From the Guidelines
Yes, there is a link between influenza and hepatotoxicity.
Hepatotoxicity Associated with Influenza
- Influenza A, including avian influenza A (H5N1), has been associated with deranged liver function tests, indicating potential hepatotoxicity 1.
- The clinical features of influenza A (H5N1) infection in humans include gastrointestinal symptoms, lymphopenia, thrombocytopenia, and deranged liver function tests, which can progress to renal failure and multi-organ failure 1.
- A study published in the Journal of Hepatology in 2023 lists influenza A and B as potential precipitants of acute-on-chronic liver failure, with mild elevations of AST and/or ALT, and positive PCR in respiratory samples 1.
- The presence of lymphopenia and deranged liver function tests in patients with influenza A (H5N1) infection has been associated with a poorer prognosis 1.
Clinical Management
- Early antiviral treatment can reduce the risk of complications from influenza, including hepatotoxicity, and is recommended for patients with confirmed or suspected influenza who are at higher risk for complications, including those with underlying hepatic disorders 1.
- The treatment of influenza with antiviral medications, such as neuraminidase inhibitors, can help alleviate symptoms and prevent progression to severe disease, including hepatotoxicity 1.
From the Research
Influenza and Hepatotoxicity
- There is evidence to suggest a link between influenza and hepatotoxicity, with studies showing that abnormal liver tests are common in patients with severe influenza infection 2, 3, 4, 5, 6.
- A retrospective cohort study found that abnormal liver tests were associated with worse outcomes in patients with influenza, including death 2.
- Another study found that serum levels of liver enzymes were significantly higher in patients with pandemic influenza compared to seasonal influenza, and were correlated with hypoxia 3.
- A case report described a patient who developed acute liver failure associated with influenza A virus infection, with autopsy findings showing extensive centrilobular hepatocyte necrosis 6.
- Influenza infection can cause hepatic decompensation and hospitalization in patients with cirrhosis or those awaiting liver transplantation 4.
- The mechanism of influenza-associated hepatitis is thought to involve the formation of inflammatory foci, including apoptotic hepatocytes, antigen-specific CD8(+) T cells, and Kupffer cells, with no virus detected in the liver 5.
Key Findings
- Abnormal liver tests are common in patients with severe influenza infection 2, 3.
- Influenza infection can cause hepatic decompensation and hospitalization in patients with cirrhosis or those awaiting liver transplantation 4.
- The mechanism of influenza-associated hepatitis involves the formation of inflammatory foci, including apoptotic hepatocytes, antigen-specific CD8(+) T cells, and Kupffer cells 5.
- Hypoxic hepatitis can be an important causative factor for acute liver failure associated with influenza virus infection 6.