Highlights In this meta-analysis of 24 studies with 12882 confirmed COVID-19 patients, we assessed the association of comorbid liver disease, acute liver injury, and elevated liver enzymes with outcomes in COVID-19 hospitalized patients. Overall prevalence of pre-existing chronic liver disease and COVID-19-associated acute liver injury were 2.6% and 26.5%, respectively and elevated AST and ALT were 41.1% and 29.1%, respectively. In our study, COVID-19-associated acute liver injury was having 1.7 folds higher risk of poor outcomes. Elevated AST and ALT were also independently associated with higher odds of poor outcomes. These findings may help in early triage, close monitoring of the occurrence of liver injury, and careful use of drugs which can cause liver toxicity in COVID-19 patients.

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Introduction: Literature reported, 9-17% transient ischemic attack (TIA) patients have a vascular event within 90 days but there is limited data on long term risk involvement of vascular events following TIA. Aim: To identify prevalence and association of cardiovascular diseases (CVD) and cerebrovascular disorders (CeVD) amongst early and late TIA. Methods: We performed a retrospective cross-sectional analysis of Nationwide Inpatient Sample (2016-2017) in adults hospitalizations. Early TIA (primary diagnosis), late TIA (secondary diagnosis-within a year) and vascular events [CVD (AFib, IHD, acute MI angina) and CeVD (AIS, ICeH, SAH)] amongst TIA were identified using ICD 10 CM codes. Prevalence of vascular events were compared amongst patients with TIA and without TIA. Weighted analysis to account for sampling strategy using mix-effect multivariable survey logistic regression was performed to evaluate odds of having vascular events amongst TIA in comparison to non-TIA. Results: Amongst 58,259,589 US hospitalizations, 0.38% and 5.92% patients had early and late TIA, respectively. Patients with late TIA had higher prevalence of acute MI (4.9 vs 0.5 vs 3.4%), IHD (44 vs 28.6 vs 20.6%), angina (0.3 vs 0.2 vs 0.2%), AFib (22 vs 15.3 vs 10.9%), AIS (5.3 vs 0.6 vs 2%), SAH (0.2 vs 0.03 vs 0.1%) and ICeH (0.8 vs 0.04 vs 0.4%) compared to early TIA and no-TIA, respectively. (p<.0001) Patients with late TIA had 23% higher risk of having Afib [aOR 1.23; 95%CI 1.22-1.23] and higher odds of having IHD [1.52; 1.52-1.53], AIS [1.72; 1.70-1.74], and ICeH [1.29; 1.25-1.33]. (Table 1) Conclusion: We found a higher prevalence of late TIA amongst US hospitalizations. Additionally, late TIA patients had a higher risk of vascular events like Afib, IHD, and stroke. Hence, a thorough clinical investigation and long term followup of TIA patients may mitigate the risk of future vascular events and associated health care burden.

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Background and Objective: Few small observational studies have described various therapeutic interventions utilized in coronavirus disease 2019 (COVID-19) patients based on single/multi-center experiences across the globe. Understanding the utilization of available and possible treatments to curb the COVID-19 pandemic is paramount. We aimed to identify the prevalence and disease-associated utilization of specific therapeutic reagents in hospitalized COVID-19 patients as a function of severity status. Methods: In systematic review and meta-analysis, extracted data on treatments utilized and severity of COVID-19 hospitalized patients from observational studies using PRISMA guidelines from December 1, 2019 to August 20, 2020. The pooled prevalence and odds of treatment utilization were obtained, and created forest plots using random‐effects models. Results: 29 studies with 8570 COVID-19-positive patients were included. Higher odds of the utilization of steroids (pooled OR:4.47; 95%CI:3.18–6.28; p<0.00001), antibiotics (3.1;1.81–5.30; p<0.0001), and IV Immunoglobulin (IVIG) (3.76;2.11–6.72; p<0.00001) was observed in patients with severe disease. No association of remdesivir (initially administered via clinical trials and subsequently FDA-approved during this study period), lopinavir/ritonavir, or hydroxychloroquine (HCQ) treatment with the severity of disease was observed. Conclusion: Higher utilization of steroids, lopinavir/ritonavir, antibiotics, hydroxychloroquine (HCQ), and IV Immunoglobulin (IVIG) was observed in severe COVID-19 patients. Due to limited studies on remdesivir, its accurate utilization could not be delineated. Currently, no Level A evidence favoring single-drug treatment for COVID-19 exists, and trials are needed of combination therapy to evaluate efficacy on the survival outcome.