COVID-19 and liver injury: a meta-analysis

Wijarnpreecha, Karn; Ungprasert, Patompong; Panjawatanan, Panadeekarn; Harnois, Denise M.; Zaver, Himesh; Ahmed, Aijaz; Kim, Dong‐Hee

doi:10.1097/meg.0000000000001817

Cited by 77 publications

(85 citation statements)

References 17 publications

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“… 16 – 18 Moreover, several studies found that SARS-CoV-2 infection was associated with abnormal liver enzymes and liver injury. 20 – 22 In the present study, we described LD among COVID-19 patients. LD was determined by measuring biochemical indexes, such as ALT, AST, DBIL and IBIL, several hepatocellular injury markers, total protein, albumin and globulin (three protein metabolic indexes), and ALP, TBA and γ-GGT (three markers of cholestasis).…”

Section: Discussionmentioning

confidence: 84%

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Liver Dysfunction and Its Association with the Risk of Death in COVID-19 Patients: A Prospective Cohort Study

Fu¹,

Fei²,

Xu³

et al. 2020

Journal of Clinical and Translational Hepatology

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Background and Aims: Coronavirus disease 2019 (COVID-19) is a new respiratory infectious disease caused by severe acute respiratory syndrome coronavirus-2 (commonly known as SARS-CoV-2) with multiple organ injuries. The aim of this study was to analyze COVID-19-associated liver dysfunction (LD), its association with the risk of death and prognosis after discharge. Methods: Three-hundred and fifty-five COVID-19 patients were recruited. Clinical data were collected from electronic medical records. LD was evaluated and its prognosis was tracked. The association between LD and the risk of death was analyzed. Results: Of the 355 COVID-19 patients, 211 had mild disease, 88 had severe disease, and 51 had critically ill disease. On admission, 223 (62.8%) patients presented with hypoproteinemia, 151(42.5%) with cholestasis, and 101 (28.5%) with hepatocellular injury. As expected, LD was more common in critically ill patients. By multivariate logistic regression, male sex, older age and lymphopenia were three important independent risk factors predicting LD among COVID-19 patients. Risk of death analysis showed that the fatality rate was higher in patients with hypoproteinemia than in those without hypoproteinemia (relative risk=9.471, p<0.01). Moreover, the fatality rate was higher in patients with cholestasis than those without cholestasis (relative risk=2.182, p<0.05). Follow-up observation found that more than one hepatic functional index of two-third patients remained abnormal at 14 days after discharge. Conclusions: LD at early disease stage elevates the risk of death of COVID-19 patients. COVID-19-associated LD does not recover completely by 14 days after discharge.

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Section: Discussionmentioning

confidence: 84%

“…19 Liver injury was more popular in the critically ill COVID-19 patients with intensive care unit admission. 20 Nevertheless, the clinical characteristics of COVID-19-associated liver dysfunction (LD) are rarely described. The prognosis of LD of COVID-19 patients remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Liver Dysfunction and Its Association with the Risk of Death in COVID-19 Patients: A Prospective Cohort Study

Fu¹,

Fei²,

Xu³

et al. 2020

Journal of Clinical and Translational Hepatology

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“…Multiple studies have reported a correlation between COVID-19 severity and LFT abnormalities, with elevated aminotransaminase levels being more frequent in ICU inpatients, and patients requiring ventilation (27)(28)(29). The pattern of liver injury is typically hepatocellular rather than cholestatic (30,31). The aspartate aminotransferase (AST) levels correlate highly with alanine aminotransferase (ALT) levels throughout the course of the illness suggesting a hepatocellular origin (32).…”

Section: Prevalence and Manifestations Of Liver Injury In Covid-19mentioning

confidence: 99%

Liver Disease and Coronavirus Disease 2019: From Pathogenesis to Clinical Care

et al. 2021

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Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus that emerged in late 2019, is posing an unprecedented challenge to global health. Coronavirus disease 2019 (COVID-19), the clinical disease caused by SARS-CoV-2, has a variable presentation ranging from asymptomatic infection to life-threatening acute respiratory distress syndrome and multiorgan failure. Liver involvement is common during COVID-19 and exhibits a spectrum of clinical manifestations from asymptomatic elevations of liver function tests to hepatic decompensation. The presence of abnormal liver tests has been associated with a more severe presentation of COVID-19 disease and overall mortality. Although SARS-CoV-2 RNA has been detected in the liver of patients with COVID-19, it remains unclear whether SARS-CoV-2 productively infects and replicates in liver cells and has a direct liver-pathogenic effect. The cause of liver injury in COVID-19 can be attributed to multiple factors, including virus-induced systemic inflammation, hypoxia, hepatic congestion, and drug-induced liver disease. Among patients with cirrhosis, COVID-19 has been associated with hepatic decompensation and liver-related mortality. Additionally, COVID-19's impact on health care resources can adversely affect delivery of care and outcomes of patients with chronic liver disease. Understanding the underlying mechanisms of liver injury during COVID-19 will be important in the management of patients with COVID-19, especially those with advanced liver disease. This review summarizes our current knowledge of SARS-CoV-2 virus-host interactions in the liver as well the clinical impact of liver disease in COVID-19. (Hepatology 2021;74:1088-1100). Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was officially declared a pandemic by the World Health Organization in March 2020. COVID-19 has a variable presentation ranging from an asymptomatic illness to severe pneumonia with acute respiratory distress syndrome, accompanied by multiorgan failure, shock, and severe thromboembolic events. The most common clinical features reported among patients who were symptomatic include fever, dry cough, shortness of breath, anosmia and ageusia, and diarrhea.Coronaviruses are enveloped, positive-sense, singlestranded RNA viruses belonging to the Coronaviridae family, responsible for mild upper respiratory and gastrointestinal tract infections in humans. Two emerging members of the Coronaviridae family were previously demonstrated to pose a major public health threat, namely the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle Eastern respiratory syndrome coronavirus (MERS)-CoV. In December 2019, the first cases of viral pneumonia caused by a novel coronavirus (SARS-CoV-2) was reported. Over the ensuing months, the virus has rapidly spread globally, resulting in over 50 million infected persons and one million deaths, exceeding other major infectious causes of death worldwide.

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“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus that primarily affects the lungs of the human host and that causes, in susceptible individuals, an unrestrained response of the immune system, respiratory failure, cardiovascular system damage, neuropsychiatric manifestations, and multiple organ injuries (1)(2)(3)(4). Since the first outbreak testimony in China at the end of the year 2019, the apparent disease termed coronavirus disease 2019 (COVID-19) had a large-scale spread within a few months.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Severe COVID-19 Patients Admitted to an Intensive Care Unit in Lombardy During the Italian Pandemic

et al. 2021

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Italy was one of the worst affected European countries during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. More than 50% of Italian cases occurred in the northern region of Lombardy, where the saturation of health services between March and April 2020 forced hospitals to allocate patients according to available resources. Eighteen severe coronavirus disease 2019 (COVID-19) patients were admitted to our hospital needing intensive support. Given the disease fatality, we investigated the patients' characteristics to identify mortality predictors. We counted seven deaths from multiple organ failure, two from septic shock, and two from collapsed lungs. The maximum case fatality was observed in patients who contracted SARS-CoV-2 in hospitals. The fatal outcome was associated with the following baseline characteristics: polymorbidity (OR 2.519, p = 0.048), low body mass index (OR 2.288, p = 0.031), low hemoglobin (OR 3.012, p = 0.046), and antithrombin III (OR 1.172, p = 0.048), along with a worsening of PaO2/FiO2 ratio in the first 72 h after admission (OR 1.067, p = 0.031). The occurrence of co-infections during hospitalization was associated with a longer need for intensive care (B = 4.511, p = 0.001). More information is needed to inform intensive care for patients with severe COVID-19, but our findings would certainly contribute to shed some light on this unpredictable and multifaceted disease.

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COVID-19 and liver injury: a meta-analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 77 publications

References 17 publications

Liver Dysfunction and Its Association with the Risk of Death in COVID-19 Patients: A Prospective Cohort Study

Liver Dysfunction and Its Association with the Risk of Death in COVID-19 Patients: A Prospective Cohort Study

Liver Disease and Coronavirus Disease 2019: From Pathogenesis to Clinical Care

Clinical Characteristics of Severe COVID-19 Patients Admitted to an Intensive Care Unit in Lombardy During the Italian Pandemic

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