tetano
Editor, Senior Moderator
Ann Hepatol
. 2020 Oct 16;S1665-2681(20)30188-5.
doi: 10.1016/j.aohep.2020.10.001. Online ahead of print.
Liver disease and outcomes among COVID-19 hospitalized patients- a systematic review and meta-analysis
Ashish Sharma[SUP] 1 [/SUP], Pragya Jaiswal[SUP] 2 [/SUP], Yasameen Kerakhan[SUP] 3 [/SUP], Lakshmi Saravanan[SUP] 4 [/SUP], Zeba Murtaza[SUP] 5 [/SUP], Azka Zergham[SUP] 6 [/SUP], Nagaraj-Sanchitha Honganur[SUP] 7 [/SUP], Aelia Akbar[SUP] 8 [/SUP], Aran Deol[SUP] 9 [/SUP], Benedict Francis[SUP] 10 [/SUP], Shakumar Patel[SUP] 11 [/SUP], Deep Mehta[SUP] 12 [/SUP], Richa Jaiswal[SUP] 13 [/SUP], Jagmeet Singh[SUP] 14 [/SUP], Urvish Patel[SUP] 15 [/SUP], Preeti Malik[SUP] 16 [/SUP]
Affiliations
Abstract
Introduction and objectives: The coronavirus disease 2019 (COVID-19) pandemic has been a challenge globally. In severe acute respiratory syndrome (SARS) epidemic 60% of patients had hepatic injury, due to phylogenetic similarities of the viruses it is assumed that COVID-19 is associated with acute liver injury. In this meta-analysis, we aim to study the occurrence and association of liver injury, comorbid liver disease and elevated liver enzymes in COVID-19 confirmed hospitalizations with outcomes.
Materials and methods: Data from observational studies describing comorbid chronic liver disease, acute liver injury, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020 was extracted following PRISMA guidelines. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality. Odds ratio (OR) and 95% confidence interval (95%CI) were obtained.
Results: 24 studies with 12882 confirmed COVID-19 patients were included. Overall prevalence of CM-CLD was 2.6%, COVID-19-ALI was 26.5%, elevated AST was 41.1% and elevated ALT was 29.1%. CM-CLD had no significant association with poor outcomes (pooledOR:0.96;95%CI:0.71-1.29; p=0.78). COVID-19-ALI (1.68;1.04-2.70; p=0.03), elevated AST (2.98;2.35-3.77; p<0.00001) and elevated ALT (1.85;1.49-2.29; p<0.00001) were significantly associated with higher odds of poor outcomes.
Conclusion: Our meta-analysis suggests that acute liver injury and elevated liver enzymes were significantly associated with COVID-19 severity. Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19 and causes of liver injury during COVID-19 infection.
Keywords: 2019-nCoV; COVID-19; SARS-CoV-2; acute liver injury; biomarkers; chronic liver disease; coronavirus disease; outcomes.
. 2020 Oct 16;S1665-2681(20)30188-5.
doi: 10.1016/j.aohep.2020.10.001. Online ahead of print.
Liver disease and outcomes among COVID-19 hospitalized patients- a systematic review and meta-analysis
Ashish Sharma[SUP] 1 [/SUP], Pragya Jaiswal[SUP] 2 [/SUP], Yasameen Kerakhan[SUP] 3 [/SUP], Lakshmi Saravanan[SUP] 4 [/SUP], Zeba Murtaza[SUP] 5 [/SUP], Azka Zergham[SUP] 6 [/SUP], Nagaraj-Sanchitha Honganur[SUP] 7 [/SUP], Aelia Akbar[SUP] 8 [/SUP], Aran Deol[SUP] 9 [/SUP], Benedict Francis[SUP] 10 [/SUP], Shakumar Patel[SUP] 11 [/SUP], Deep Mehta[SUP] 12 [/SUP], Richa Jaiswal[SUP] 13 [/SUP], Jagmeet Singh[SUP] 14 [/SUP], Urvish Patel[SUP] 15 [/SUP], Preeti Malik[SUP] 16 [/SUP]
Affiliations
- PMID: 33075578
- PMCID: PMC7566821
- DOI: 10.1016/j.aohep.2020.10.001
Abstract
Introduction and objectives: The coronavirus disease 2019 (COVID-19) pandemic has been a challenge globally. In severe acute respiratory syndrome (SARS) epidemic 60% of patients had hepatic injury, due to phylogenetic similarities of the viruses it is assumed that COVID-19 is associated with acute liver injury. In this meta-analysis, we aim to study the occurrence and association of liver injury, comorbid liver disease and elevated liver enzymes in COVID-19 confirmed hospitalizations with outcomes.
Materials and methods: Data from observational studies describing comorbid chronic liver disease, acute liver injury, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020 was extracted following PRISMA guidelines. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality. Odds ratio (OR) and 95% confidence interval (95%CI) were obtained.
Results: 24 studies with 12882 confirmed COVID-19 patients were included. Overall prevalence of CM-CLD was 2.6%, COVID-19-ALI was 26.5%, elevated AST was 41.1% and elevated ALT was 29.1%. CM-CLD had no significant association with poor outcomes (pooledOR:0.96;95%CI:0.71-1.29; p=0.78). COVID-19-ALI (1.68;1.04-2.70; p=0.03), elevated AST (2.98;2.35-3.77; p<0.00001) and elevated ALT (1.85;1.49-2.29; p<0.00001) were significantly associated with higher odds of poor outcomes.
Conclusion: Our meta-analysis suggests that acute liver injury and elevated liver enzymes were significantly associated with COVID-19 severity. Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19 and causes of liver injury during COVID-19 infection.
Keywords: 2019-nCoV; COVID-19; SARS-CoV-2; acute liver injury; biomarkers; chronic liver disease; coronavirus disease; outcomes.