Liver involvement during influenza infection: perspective on the 2009 influenza pandemic

Abstract

Elevation of liver transaminase levels is a frequent observation during systemic infections. The aim of our study was to investigate liver damage during pandemic 2009 influenza A/H1N1 infection in comparison with seasonal influenza. Serum levels of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase (GGT) were significantly higher in patients with pandemic influenza compared to seasonal influenza, which was strongly correlated with hypoxia. Moreover, a positive correlation between C-reactive protein and serum GGT, alkaline phosphatase, and lactate dehydrogenase was noticed. Our findings support the hypothesis that the pandemic 2009 influenza A/H1N1 is an illness with a significant immune response to infection leading to hepatocellular injury.

Figure 1

(A, B) Correlation between liver enzymes and peripheral oxygen saturation in pandemic 2009 influenza A/H1N1 and seasonal influenza, respectively. (C, D) Correlation between C‐reactive protein and liver enzymes in pandemic 2009 influenza A (H1N1) and seasonal influenza, respectively. Pearson’s r value and P‐value were presented. P < 0·05 is considered significant. AST, Aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma‐glutamyl transpeptidase; ALP, alkaline phosphatase; LDH, lactate dehydrogenase; BIL, total bilirubin; CRP, C‐reactive protein; SpO2, pulse oximeter oxygen saturation.