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Meta-Analysis
. 2020 Aug;52(4):584-599.
doi: 10.1111/apt.15916. Epub 2020 Jul 8.

Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19

Anand V Kulkarni  1 , Pramod Kumar  1 , Harsh Vardhan Tevethia  2 , Madhumita Premkumar  3 , Juan Pablo Arab  4 , Roberto Candia  4 , Rupjyoti Talukdar  2 , Mithun Sharma  1 , Xiaolong Qi  5 , Padaki Nagaraja Rao  1 , Duvvuru Nageshwar Reddy  2
Affiliations
Meta-Analysis

Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19

Anand V Kulkarni et al. Aliment Pharmacol Ther. 2020 Aug.

Abstract

Background: The incidence of elevated liver chemistries and the presence of pre-existing chronic liver disease (CLD) have been variably reported in COVID-19.

Aims: To assess the prevalence of CLD, the incidence of elevated liver chemistries and the outcomes of patients with and without underlying CLD/elevated liver chemistries in COVID-19.

Methods: A comprehensive search of electronic databases from 1 December 2019 to 24 April 2020 was done. We included studies reporting underlying CLD or elevated liver chemistries and patient outcomes in COVID-19.

Results: 107 articles (n = 20 874 patients) were included for the systematic review. The pooled prevalence of underlying CLD was 3.6% (95% CI, 2.5-5.1) among the 15 407 COVID-19 patients. The pooled incidence of elevated liver chemistries in COVID-19 was 23.1% (19.3-27.3) at initial presentation. Additionally, 24.4% (13.5-40) developed elevated liver chemistries during the illness. The pooled incidence of drug-induced liver injury was 25.4% (14.2-41.4). The pooled prevalence of CLD among 1587 severely infected patients was 3.9% (3%-5.2%). The odds of developing severe COVID-19 in CLD patients was 0.81 (0.31-2.09; P = 0.67) compared to non-CLD patients. COVID-19 patients with elevated liver chemistries had increased risk of mortality (OR-3.46 [2.42-4.95, P < 0.001]) and severe disease (OR-2.87 [95% CI, 2.29-3.6, P < 0.001]) compared to patients without elevated liver chemistries.

Conclusions: Elevated liver chemistries are common at presentation and during COVID-19. The severity of elevated liver chemistries correlates with the outcome of COVID-19. The presence of CLD does not alter the outcome of COVID-19. Further studies are needed to analyse the outcomes of compensated and decompensated liver disease.

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Figures

FIGURE 1
FIGURE 1
Flowchart depicting the articles screened, excluded and included for the systematic review
FIGURE 2
FIGURE 2
Countries from which studies were analysed. The number of studies and number of patients from each country in the table
FIGURE 3
FIGURE 3
Pooled prevalence of liver disease in COVID‐19 patients
FIGURE 4
FIGURE 4
Pooled incidence of elevated liver chemistries at initial presentation in COVID‐19 patients
FIGURE 5
FIGURE 5
Funnel plot of the studies included for (A) prevalence of chronic liver disease (B) incidence of elevated liver chemistries at initial presentation (C) incidence of elevated liver chemistries during the illness (D) incidence of drug‐induced liver injury
See this image and copyright information in PMC

Comment in

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