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Meta-Analysis
. 2020 Nov-Dec;19(6):627-634.
doi: 10.1016/j.aohep.2020.08.064. Epub 2020 Aug 31.

A systematic review and meta-analysis of the COVID-19 associated liver injury

Yu Jun Wong  1 , Malcolm Tan  2 , Qishi Zheng  3 , James Weiquan Li  2 , Rahul Kumar  4 , Kwong Ming Fock  5 , Eng Kiong Teo  2 , Tiing Leong Ang  2
Affiliations
Meta-Analysis

A systematic review and meta-analysis of the COVID-19 associated liver injury

Yu Jun Wong et al. Ann Hepatol. 2020 Nov-Dec.

Abstract

Introduction and objectives: The novel coronavirus disease 2019 (COVID-19) has affected more than 5 million people globally. Data on the prevalence and degree of COVID-19 associated liver injury among patients with COVID-19 remain limited. We conducted a systematic review and meta-analysis to assess the prevalence and degree of liver injury between patients with severe and non-severe COVID-19.

Methods: We performed a systematic search of three electronic databases (PubMed/MEDLINE, EMBASE and Cochrane Library), from inception to 24th April 2020. We included all adult human studies (>20 subjects) regardless of language, region or publication date or status. We assessed the pooled odds ratio (OR), mean difference (MD) and 95% confidence interval (95%CI) using the random-effects model.

Results: Among 1543 citations, there were 24 studies (5961 subjects) which fulfilled our inclusion criteria. The pooled odds ratio for elevated ALT (OR = 2.5, 95%CI: 1.6-3.7, I2 = 57%), AST (OR = 3.4, 95%CI: 2.3-5.0, I2 = 56%), hyperbilirubinemia (OR = 1.7, 95%CI: 1.2-2.5, I2 = 0%) and hypoalbuminemia (OR = 7.1, 95%CI: 2.1-24.1, I2 = 71%) were higher subjects in critical COVID-19.

Conclusion: COVID-19 associated liver injury is more common in severe COVID-19 than non-severe COVID-19. Physicians should be aware of possible progression to severe disease in subjects with COVID-19-associated liver injury.

Keywords: Alanine Transaminase; Aspartate Aminotransferases; Liver Disease; SARS-CoV-2 infection.

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Figures

Fig. 1
Fig. 1
PRISMA Flowchart.
Fig. 2
Fig. 2
Pooled odds for ALT elevation in critical COVID-19.
Fig. 3
Fig. 3
Pooled odds for AST elevation in critical COVID-19.
Fig. 4
Fig. 4
Pooled odds for hyperbilirubinemia in critical COVID-19.
Fig. 5
Fig. 5
Funnel plot.
See this image and copyright information in PMC

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