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    Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
    (Lippincott Williams & Wilkins, 2022) Efe, Cumali; Kulkarni, Anand V.; Terziroli Beretta-Piccoli, Benedetta; Magro, Bianca; Friedrich Staettermayer, Albert; Cengiz, Mustafa; Clayton-Chubb, Daniel
    Background and Aims A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. Approach and Results We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. Conclusions SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.
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    Noninvasive assesment in differentiating benign and malign pancreatic lesions with endosonographic elastography score and strain ratio
    (2020) Utku, Özlem Gül; Ergül, Bilal; Karatay, Eylem; Efe, Cumali; Turhan, Nesrin; Oğuz, Dilek
    Background: We aimed to evaluate the diagnostic capability of endoscopic ultrasound elastography (EUS-EG) score and strain ratio (SR) for differentiating benign pancreatic lesions from the malign lesions Material and Method: We retrospectively evaluated well collected data of patients who undergone EUS-EG in a single center during the period of January 2016-June 2019. Patients who had pancreatic disorders were further evaluated for the study. The final diagnosis of solid pancreatic lesions (SPL) was made by histopathologic examination. Control group consisted of patients with chronic pancreatitis (CP) who diagnosed according to Rosemont criteria. Elastography was evaluated by a qualitative (elastography scores) and a quantitative method SR. Results: A total of 66 patients (42 (63.6%)female/24(63.6%)male) with mean age of 58.88±15.32 (19- 80) were included in the study. Thirty-eight patients had SLP, remain 28 patients were CP. In SPL group, 32 (84.2%) had adenocarcinomas and 6 (15.8%) had neuroendocrine tumors. Among 28 patients with benign pancreatic lesions, 23 (82.1%) had CP while five (17.9%) had autoimmune pancreatitis. Median SR values were significantly higher in patients with SPL than those with CP (44.0 (10.0-110.0) vs 7.0 (2.6- 14.6), p<0.001). Elasticity scores were also significantly different between patients with SLP and CP (p<0.001). Elasticity scores were significantly different between adenocarcinomas and CP (p<0.001). A 14 cut-off value of SR had 97% sensitive and 100% specificity for SPL and receiver-operating characteristic curves showed an area under the curve of 0.99.6. Likelihood Ratio test revealed that SR appears as the best parameter in discrimination of lesion type either as benign or malignant (X2 = 54.031, p<0.001). Conclusion: Our study suggested that EUS-elastography and SR scores are highly effective in differentiating malign-benign pancreatitis lesions.