Association of plasma antimony concentration with markers of liver function in Chinese adults

2020 ◽  
Vol 17 (4) ◽  
pp. 304
Author(s):  
Xiaomin You ◽  
Yang Xiao ◽  
Kang Liu ◽  
Yanqiu Yu ◽  
Yiyi Liu ◽  
...  
Keyword(s):  
Liver Function ◽  
Inductively Coupled Plasma ◽  
Linear Models ◽  
Liver Enzymes ◽  
Large Population ◽  
Convincing Evidence ◽  
Baseline Survey ◽  
Potential Hazard ◽  
Potential Threat ◽  
Antimony Concentration

Environmental contextAntimony pollution has become a global issue given its wide distribution in the environment and its potential threat to human health. This large population-based study demonstrated that exposure to high levels of antimony may impair liver function in adults. The study highlights the potential hazard to liver function of antimony exposure, and provides convincing evidence of the need to monitor and control antimony exposure in the prevention of liver dysfunction. AbstractThe association of antimony exposure with serum liver enzymes and bilirubin levels remains unknown. We aimed to prospectively evaluate the associations of the plasma antimony concentration with serum liver enzymes [alkaline phosphatase (ALP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] and bilirubin [total (TBil), direct (DBil) and indirect bilirubin (IBil)] levels among the Chinese middle-aged and elderly population. A total of 4733 participants who were free of cardiovascular disease (CVD), cancer and chronic hepatitis at the baseline survey (2008–2010) of the Dongfeng-Tongji cohort were included in the current study. We measured the baseline plasma antimony concentration by inductively coupled plasma mass spectrometry (ICP-MS), and the serum liver enzymes and bilirubin levels at the resurvey visit (2013) by using an automatic analyser. In the fully adjusted generalised linear models, we observed that an increased plasma antimony concentration was significantly associated with higher bilirubin levels. Moreover, we found that plasma antimony was positively associated with the elevation of DBil (≥7.0μmolL−1), where the adjusted odds ratios (ORs) comparing the extreme tertiles was 1.35 (95% CI: 1.06, 1.70, P trend=0.01). Spline regression analyses indicated that the plasma antimony concentration was linearly associated with the elevation of TBil and DBil (overall P=0.004 and P=0.002 respectively). Our study suggested that exposure to high levels of antimony may impair liver function in adults. Further investigations are warranted to confirm these findings in other populations.

scholarly journals Vegan Diet Advice Might Benefit Liver Enzymes in Nonalcoholic Fatty Liver Disease: an Open Observational Pilot Study

2021 ◽  
Author(s):  
Giuseppe Chiarioni ◽  
Stefan Lucian Popa ◽  
Andrea Dalbeni ◽  
Carlo Senore ◽  
Daniel Corneliu Leucuta ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Liver Disease ◽  
Liver Function ◽  
Fatty Liver Disease ◽  
Liver Enzymes ◽  
Liver Function Tests ◽  
Vegan Diet ◽  
Nonalcoholic Fatty Liver ◽  
Function Tests

Background and Aims: The Western diet is rich in saturated fats, refined sugars and meat consistent with a high-energy load and secondary risk of increased metabolic diseases including nonalcoholic fatty liver disease (NAFLD). However, no data are available on potential benefit of vegan diets in NAFLD and/or nonalcoholic steatohepatitis (NASH). We aimed to study prospectively the effect of a vegan diet, excluding all animal products on liver chemistry in a group of consecutive NAFLD patients. Methods: This was a prospective, pilot study run on 40 consecutive patients affected by NAFLD. Eight subjects refused to join the study for poor diet palatability, leaving 32 patients (19 males, mean age 50 years), with abnormal measures of liver function who agreed to adhere to a vegan diet for six months. The caloric intake was tailored by the dietitian to obtain a weight loss ≥5% of body weight in overweight patients [body-mass index (BMI) ≥25] and ranged from 1500 Kcal to 1800 Kcal. Patients were contacted monthly by phone to reinforce diet and lifestyle advice and were seen at the gastrointestinal clinic when doubtful about diet advice. Results: At six-month follow-up, 6 subjects did not attend the clinic leaving only 26 patients for data analysis. Initial anthropometric values were mean weight 78 kg (range 52-95), mean body mass index (BMI) 26.8 Kg/m2 (range 20.3-31.2). Liver function tests showed mean ALT value 99 U/L (SD±45), mean AST value 54 U/L (SD±44), mean GGT value 160 U/L (SD±122), pre-treatment. After six months mean body weight was 73 Kg (range 52-87), mean BMI was 25.2 Kg/m2 (range 20.3-29.7) (p<0.001 compared to baseline for both parameters). Liver enzymes improved to a mean of ALT value 36 U/L (SD±21), AST value 27 U/L (SD±10) and GGT value 55 U/L (SD±57), respectively (p<0.001 compared to baseline for all enzymes). Normalization of liver function tests as a whole was observed in 20/26 patients (76.9%). A loss of ≥ 5% of body weight was observed in 12 patients (46.1%), but it did not correlate with the normalization of liver function tests (p=0.5). Conclusions: Our data provide preliminary evidence of improved liver enzymes in NAFLD patients with a strict vegan diet and although our study sample is limited, decreased body weight did not seem critical to the outcome.

scholarly journals EFFECT OF ALCOHOLISM ON LIVER FUNCTION TEST IN RURAL POPULATION IN INDIA

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Richa K Lath ◽  
Aniruddha Jibhkate
Keyword(s):  
Liver Function ◽  
Liver Function Test ◽  
Liver Damage ◽  
Total Protein ◽  
Liver Enzymes ◽  
Normal Individual ◽  
Public Health Problem ◽  
Albumin Level ◽  
Study Group ◽  
Function Test

Background: alcoholism is one of the major socioeconomic as well as public health problem in India. The problem is occurring equally in urban as well as in rural India. This study was carried out in essence of liver damage in alcoholics and alteration in the biochemical enzymes in the serum with respect to liver damage. Method: 100 alcoholics and 100 non alcoholic patients were selected from the hospital OPD. Liver function test was performed in both the study group. Liver  enzymes ALT,AST,ALP and the total protein and albumin level were compared in  the study group and controls. Results: The results showed there is significant increase in the liver enzymes ALT,AST,ALP in the alcoholic patients as compared to normal individual and significant fall in concentration of the total protein and albumin level in the alcoholics. Keywords: Alcoholics, liver function test

scholarly journals Prognostic Potential of Liver Enzymes in Patients With COVID-19 at the Leishenshan Hospital in Wuhan

2021 ◽  
Vol 11 ◽  
Author(s):  
Zeming Liu ◽  
Di Hu ◽  
Jinpeng Li ◽  
Qing Xia ◽  
Yan Gong ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Enzymes ◽  
Cox Regression ◽  
Liver Function Tests ◽  
Regression Analyses ◽  
Survival Curves ◽  
Severity Of Disease ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Disease Mortality

BackgroundCoronavirus disease 2019 (COVID-19) has evolved into a pandemic. We hypothesized that biochemical indicators of liver function may help determine the prognosis of COVID-19 patients.MethodsPatient information was collected from the Wuhan-Leishenshan hospital. Logistic and Cox regression analyses, Kaplan-Meier curves, and Curve fitting were used to determine the correlation between elevated levels of aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT and severity of disease/mortality.ResultsLogistic and Cox regression analyses and Kaplan-Meier survival curves showed that COVID-19 progression correlated with elevated levels of AST and AST/ALT. The odds ratios for elevated levels of AST and AST/ALT in patients were 0.818 (95% confidence interval [CI]: 0.274-2.441, P = 0.035) and 2.055 (95% CI: 1.269-3.327, P = 0.003), respectively; the hazard ratios were 4.195 (95% CI: 1.219-14.422, P = 0.023) and 3.348 (95% CI: 1.57-7.139, P = 0.002), respectively. The Kaplan-Meier survival curves demonstrated that patients with elevated AST and AST/ALT levels had a higher risk of developing severe COVID-19.ConclusionElevated AST and AST/ALT levels correlated with severity of COVID-19 and mortality. Liver function tests may help clinicians in determining the prognosis of patients undergoing treatment for COVID-19.

scholarly journals Inhibitory control of positive and negative information and adolescent depressive symptoms: a population-based cohort study

2020 ◽  
pp. 1-11
Author(s):  
Gemma Lewis ◽  
Katherine S. Button ◽  
Rebecca M. Pearson ◽  
Marcus R. Munafò ◽  
Glyn Lewis
Keyword(s):  
Cohort Study ◽  
Depressive Symptoms ◽  
Inhibitory Control ◽  
Adolescent Depression ◽  
Large Population ◽  
Population Based ◽  
Negative Information ◽  
Convincing Evidence ◽  
Cross Sectional ◽  
Adolescent Depressive Symptoms

Abstract Background Large population-based cohort studies of neuropsychological factors that characterise or precede depressive symptoms are rare. Most studies use small case-control or cross-sectional designs, which may cause selection bias and cannot test temporality. In a large UK population-based cohort, we investigated cross-sectional and longitudinal associations between inhibitory control of positive and negative information and adolescent depressive symptoms. Methods Cohort study of 2328 UK adolescents who completed an affective go/no-go task at age 18. Depressive symptoms were assessed with the Clinical Interview Schedule Revised (CIS-R) and short Mood and Feeling Questionnaire (sMFQ) at age 18, and with the sMFQ 1 year later (age 19). Analyses were multilevel and traditional linear regressions, before and after adjusting for confounders. Results Cross-sectionally, we found little evidence that adolescents with more depressive symptoms made more inhibitory control errors [after adjustments, errors increased by 0.04% per 1 s.d. increase in sMFQ score (95% confidence interval 0.02–0.06)], but this association was not observed for the CIS-R. There was no evidence for an influence of valence. Longitudinally, there was no evidence that reduced inhibitory control was associated with future depressive symptoms. Conclusions Inhibitory control of positive and negative information does not appear to be a marker of current or future depressive symptoms in adolescents and would not be a useful target in interventions to prevent adolescent depression. Our lack of convincing evidence for associations with depressive symptoms suggests that the affective go/no-go task is not a promising candidate for future neuroimaging studies of adolescent depression.

scholarly journals Silymarin in Combination with Vitamin C, Vitamin E, Coenzyme Q10 and Selenomethionine to Improve Liver Enzymes and Blood Lipid Profile in NAFLD Patients

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 544
Author(s):  
Annalisa Curcio ◽  
Adriana Romano ◽  
Simona Cuozzo ◽  
Antonio Di Nicola ◽  
Orazio Grassi ◽  
...  
Keyword(s):  
Vitamin E ◽  
Liver Function ◽  
Vitamin C ◽  
Coenzyme Q10 ◽  
Liver Enzymes ◽  
Lifestyle Modification ◽  
Tolerability Profile ◽  
Blood Profile ◽  
Alcoholic Fatty Liver ◽  
Glutamyl Transferase

Background and Objectives: Non-Alcoholic Fatty Liver Disease (NAFLD) is an emerging cause of hepatopathy that is showing an increasing trend and where the recommendations of lifestyle modification are often not sufficient. The aim of this study is to evaluate the efficacy and tolerability profile of the association of silymarin, vitamin C, vitamin E, coenzyme Q10 and selenomethionine (Medronys epato®) by analyzing liver enzymes, along with the lipidic profile, as markers of liver function, and ultrasound results in NAFLD patients. Materials and Methods: This study enrolled 81 patients with mild to severe NAFLD, divided into two groups: Group A (N = 41) received two capsules a day of silymarin, vitamin C, vitamin E, coenzyme Q10 and selenomethionine (Medronys epato®), and Group B (N = 40) received only recommendations for lifestyle modification including hypocaloric diet, physical exercise and encouragement for weight loss. Patients have been evaluated at three timepoints: baseline (T0), after 45 days of treatment (T1) and after 90 days of treatment (T2), by collecting blood parameters of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and the lipid blood profile. Ultrasonographic results have been analyzed at T0 and T2, along with the tolerability profile and side effects, registered at time T2. Results: The administration of the association of silymarin, vitamin C, vitamin E, coenzyme Q10 and selenomethionine (Medronys epato®) was effective since it showed a significant reduction of the evaluated parameters of ALT, AST, ALP and GGT, a significant improvement of lipid parameters, evaluated as markers of liver function, and improvements of ultrasonographic results. The use of this formulation at the dosage of two capsules a day has been well tolerated and no adverse events have been reported during study period of three months. Conclusions: The administration of the association of silymarin, vitamin C, vitamin E, coenzyme Q10 and selenomethionine (Medronys epato®) was effective and well tolerated in the improvement of hepatic function of NAFLD patients.

A dose-response and meta-analysis of phytosterols consumption on liver enzymes

2019 ◽  
Vol 50 (3) ◽  
pp. 579-600
Author(s):  
Somayeh Tajik ◽  
Kevan Jacobson ◽  
Sam Talaei ◽  
Hamed Kord-Varkaneh ◽  
Zeinab Noormohammadi ◽  
...  
Keyword(s):  
Liver Function ◽  
Design Methodology ◽  
Liver Enzymes ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Serum Biochemistry ◽  
Effect Sizes ◽  
Random Effects Model ◽  
Weighted Mean ◽  
Content Type

Purpose The results of human studies evaluating the efficacy of plant Phytosterols on liver function were inconsistent. Therefore, the purpose of this paper is to eliminate these controversies about the Phytosterols consumption on liver serum biochemistry in adult subjects. Design/methodology/approach The literatures systematically searched throughout PubMed and Scopus databases up to June 2018; it was conducted by using related keywords. Estimates of effect sizes were expressed based on weighted mean difference (WMD) and 95% CI from the random-effects model (erSimonian and Laird method). Heterogeneity across studies was assessed by using I2 index. Eighteen studies reported the effects of Phytosterols (PS) supplementation on liver serum biochemistry. Findings The current meta-analysis did not show a significant effect on ALT (MD: 0.165 U/L, 95% CI: −1.25, 1.58, p = 0.820), AST (MD: −0.375 IU/Liter, 95% CI: −1.362, 0.612, p = 0.457), ALP (MD: 0.804 cm, 95% CI: −1.757, 3.366, p = 0.538), GGT (MD: 0.431 U/L, 95% CI: −1.803, 2.665, p = 0.706) and LDH (MD: 0.619 U/L, 95% CI: −4.040, 5.277, p = 0.795) following PS consumption. Originality/value The authors found that no protective or toxic effects occur after the consumption of Phytosterols on liver enzymes including ALT, AST, ALP, LDH and GGT.

scholarly journals A májfunkció romlásának rizikófaktorai sikeres vesetranszplantációt követően

2019 ◽  
Vol 160 (5) ◽  
pp. 186-190
Author(s):  
Bernadett Borda ◽  
Attila Nemes ◽  
Csaba Lengyel ◽  
Tamás Várkonyi ◽  
Ferenc Rárosi ◽  
...  
Keyword(s):  
Liver Function ◽  
Immunosuppressive Therapy ◽  
Liver Enzymes ◽  
Graft Loss ◽  
Study Results ◽  
Allograft Function ◽  
The Difference ◽  
The Impact ◽  
The Relationship

Abstract: Introduction: Increase of liver function is one of the most common complications after kidney transplantation due to the use of immunosuppressive therapy and hyperlipidemia in addition to hepatitis C virus (HCV) infection. Method: Following the selection criteria (n = 59), the study is based on applied immunosuppressive therapy, baseline data of patients, further correlation between HCV and liver function deterioration. Patients were subjected to fasting laboratory examination to monitor serum electrolytes, uric acid and albumin levels. We looked at the effects of immunosuppressive therapy on the lipids (TG, TC, HDL, LDL) and liver enzymes (GOT, GPT, ALP, GGT). The analysis of the relationship between lipids and liver enzymes was also included in our study. Results: The data basics were not significantly different between the tacrolimus and the cyclosporine groups. In the laboratory results, Mg levels were significantly different between the two groups (p = 0.044). The impact of HCV on the liver function was significantly different on GGT (p = 0.008). We examed the lipids and liver function level between the tacrolimus and the patients receiving cyclosporine-based immunosuppression and the total cholesterol (p = 0.005) and GOT (p = 0.05) were significantly different between the two groups. Hyperlipidemia was associated with 26% of patients taking tacrolimus-based immunosuppression, and 89% of those receiving cyclosporine; the difference was significant (p = 0.002). Regarding the effect of hyperlipidemia on liver enzymes, ALP (p = 0.006) and GGT (p = 0.0001) were significantly higher. Conclusion: Increases in hepatic enzymes, ALT and GGT indicate the damage to hepatocytes. Beside the increase of liver function, which is the main risk factor in hepatitis on HCV soil, the applied immunosuppressive therapy and hyperlipidemia lead to degradation of allograft function and long-term graft loss. Orv hetil. 2019; 160(5): 186–190.

The composition of human preimplantation embryo culture media and their stability during storage and culture

2019 ◽  
Vol 34 (8) ◽  
pp. 1450-1461 ◽  
Author(s):  
M Tarahomi ◽  
F M Vaz ◽  
J P van Straalen ◽  
F A P Schrauwen ◽  
M van Wely ◽  
...  
Keyword(s):  
Amino Acids ◽  
Embryo Culture ◽  
Human Liver ◽  
Linear Models ◽  
Liver Enzymes ◽  
Preimplantation Embryo ◽  
Culture Media ◽  
Secondary Analysis ◽  
Success Rates ◽  
Expiry Date

Abstract STUDY QUESTION What is the composition and stability during storage and culture of fifteen commercially available human preimplantation embryo culture media? SUMMARY ANSWER No two culture media had the same composition, and both storage and culture had an effect on the concentrations of multiple components. WHAT IS KNOWN ALREADY The choice of embryo culture medium not only affects the success rate of an IVF treatment, but also affects the health of the future child. Exact formulations of embryo culture media are often not disclosed by manufacturers. It is unknown whether the composition of these media changes during storage or culture in the IVF laboratory. Without details on the exact concentrations, it is not possible to determine which components might be responsible for the differences in IVF success rates and health of the resulting children. STUDY DESIGN, SIZE, DURATION Between October 2014 and October 2015, all complete human preimplantation embryo culture media, i.e. ready to use for IVF, that were commercially available at that time, were included (n = 15). Osmolality and the concentration of thirty seven components including basic elements, metabolites, immunoglobulins, albumin, proteins and 21 amino acids were tested immediately upon arrival into the IVF laboratory, after three days of culture without embryos (sham culture) starting from the day of arrival, just before the expiry date, and after three days of sham culture just before the expiry date. PARTICIPANTS/MATERIALS, SETTING, METHODS Ions, glucose, immunoglobulins, albumin and the total amount of proteins were quantified using a combination of ion selective electrodes and photometric analysis modules, and lactate, pyruvate and 21 amino acids were analysed by ultra performance liquid chromatography mass spectrometry. Osmolality was analysed by an advanced micro-osmometer. Statistical analysis was done using multivariate general linear models. MAIN RESULTS AND THE ROLE OF CHANCE The composition varied between media, no two media had the same concentration of components. Storage led to significant changes in 17 of the 37 analyzed components (magnesium, chloride, phosphate, albumin, total amount of proteins, tyrosine, tryptophan, alanine, methionine, glycine, leucine, glutamine, asparagine, arginine, serine, proline, and threonine). Storage affected the osmolality in 3 of the 15 media, but for all media combined this effect was not significant (p = 0.08). Sham culture of the analyzed media had a significant effect on the concentrations of 13 of the 37 analyzed components (calcium, phosphate, albumin, total amount of proteins, tyrosine, alanine, methionine, glycine, leucine, asparagine, arginine, proline, and histidine). Sham culture significantly affected the osmolality of the analysed culture media. Two media contained 50% D-lactate, which a toxic dead-end metabolite. In a secondary analysis we detected human liver enzymes in more than half of the complete culture media. LIMITATIONS, REASONS FOR CAUTION The analyzed culture media could contain components that are not among the 37 components that were analyzed in this study. The clinical relevance of the varying concentrations is yet to be determined. WIDER IMPLICATIONS OF THE FINDINGS The presence of D-lactate could be avoided and the finding of human liver enzymes was surprising. The wide variation between culture media shows that the optimal composition is still unknown. This warrants further research as the importance of embryo culture media on the efficacy and safety in IVF is evident. Companies are urged to fully disclose the composition of their culture media, and provide clinical evidence supporting the composition or future changes thereof. STUDY FUNDING/COMPETING INTEREST(S) None.

scholarly journals O4A.5 Night shift work is associated with abnormal liver function

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A33.2-A33
Author(s):  
Lap Ah Tse ◽  
Feng Wang ◽  
Liuzhuo Zhang ◽  
Zhimin Li
Keyword(s):  
Liver Function ◽  
Shift Work ◽  
Night Shift ◽  
Abnormal Liver Function ◽  
Baseline Survey ◽  
Shift Workers ◽  
Night Shift Work ◽  
Logistic Regression Models ◽  
Biochemical Analyzer ◽  
Stratified Analysis

ObjectiveTo examine the relationship between night shift work and elevated level of alanine transaminase (e-ALT) of workers, stratified by status of non-alcohol fatty liver.MethodsWe established a prospective cohort of night shift workers in Shenzhen, China. All 4740 male workers who had liver function data from the baseline survey of this night shift workers’ cohort were included in the current analysis. We collected information on demographics, lifestyles, and lifetime working schedule from standardized questionnaire. We examined workers’ NAFL status using liver sonography and their serum ALT levels using the automatic biochemical analyzer. Unconditional logistic regression models were used to evaluate odds ratios (ORs) and 95% confidence interval (95% CI).ResultsThis cohort contained 39.5% night shift workers. Compared with the day workers, night shift workers had higher odds of e-ALT (OR: 1.18; 95% CI 1.00–1.40). Stratified analysis showed that a positive gradient between night shift years and elevated e-ALT was only restricted to the night shift workers without NAFL. No similar trend was observed among those with NAFL.ConclusionsNight shift work is positively associated with the abnormal liver function in workers without NAFL, which indicates that shift work involving circadian disruption is likely to affect abnormal liver function.[National Natural Science Foundation of China (Project number 81273172 and 81372964), [email protected] (Lap Ah Tse)]

scholarly journals COVID-19 associated variations in liver function parameters: a retrospective study

2020 ◽  
pp. postgradmedj-2020-138930
Author(s):  
Ram Krishan Saini ◽  
Neha Saini ◽  
Sant Ram ◽  
Shiv Lal Soni ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Liver Injury ◽  
Liver Function ◽  
Liver Enzyme ◽  
Inflammatory Markers ◽  
Liver Enzymes ◽  
Tertiary Care ◽  
Abnormal Liver Function ◽  
Gamma Glutamyl Transferase ◽  
Number Of Patients ◽  
Glutamyl Transferase

BackgroundCharacteristics of laboratory findings of COVID-19 patients are of great significance for diagnosis and treatment. Studies that have analysed the variations in hepatic profile in correlation with the inflammatory markers in SARS-CoV-2 are limited.MethodsWe retrospectively analysed liver function tests and inflammatory markers of 170 admitted patients with confirmed COVID-19 in the tertiary care centre, Post Graduate Institute of Medical Education and Research (PGIMER), India, using Roche Cobas Autoanalyzer.ResultsNumber of patients with normal liver enzyme levels were 63 (41.5%), while with raised levels of any of the liver enzymes were 89 (58.5%), out of which 43 (48.31%) had liver injury which manifested as increased severity in terms of intensive care unit (ICU) requirement (p=0.0005). Significantly raised levels of liver enzymes and liver injury were observed with age (p<0.0001) and in males (p=0.004). Significantly decreased levels of albumin and total proteins and increased levels of total bilirubin (p<0.0001) were seen in patients with abnormal liver enzyme levels and liver injury as compared to patients with normal levels. Significant increase in the levels of alanine transaminase and gamma-glutamyl transferase was seen on the 7th day, CRP and ferritin (p<0.0001) peaks were observed on 2nd and 3rd day respectively. A significant positive correlation was found between the levels of these inflammatory markers and liver function parameters.ConclusionsMore than half of patients admitted to the hospital with SARS-CoV-2 infection had an abnormal liver function which was found to be associated with raised levels of inflammatory markers. Significantly higher proportions of patients with abnormal liver function were elderly and males and were at higher risk of progressing to severe disease.

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