Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Sep;14(5):612-620.
doi: 10.1007/s12072-020-10078-2. Epub 2020 Jul 28.

Prevalence of chronic liver disease in patients with COVID-19 and their clinical outcomes: a systematic review and meta-analysis

Affiliations
Meta-Analysis

Prevalence of chronic liver disease in patients with COVID-19 and their clinical outcomes: a systematic review and meta-analysis

Alexander J Kovalic et al. Hepatol Int. 2020 Sep.

Abstract

Abnormal liver enzymes are seen in 20% of hospitalized patients with COVID-19. The etiology of elevated liver enzymes is thought to be multifactorial including medications and underlying liver disease. The true prevalence and clinical significance of underlying chronic liver diseases (CLD) in COVID-19 remains poorly defined. In this systematic review and meta-analysis, we included 74 clinical studies that were identified after a thorough literature search across three databases. The prevalence of CLD patients (73 studies, 24,299 patients) was 3% among all COVID-19 patients. The prevalence of CLD patients was similar in COVID-19 positive and negative population (pooled OR 0.79 [95% CI 0.60, 1.05], p = 0.10). The presence of CLD was significantly associated with more severe COVID-19 infection (pooled OR 1.48 [95% CI 1.17, 1.87], p = 0.001) and overall mortality (pooled OR 1.78 [95% CI 1.09, 2.93], p = 0.02). Additionally, there was a non-significant trend noted for increased ICU admissions and need for invasive mechanical ventilation among COVID-19 patients with CLD. To date, the clinical importance of chronic liver diseases among COVID-19 infection has remained undefined. In this novel systematic review and meta-analysis, the presence of underlying chronic liver disease was significantly associated with more severe COVID-19 infections and mortality.

Keywords: COVID-19; Chronic liver disease; Cirrhosis; Coronavirus; Critical; ICU; Liver; Mechanical ventilation; Mortality; Severe.

PubMed Disclaimer

Conflict of interest statement

Alexander J. Kovalic, Sanjaya K. Satapathy and Paul J. Thuluvath authors have no conflict of interest to disclose in the writing of this manuscript.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Forest plot comparison of patients with underlying chronic liver disease among COVID-19 positive versus COVID-19 negative patients
Fig. 3
Fig. 3
Forest plot comparison of severity of illness [3.1.1] and mortality [3.1.2] among COVID-19 positive patients with versus without chronic liver diseases
Fig. 4
Fig. 4
Forest plot comparison of ICU admissions [4.1.1] and rates of invasive mechanical ventilation [4.1.2] among COVID-19 positive patients with versus without chronic liver diseases

References

    1. Sultan S, Altayar O, Siddique SM, Davitkov P, Feuerstein JD, Lim JK, Falck-Ytter Y, et al. 7 on behalf of the AGA. AGA institute rapid review of the GI and liver manifestations of COVID-19, meta analysis of international data, and recommendations for the consultative management of patients with COVID-19. Gastroenterology. 2020 doi: 10.1053/j.gastro.2020.05.001. - DOI - PMC - PubMed
    1. Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, Li Z, et al. COVID-19: abnormal liver function tests. J Hepatol. 2020 doi: 10.1016/j.jhep.2020.04.006. - DOI - PMC - PubMed
    1. Mao R, Liang J, Shen J, Ghosh S, Zhu LR, Yang H, Wu KH, et al. On behalf og Chinese Society of IBD. Implications of COVID-19 for patients with pre-existing digestive diseases. Lancet Gastroenterol Hepatol. 2020;5(5):425–427. doi: 10.1016/S2468-1253(20)30076-5. - DOI - PMC - PubMed
    1. Gandhi RT, Lynch JB, Del Rio C. Mild or moderate covid-19. N Engl J Med. 2020 doi: 10.1056/NEJMcp2009249. - DOI - PubMed
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized With COVID-19 in the New York city area. JAMA. 2020 doi: 10.1001/jama.2020.6775. - DOI - PMC - PubMed

MeSH terms