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Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis.
Hepatol Int. 2020 Sep; 14(5):621-637.HI

Abstract

BACKGROUND AND AIMS

Coronavirus disease 2019 (COVID-19) pandemic is ongoing. Except for lung injury, it is possible that COVID-19 patients develop liver injury. Thus, we conducted a systematic review and meta-analysis to explore the incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients.

METHODS

PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases were searched. The incidence of abnormal liver biochemical tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and albumin (ALB), was pooled. Risk ratio (RR) was calculated to explore the association of abnormal liver biochemical tests with severity and prognosis of COVID-19 patients.

RESULTS

Forty-five studies were included. The pooled incidence of any abnormal liver biochemical indicator at admission and during hospitalization was 27.2% and 36%, respectively. Among the abnormal liver biochemical indicators observed at admission, abnormal ALB was the most common, followed by GGT, AST, ALT, TBIL, and ALP (39.8%, 35.8%, 21.8%, 20.4%, 8.8%, and 4.7%). Among the abnormal liver biochemical indicators observed during hospitalization, abnormal ALT was more common than AST and TBIL (38.4%, 28.1%, and 23.2%). Severe and/or critical patients had a significantly higher pooled incidence of abnormal liver biochemical indicators at admission than mild and/or moderate patients. Non-survivors had a significantly higher incidence of abnormal liver biochemical indicators than survivors (RR = 1.34, p = 0.04).

CONCLUSIONS

Abnormal liver biochemical tests are common in COVID-19 patients. Liver biochemical indicators are closely related to the severity and prognosis of COVID-19 patients.

Authors+Show Affiliations

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China. Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China.Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada.Liver Research Unit Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.Department of Surgical Sciences, Sapienza University of Rome, 00161, Rome, Italy.Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Hanau, Germany.Faculdade de Medicina de Botucatu, UNESP, Campus de Botucatu, Botucatu, Brazil.Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Parel, Mumbai, India.Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China. xingshunqi@126.com.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32710250

Citation

Wu, Yanyan, et al. "Incidence, Risk Factors, and Prognosis of Abnormal Liver Biochemical Tests in COVID-19 Patients: a Systematic Review and Meta-analysis." Hepatology International, vol. 14, no. 5, 2020, pp. 621-637.
Wu Y, Li H, Guo X, et al. Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis. Hepatol Int. 2020;14(5):621-637.
Wu, Y., Li, H., Guo, X., Yoshida, E. M., Mendez-Sanchez, N., Levi Sandri, G. B., Teschke, R., Romeiro, F. G., Shukla, A., & Qi, X. (2020). Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis. Hepatology International, 14(5), 621-637. https://doi.org/10.1007/s12072-020-10074-6
Wu Y, et al. Incidence, Risk Factors, and Prognosis of Abnormal Liver Biochemical Tests in COVID-19 Patients: a Systematic Review and Meta-analysis. Hepatol Int. 2020;14(5):621-637. PubMed PMID: 32710250.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis. AU - Wu,Yanyan, AU - Li,Hongyu, AU - Guo,Xiaozhong, AU - Yoshida,Eric M, AU - Mendez-Sanchez,Nahum, AU - Levi Sandri,Giovanni Battista, AU - Teschke,Rolf, AU - Romeiro,Fernando Gomes, AU - Shukla,Akash, AU - Qi,Xingshun, Y1 - 2020/07/24/ PY - 2020/05/06/received PY - 2020/07/09/accepted PY - 2020/7/28/pubmed PY - 2020/10/31/medline PY - 2020/7/26/entrez KW - COVID-19 KW - Hepatic KW - Incidence KW - Liver KW - Risk KW - SARS-CoV-2 SP - 621 EP - 637 JF - Hepatology international JO - Hepatol Int VL - 14 IS - 5 N2 - BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) pandemic is ongoing. Except for lung injury, it is possible that COVID-19 patients develop liver injury. Thus, we conducted a systematic review and meta-analysis to explore the incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients. METHODS: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases were searched. The incidence of abnormal liver biochemical tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and albumin (ALB), was pooled. Risk ratio (RR) was calculated to explore the association of abnormal liver biochemical tests with severity and prognosis of COVID-19 patients. RESULTS: Forty-five studies were included. The pooled incidence of any abnormal liver biochemical indicator at admission and during hospitalization was 27.2% and 36%, respectively. Among the abnormal liver biochemical indicators observed at admission, abnormal ALB was the most common, followed by GGT, AST, ALT, TBIL, and ALP (39.8%, 35.8%, 21.8%, 20.4%, 8.8%, and 4.7%). Among the abnormal liver biochemical indicators observed during hospitalization, abnormal ALT was more common than AST and TBIL (38.4%, 28.1%, and 23.2%). Severe and/or critical patients had a significantly higher pooled incidence of abnormal liver biochemical indicators at admission than mild and/or moderate patients. Non-survivors had a significantly higher incidence of abnormal liver biochemical indicators than survivors (RR = 1.34, p = 0.04). CONCLUSIONS: Abnormal liver biochemical tests are common in COVID-19 patients. Liver biochemical indicators are closely related to the severity and prognosis of COVID-19 patients. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/32710250/Incidence_risk_factors_and_prognosis_of_abnormal_liver_biochemical_tests_in_COVID_19_patients:_a_systematic_review_and_meta_analysis_ L2 - https://dx.doi.org/10.1007/s12072-020-10074-6 DB - PRIME DP - Unbound Medicine ER -