Increased inflammatory markers correlate with liver damage and predict severe COVID-19: a systematic review and meta-analysis
Gastroenterology and Hepatology from Bed to Bench,
20 September 2020
Aim: We aim here to seek whether or not patients with elevated CRP, TNF-a and IL-6 levels may be at increased chance of the severe type and liver damage of COVID-19.
Background: The COVID-19 outbreak is a serious health problem to human beings. However, the evidence has suggested that inflammatory markers related to liver damage increase in severe forms of COVID-19 compared to mild cases.
Methods: The electronic databases were comprehensively searched using ISI Web of Science, EMBASE, and Cochrane Library up to May 2020. Data from each study were combined using the random-effects model, to estimate standardized mean difference (SMD) and 95% confidence intervals (95% CIs). Sensitivity analysis and publication bias were also calculated.
Results: Totally 23 studies were included in this meta-analysis comprising of 4313 patients
with COVID-19. Random-effects results demonstrated that patients with COVID-19 in
severe group had significantly higher levels of CRP [SMD = 3.26 mg/L; (95% CI 2.5, 3.9); P<0.05; I2 = 98.02%; P Heterogeneity = 0.00], TNF-a [SMD = 1.78 ng/mL; (95% CI 0.39, 3.1); P=0.012; I2 = 98.2%; P Heterogeneity = 0.00] and IL-6 [ SMD = 3.67 ng/mL; (95% CI 2.4, 4.8); P<0.05; I2 = 97.8%; P Heterogeneity = 0.00] compared to with those in mild group. Significant heterogeneity was present. No significant publication bias was observed in the meta-analysis. Sensitivity analyses showed a similar effect size while reducing the heterogeneity.
Conclusion: These data suggest that enhanced inflammation may be associated with COVID-19-related liver damage, possibly involving inflammatory markers related mechanisms.
- Inflammatory markers
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