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

• Published in: Annals of hepatology Vol. 21; p. 100273
• Main Authors: Sharma, Ashish, Jaiswal, Pragya, Kerakhan, Yasameen, Saravanan, Lakshmi, Murtaza, Zeba, Zergham, Azka, Honganur, Nagaraj-Sanchitha, Akbar, Aelia, Deol, Aran, Francis, Benedict, Patel, Shakumar, Mehta, Deep, Jaiswal, Richa, Singh, Jagmeet, Patel, Urvish, Malik, Preeti
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier España, S.L.U 01.03.2021; Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U; Elsevier
• Subjects: 2019-nCoV; Acute liver injury; Biomarkers; Chronic liver disease; Comorbidity; Coronavirus disease; COVID-19; COVID-19 - epidemiology; Gastroenterology and Hepatology; Global Health; Hospital Mortality - trends; Humans; Intensive Care Units - trends; Liver Diseases - epidemiology; Original; Outcomes; Pandemics; Prevalence; SARS-CoV-2; COVID-19; SARS-CoV-2; Coronavirus disease; Biomarkers; 2019-nCoV; Chronic liver disease; Acute liver injury; Outcomes
• ISSN: 1665-2681; 2659-5982; 1665-2681
• DOI: 10.1016/j.aohep.2020.10.001

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. 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. 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. 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.