Positive association between severity of COVID-19 infection and liver injury: a systematic review and meta-Analysis COVID-19 Infection and Liver Injury
Gastroenterology and Hepatology from Bed to Bench,
20 September 2020
Aim: Current study aimed to report a pooled analysis of the association of the circulating levels of liver enzymes and total bilirubin with severe and non-severe COVID-19.
Background: The ongoing novel coronavirus outbreak is an important threat to health worldwide. Epidemiological data representing greater risk of liver failure in patients infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).
Methods: Electronic databases were comprehensively searched using Medline, ISI Web of Science, EMBASE and Cochrane Library up to July 2020. Outcomes from each relevant study were pooled using random-effects model. Heterogeneity was analysed by Q test and I2 statistics. Sensitivity analysis was also evaluated.
Results: A total of 24 studies were included (4,246 patients). We found a significant association of COVID-19 severity with increased levels of ALT [SMD: 1.40 U/L; 95% CI (0.93, 1.88); P<0.05, I2=96.5%, PHeterogenity= 0.000 ], AST [SMD: 2.11 U/L; 95% CI (1.40, 2.83); P<0.05, I2 = 97.9%, PHeterogenity= 0.000], LDH [SMD: 3.88 U/L; 95% CI (2.70, 5); P<0.05, I2 = 98.7%, PHeterogenity= 0.000] and TBil [SMD: 1.08 mmol/L ; 95% CI (0.44, 1.72); P = 0.001, I2=97.7, PHeterogenity= 0.000], whereas, ALP values [SMD: 0.31; 95% CI (-1.57, 2.20); P = 0.74] was not significant between severe and non-severe COVID-19 patients. Moreover, elevated liver enzymes were found in males [OR: 1.52, (95% CI 1.26, 1.83), P<0.05] with severe COVID-19 infection than females.
Conclusion: The alterations of liver function indexes caused by SARS-CoV-2 infection, suggested as potential prognosis biomarkers for screening of severe patients at early stages of disease.
- COVID-19, Coronavirus, Liver injury, Liver enzymes, Meta-analysis
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