Liver disease and outcomes among COVID-19 hospitalized patients - A systematic review and meta-analysis.

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 12,882 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 (pooled OR: 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.

• Authors: Ashish Sharma, Pragya Jaiswal, Yasameen Kerakhan, Lakshmi Saravanan, Zeba Murtaza, Azka Zergham, Nagaraj-Sanchitha Honganur, Aelia Akbar, Aran Deol, Benedict Francis, Shakumar Patel, Deep Mehta, Richa Jaiswal, Jagmeet Singh, Urvish Patel, Preeti Malik
• Journal: Annals of hepatology (Ann Hepatol) 2021 Mar-Apr Vol. 21 Pg. 100273 ISSN: 1665-2681 [Print] Mexico
• PMID: 33075578 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2020 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

Topics

• COVID-19 (epidemiology)
• Comorbidity
• Global Health
• Hospital Mortality (trends)
• Humans
• Intensive Care Units (trends)
• Liver Diseases (epidemiology)
• Pandemics
• Prevalence
• SARS-CoV-2