>2). This study aimed to know what proportion of diabetic patients is at risk of suffering from high-risk NASH according to the FAST® index. Materials and Methods: Observational, transversal study to estimate prevalence. Diabetic patients who agreed to perform Fibroscan® and liver biochemical profile were included, and the FAST® index was calculated (

Introduction and Objectives: Minimal hepatic encephalopathy (MHE) is associated with the risk of accidents, falls, and impaired quality of life. Treatment with L-ornithine L-aspartate (LOLA) could be an effective strategy. This study aimed to verify the efficacy and safety of LOLA treatment in a real-life cohort of cirrhotic patients with MHE. Materials and Methods: Cirrhotic patients with MHE were included. Those who had received any anti-ammoniacal measure or with alcohol consumption in the last six months, creatinine > 1.5 mg/dL, or previously known chronic kidney disease were excluded. The diagnosis of MHE was made using the psychometric hepatic encephalopathy score (PHES) and the critical flicker frequency (CFF). MHE patients received LOLA 6 g t.i.d. for three days and were reassessed with PHES and CFF. The project was approved by the local research and ethics committees. Results: 98 cirrhotic patients were evaluated; 38 (38.8%) had baseline MHE, 26 (68.4%) women, mean age 53.3±8.8 years, median education nine years (range 0-15). According to Child-Pugh: 26 (68.4%) A, 9 (23.7%) B, and 3 (7.9%) C. The median MELD was 11 (range 6-21), and MELD-Na 12 (range 6-26). Intention to treat analysis: According to PHES, 30(78.9%) patients showed remission of MHE (p

COVID-19 is mainly a respiratory illness caused by the SARS-CoV-2 but can also lead to GI symptoms. The primary host receptor which mediates the mechanism as SARS-CoV-2 enters the cell is the ACE2 receptor. Therefore, GI symptoms can be common in COVID-19, and in some cases, they are the first manifestation even before fever and respiratory symptoms. In addition, the liver function tests alteration often is related to a worse prognosis. The exact incidence of GI symptoms is a matter of debate. Moreover, wide variation concerning GI symptoms frequency exists, but the predominant ones seem to be diarrhea, anorexia, nausea, vomiting, and abdominal pain or discomfort. This review summarizes the most relevant findings of COVID-19 on the digestive system, including the liver, biliary tract, pancreas, the most common GI symptoms, and the atypical clinical GI manifestations.

Background and aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the current pandemic, can have multi-organ impact. Recent studies show that liver injury could be a manifestation of the disease, and that liver disease could also be related to a worse prognosis. Our aim was to compare the characteristics of patients with severe coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 who required intubation versus stable hospitalized patients to identify the early biochemical predictive factors of a severe course of COVID-19 and subsequent requirement for intubation, specifically in Mexican. Methods: This was an observational case-control study nested in a cohort study. Complete medical records of patients admitted for confirmed COVID-19 at a tertiary level center in Mexico City were reviewed. Clinical and biochemical data were collected, and the characteristics of patients who required invasive mechanical ventilation (IMV) (cases) were compared with stable hospitalized patients without ventilation (controls). Results: We evaluated 166 patients with COVID-19 due to SARS-CoV-2 infection; 114 (68.7%) were men, the mean age was 50.6 ± 13.3 years, and 27 (16.3%) required IMV. The comparative analysis between cases and controls showed (respectively) significantly lower blood oxygen saturation (SpO2) (73.5 ± 12.0% vs. 83.0 ± 6.8%, P

Introduction: Some patients with SARSCov-2 infection develop severe disease (SARS); however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. Aim: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods Type of study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS+MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Results: 166 patients were included, 114(68.7%) men, mean age 50.6±13.3 years-old, 27(16.3%) developed SARS+MV. In the comparative analysis between those with SARS+MV versus stable patients without MV we found significant raises of ALT (225.4±341.2 vs. 41.3±41.1; P=0.003), AST 325.3±382.4 vs. 52.8±47.1; P=0.001), LDH (764.6±401.9 vs. 461.0±185.6; P=0.001), D dimer (7765±9109 vs. 1871±4146; P=0.003), age (58.6±12.7 vs. 49.1±12.8; P=0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS+MV; with these variables was constructed the model called AAD, where: [AAD= 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value ≤ 2.75 had sensitivity=0.797 and 1-specificity= 0.391, AUROC=0.74 (95%CI: 0.62-0.86; P