Sorbitol Dehydrogenase and Other Liver Enzymes Before and After Five Days Remdesivir Therapy in Covid-19 Patients

The antiviral remdesivir has the potential to cause drug-induced liver injury in Covid-19 patients as seen in increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Sorbitol dehydrogenase (SDH) is a cytoplasmic liver enzyme and can increase in acute liver injury, so it has been proposed as an alternative biomarker in liver injury. This study aimed to analyze the differences in serum SDH levels and other liver enzymes before and after 5 days of remdesivir therapy in Covid-19 patients. This was a prospective observational cohort conducted at RSUD Dr. Soetomo Surabaya, East Java between September and November 2022. The samples included in this study were selected consecutively. The venous blood sample were collected twice from each patient of 34 Covid-19 patients with positive real-time polymerase, namely on the first day of admission before receiving remdesivir therapy and after the fifth day of remdesivir therapy. Venous blood samples are then processed to obtain serum which will be used to measure SDH levels using the sandwich Enzyme-linked immunosorbent assay (ELISA) method and liver enzyme with Alinity-c analyzer. There were 34 subjects, 18 males and 16 females with median ages 56 years old. The median of serum SDH before and after 5 days therapy, respectively, was 0.75 U/L (SD=1.88) and 0.85 U/L (SD=1.32). The median difference of AST, ALT, direct bilirubin, total bilirubin, alkaline phosphatase (ALP), and gamma-glutamil transferase (GGT), respectively, were -3.75 mg/dL, -2 mg/dL, 0.045 mg/dL, 0.05 mg/dL, -3.5 mg/dL, and -1 mg/dL.