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Meta-Analysis
. 2021 Apr;73(4):1521-1530.
doi: 10.1002/hep.31472.

Elevated Liver Biochemistries in Hospitalized Chinese Patients With Severe COVID-19: Systematic Review and Meta-analysis

Alexander J Kovalic  1 , Glen Huang  2 , Paul J Thuluvath  3   4 , Sanjaya K Satapathy  5
Affiliations
Meta-Analysis

Elevated Liver Biochemistries in Hospitalized Chinese Patients With Severe COVID-19: Systematic Review and Meta-analysis

Alexander J Kovalic et al. Hepatology. 2021 Apr.

Abstract

Background and aims: Several recent studies have reported an abnormal liver chemistry profile among patients with coronavirus disease 2019 (COVID-19), although its clinical significance remains unknown.

Approach and results: This systematic review and meta-analysis identified six studies of 586 patients delineating liver chemistries among patients with severe/critical illness versus mild cases of COVID-19 infection. Patients with severe/critical illness with COVID-19 infection have increased prevalence of coronary artery disease, cerebrovascular disease, and chronic obstructive pulmonary disease as compared with mild cases. A significant association between severe/critical COVID-19 infections with elevations in aspartate aminotransferase (pooled mean difference [MD], 11.70 U/L; 95% confidence interval [CI], 2.97, 20.43; P = 0.009), elevated total bilirubin (pooled MD, 0.14 mg/dL; 95% CI, 0.06, 0.22; P = 0.0005), and decreased albumin (pooled MD, -0.68 g/L; 95% CI, -0.81, -0.55; P < 0.00001) was noted. There was also a trend toward elevated alanine aminotransferase levels among these severe cases (pooled MD, 8.84 U/L; 95% CI, -2.28, 19.97; P = 0.12); however, this did not reach statistical significance. More severe/critically ill cases were associated with leukocytosis, neutrophilia, lymphopenia, elevated creatinine kinase, elevated lactate dehydrogenase (LDH), and elevated prothrombin time (PT).

Conclusions: Comorbidities, including coronary artery disease, cerebrovascular disease and chronic obstructive pulmonary disease, are more prevalent in hospitalized Chinese patients with severe/critical illness from COVID-19, and these patients are more likely to manifest with abnormal liver chemistries. Further prospective studies are crucial to understand the pathophysiologic mechanisms underlying the hepatic manifestations of the novel COVID-19 infection and its clinical significance.

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Figures

Fig. 1
Fig. 1
Study flow diagram.
Fig. 2
Fig. 2
Forest plot comparison of demographic data with respect to gender, hypertension, diabetes mellitus, coronary artery disease, and cerebrovascular disease [Figure 2A] as well as smoking, chronic obstructive pulmonary disease, chronic liver disease, chronic kidney disease, malignancy, and ACEi/ARB treatment [Figure 2B] among patients with severe/critical illness versus mild COVID‐19 infection.
Fig. 3
Fig. 3
Forest plot comparison of liver chemistries among patients with severe/critical illness versus mild COVID‐19 infection. Abbreviation; IV, inverse variance.
Fig. 4
Fig. 4
Forest plot comparison of mortality reported among patients with severe/critical illness versus mild COVID‐19 infection.
See this image and copyright information in PMC

Comment in

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