Elsevier

Annals of Hepatology

Volume 21, March–April 2021, 100273
Annals of Hepatology

Original article
Liver disease and outcomes among COVID-19 hospitalized patients – A systematic review and meta-analysis

https://doi.org/10.1016/j.aohep.2020.10.001Get rights and content
Under a Creative Commons license
open access

Abstract

Introduction and objectives

The coronavirus disease 2019 (COVID-19) pandemic has been a challenge globally. In severe acute respiratory syndrome (SARS) epidemic 60% of patients had hepatic injury, due to phylogenetic similarities of the viruses it is assumed that COVID-19 is associated with acute liver injury. In this meta-analysis, we aim to study the occurrence and association of liver injury, comorbid liver disease and elevated liver enzymes in COVID-19 confirmed hospitalizations with outcomes.

Materials and methods

Data from observational studies describing comorbid chronic liver disease, acute liver injury, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020 was extracted following PRISMA guidelines. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality. Odds ratio (OR) and 95% confidence interval (95% CI) were obtained.

Results

24 studies with 12,882 confirmed COVID-19 patients were included. Overall prevalence of CM-CLD was 2.6%, COVID-19-ALI was 26.5%, elevated AST was 41.1% and elevated ALT was 29.1%. CM-CLD had no significant association with poor outcomes (pooled OR: 0.96; 95% CI: 0.71–1.29; p = 0.78). COVID-19-ALI (1.68;1.04–2.70; p = 0.03), elevated AST (2.98; 2.35–3.77; p < 0.00001) and elevated ALT (1.85;1.49–2.29; p < 0.00001) were significantly associated with higher odds of poor outcomes.

Conclusion

Our meta-analysis suggests that acute liver injury and elevated liver enzymes were significantly associated with COVID-19 severity. Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19 and causes of liver injury during COVID-19 infection.

Keywords

COVID-19
Coronavirus disease
SARS-CoV-2
2019-nCoV
Outcomes
Chronic liver disease
Acute liver injury
Biomarkers

Cited by (0)

1

Ashish Sharma and Pragya Jaiswal are equally contributing first author.

2

Equally contributed senior authors.