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. 2020 Jul 22:7:431.
doi: 10.3389/fmed.2020.00431. eCollection 2020.

Serum Activity of Liver Enzymes Is Associated With Higher Mortality in COVID-19: A Systematic Review and Meta-Analysis

Umesha Boregowda  1 , Mark M Aloysius  2 , Abhilash Perisetti  3 , Mahesh Gajendran  4 , Pardeep Bansal  5 , Hemant Goyal  6
Affiliations

Serum Activity of Liver Enzymes Is Associated With Higher Mortality in COVID-19: A Systematic Review and Meta-Analysis

Umesha Boregowda et al. Front Med (Lausanne). .

Abstract

Background: Abnormal liver chemistries are common findings in patients with COVID-19. It is unclear whether abnormal liver chemistries can predict the severity of COVID-19. Therefore, we compared the serum liver chemistries such as hepatic transaminases, total bilirubin, albumin, and prothrombin time to evaluate whether they can predict severity and mortality in COVID-19. Methods: An electronic search was performed on PubMed/Medline, EMBASE, and Google Scholar for studies comparing liver chemistries in severe and mild COVID-19. The literature search was performed using keywords "COVID-19," "Liver," Aspartate Aminotransferase (AST)," and "Alanine Aminotransferase (ALT)," "AST," and "ALT," in various combinations of "AND/OR" from December 1, 2019, till May 8, 2020. The pooled weighted mean difference (WMD) and 95% confidence interval (CI) were calculated for each component of liver chemistries. Results: Twenty-two studies were eligible, with 3,256 patients (54.57% males). Seventeen studies compared liver chemistries for severe vs. mild COVID-19, whereas five studies compared liver chemistries in survival vs. non-survival groups. The pooled WMD of AST and ALT in severe vs. mild COVID-19 were 12.23 (95% CI; 8.07, 16.39; p < 0.01) and 8.07 (95% CI 2.55, 11.91; p < 0.01), respectively. The pooled WMD for AST in survivors vs. non-survivors analysis was 8.82 (n = 789; 95% CI; 2.27, 15.37; p < 0.01) and that of ALT was 4.70 (n = 340; 95% CI 0.04,9.35; p = 0.05). Conclusion: Our meta-analysis shows that deranged liver chemistries may indicate severe COVID-19 and could also predict mortality. Larger studies are needed to evaluate the relationship between derangement in liver chemistries and mortality in COVID-19.

Keywords: COVID-19; LFT; SARS-CoV-2; coronavirus; liver chemistries; liver tests.

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Figures

Figure 1
Figure 1
Flow chart of selecting eligible studies for the meta-analysis.
Figure 2
Figure 2
Forest plot for the pooled weighted mean difference of AST in mild vs. severe COVID-19.
Figure 3
Figure 3
Forest plot for the pooled weighted mean difference of ALT in mild vs. severe COVID-19.
Figure 4
Figure 4
Forest plot for the pooled weighted mean difference of Albumin in mild vs. severe COVID-19.
See this image and copyright information in PMC

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