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The growing need to monitor the liver function after SARS-CoV-2 infection in the Mexican population with obesity
Juan José Rivera-Valdesa, Erika Martínez-Lopeza,
Corresponding author
erikamtz27@yahoo.com.mx

Corresponding author at: Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biologia Molecular y Genómica, Guadalajara, Jalisco, 44340, Mexico.
a Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México, Sierra Mojada 950, Guadalajara, Jalisco, Mexico.
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">The current Coronavirus disease 2019 &#40;COVID-19&#41; pandemic&#44; caused by the severe acute respiratory syndrome coronavirus-2 &#40;SARS-CoV-2&#41;&#44; has become a major public health problem over the last two years&#46; It has reached 418&#44;650&#44;474 confirmed cases of COVID-19&#44; including 5&#46;856&#46;224 deaths&#44; until February 2022&#44; according to the World Health Organization <a class="elsevierStyleCrossRef" href="#bib0001">&#91;1&#93;</a>&#46; Unfortunately&#44; Mexico was already dealing with obesity&#44; another public health problem&#46; In Mexico&#44; the reported 2018 prevalence of obesity in adults was 36&#46;1&#37; <a class="elsevierStyleCrossRef" href="#bib0002">&#91;2&#93;</a>&#46; Obesity&#44; along with its underlying comorbidities&#44; such as hypertension&#44; diabetes&#44; non-alcoholic fatty liver disease &#40;NAFLD&#41;&#44; and cardiovascular disease are major factors predicting poor COVID-19 outcomes&#46; In this sense&#44; the pre-pandemic prevalence of obesity and chronic and metabolic diseases in Mexico may be related to the high COVID-19 associated lethality rate in the region <a class="elsevierStyleCrossRef" href="#bib0003">&#91;3&#93;</a>&#46;</p><p id="para0002" class="elsevierStylePara elsevierViewall">Much has been speculated about the possible consequences and long-term effects for those who have been infected by SARS-CoV-2&#46; While the most recognized sequelae are cardiac&#44; sensitive&#44; and respiratory conditions&#59; an organ that also has cells with entry pathway receptors for SARS&#8208;CoV-2 has been left out&#46; Angiotensin-converting enzyme 2 receptors are the main viral entry point for SARS-CoV-2 <a class="elsevierStyleCrossRef" href="#bib0004">&#91;4&#93;</a>&#44; and they are highly expressed in the lung and kidney&#44; but are also expressed in gastrointestinal tract&#44; vascular endothelium and cholangiocytes of the liver &#91;<a class="elsevierStyleCrossRef" href="#bib0005">5</a>&#44; <a class="elsevierStyleCrossRef" href="#bib0006">6</a>&#93;&#44; which is relevant because it positions the liver as a potential target for SARS-CoV-2&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">In this sense&#44; the term &#8220;COVID-19 associated liver injury&#8221; has emerged to define any liver damage that occurs during illness and treatment of patients with COVID-19&#44; with or without pre-existing liver disease <a class="elsevierStyleCrossRef" href="#bib0007">&#91;7&#93;</a>&#46; COVID-19&#160;affects multiple organs&#44; including anomalies in liver function <a class="elsevierStyleCrossRef" href="#bib0008">&#91;8&#93;</a>&#46; Even though studies that determine liver function biomarkers in Mexican patients with COVID-19 are scarce&#44; they coincide in the detection of abnormal values &#8203;&#8203;of hepatic transaminases&#44; whose elevated levels reflect liver damage are common in patients with COVID-19&#44; both for those with and without chronic liver disease &#40;CLD&#41;&#46; A recent study in which the majority of its population had overweight and obesity investigated the effects of the SARS-CoV-2 virus on liver function and its association with the severity of acute respiratory distress syndrome in Mexican population found a high frequency of patients who have alterations in liver function tests &#40;LFTs&#41;&#44; especially aspartate aminotransferase &#40;AST&#41; and gamma glutamyl Transferase &#40;GGT&#41; <a class="elsevierStyleCrossRef" href="#bib0009">&#91;9&#93;</a>&#46; Another study reported that higher levels of alanine aminotransferase &#40;ALT&#41; are associated with higher in-hospital mortality risk in Mexican patients admitted with COVID-19 <a class="elsevierStyleCrossRef" href="#bib0002">&#91;2&#93;</a>&#46; Abnormal LFTs on admission have been given the role of diagnostic biomarkers&#44; for manifesting within the first 7 days of infection&#44; and for their prognostic value during the disease <a class="elsevierStyleCrossRef" href="#bib0010">&#91;10&#93;</a>&#59; even they have been associated&#44; both independently and together with obesity&#44; with mortality and severe COVID-19 in hospitalized patients with SARS-CoV-2 infection and its use as a surrogate marker of inflammation has been suggested <a class="elsevierStyleCrossRef" href="#bib0011">&#91;11&#93;</a>&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">On the one hand&#44; the diagnostic and predictive value of liver markers during COVID-19 is undeniable&#59; on the other hand&#44; it is still unknown the long-term effects of the COVID-19 associated liver injury&#44; for both obese and non-obese patients&#46; However&#44; a possible bridge between obesity&#44; COVID-19 and LFTs alterations could be NAFLD&#44; since NAFLD is the most frequently liver disease associated with obesity&#44; and recently is predicted to be present in the majority of COVID-19 patients with pre-existing CLD worldwide <a class="elsevierStyleCrossRef" href="#bib0012">&#91;12&#93;</a>&#46; Evidence indicates that SARS-CoV-2 can infect the liver and cause conspicuous hepatic cytopathic injury&#46; Microvesicular and macrovesicular steatosis have been observed in liver autopsies of COVID-19 patients who presented SARS-CoV-2 infection as the only risk factor for liver injury&#46; A recent prospective&#160;cohort evaluated the histopathological evolution during COVID-19&#44; and observed prominent dilation of the sinusoids in all liver biopsies&#44; regardless of the stage of the disease&#44; while the presence of lobular inflammation was limited to patients with mild or moderate COVID-19 <a class="elsevierStyleCrossRef" href="#bib0013">&#91;13&#93;</a>&#46; Other histopathological findings in SARS-CoV-2-infected livers include mild lobular and portal activity&#44; massive apoptosis&#44; and binuclear hepatocytes with notable mitochondrial inflammation&#44; endoplasmic reticulum dilation <a class="elsevierStyleCrossRef" href="#bib0014">&#91;14&#93;</a>&#46; In this sense&#44; it has been suggested that one of the cytopathic effects of SARS-CoV-2 is through the deregulation of the host lipid metabolism and mitochondrial activity&#46; Other possible pathological mechanism involve the viral S protein&#44; which could be capable of inducing stress in endoplasmic reticulum&#44; and this in turn induce <span class="elsevierStyleItalic">de novo</span> lipogenesis&#44; which could contribute to the development of steatosis in patients with COVID-19 <a class="elsevierStyleCrossRef" href="#bib0007">&#91;7&#93;</a>&#46; This is relevant because NAFLD is an important cause of more severe pathologies such as liver cirrhosis and hepatocellular carcinoma&#46; However&#44; there is a great need for studies that confirm these hypotheses&#59; as long-term follow-up studies are also required to explore potential sequelae of SARS-CoV-2 infection&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">Even though the mechanism by which COVID-19 causes liver injury and disfunction has not yet been clarified&#44; the most prominent explanations are &#40;a&#41; immune-mediated damage due to the severe inflammatory response following infection&#44; &#40;b&#41; direct cytopathic effect of SARS&#8208;CoV&#8208;2 in hepatic tissue&#44; and &#40;c&#41; drug-induced liver injury <a class="elsevierStyleCrossRef" href="#bib0012">&#91;12&#93;</a>&#46; At this point&#44; it is important to note that certain medications commonly used during hospitalization&#44; including corticoids&#44; antiretroviral agents&#44; and methotrexate&#44; contribute to abnormal liver function test results of COVID-19 patients <a class="elsevierStyleCrossRef" href="#bib0015">&#91;15&#93;</a> and might trigger the transition of simple fatty liver to non-alcoholic steatohepatitis or worsen pre-existing steatosis&#44; necroinflammation&#44; and fibrosis <a class="elsevierStyleCrossRef" href="#bib0012">&#91;12&#93;</a>&#46; Although it is not yet clear whether SARS&#8208;CoV&#8208;2 directly or the medication used for its treatment is the main cause of liver damage during and after COVID-19&#59; it should be taken into account when providing treatment for these patients&#44; prioritizing the use of drugs that are capable of inhibiting the inflammatory response while protecting liver function <a class="elsevierStyleCrossRef" href="#bib0008">&#91;8&#93;</a>&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">Finally&#44; LFTs should be routinely ordered to assess relative liver injury in patients diagnosed with COVID-19&#46; The general recommendation for all patients in the mild category with associated comorbidity or patients in moderate category at hospital admission includes LFTs along with a complete blood count&#44; C-reactive protein&#44; and serum creatinine&#46; If any of these markers are abnormal&#44; further investigations for patients in severe category may be considered <a class="elsevierStyleCrossRef" href="#bib0010">&#91;10&#93;</a>&#46; In Mexico&#44; the need to monitor liver function should be added to the recommendation for those who have survived the mild and severe COVID-19 disease&#44; especially those with metabolic disorders&#44; also for cases of people who have been reinfected by the virus&#44; due to the possibility of presenting liver disorders after infection&#59; as well as for those people who have pre-existing CLD during COVID-19&#44; to determine the aggravation by SARS&#8208;CoV&#8208;2&#46; The effects of COVID-19 on underlying CLD require detailed evaluation and further research is warranted in this area&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Abbreviations</span><p id="para0007" class="elsevierStylePara elsevierViewall">ALT&#44; alanine aminotransferase&#59; AST&#44; aspartate aminotransferase&#59; CLD&#44; chronic liver disease&#59; COVID-19&#44; coronavirus disease 2019&#59; LFTs&#44; liver function tests&#59; NAFLD&#44; Nonalcoholic fatty liver disease&#59; SARS-CoV-2&#44; Severe Acute Respiratory Syndrome Coronavirus&#8208;2&#59; WHO&#44; World Health Organization&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Declaration of Competing Interest</span><p id="para0008" class="elsevierStylePara elsevierViewall">The authors have not conflicts of interest</p></span></span>"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos