Liver Chemistries in Patients With COVID-19 Who Were Discharged Alive or Died: A Meta-analysis

Abstract

Although abnormal liver chemistries are linked to a higher risk of coronavirus disease 2019 (COVID-19)-related death, liver manifestations may be diverse and even confusing. Thus, we performed a meta-analysis of published liver manifestations and described the liver damage in patients with COVID-19 who died or discharged alive. We searched PubMed, Google Scholar, medRxiv, bioRxiv, the Cochrane Library, Embase, and three Chinese electronic databases through April 22, 2020. We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19, using a fixed or random-effects model. In our meta-analysis of 19 studies, which included a total of 4,103 patients, the pooled mean alanine aminotransferase and aspartate aminotransferase levels were, respectively, 31.7 IU/L and 51.0 IU/L in the patients with COVID-19 who died and 27.7 IU/L and 32.9 IU/L in those discharged alive (both P < 0.0001). Compared with the patients discharged alive, those who died tended to have lower albumin levels but longer prothrombin time and higher international normalized ratio. Conclusion: In this meta-analysis, according to the main clinical outcome of COVID-19, we comprehensively describe three patterns of liver impairment related to COVID-19: hepatocellular injury, cholestasis, and hepatocellular disfunction. The patients who died from COVID-19 tended to have different liver chemistries from those discharged alive. Special caution should be given to the patients with a relatively higher index of liver chemistries. (Hepatology Communications 2020;0:1-12). C oronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a nonsegmented positive-sense RNA virus with an envelope belonging to the family Coronaviridae. The coronavirus is widely distributed in humans and other mammals. In the past 20 years, the coronavirus has caused several localized epidemics and even global pandemics, such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and the ongoing COVID-19 pandemic. Worldwide, the spread and upward trend of COVID-19 have accelerated dramatically. According to the situation report released by the World Health Organization (WHO), as of April 25, 2020, 2,719,897 COVID-19 cases were confirmed globally, with a fatality rate of 6.9%. (1) In response to the emerging threat, the WHO declared a Public Health Emergency of International Concern

Hepatic and gastrointestinal disturbances in Egyptian patients infected with coronavirus disease 2019: A multicentre cohort study

“…Similar to our study, most other studies reveal a predominant pattern of disturbances in liver enzymes in COVID-19 patients, specifically higher AST elevation than ALT elevation[ 17 - 19 ]. A meta-analysis by Wu et al [ 20 ] found that low serum albumin and high GGT were the most frequent abnormalities on admission and that ALT elevation occurred most frequently during hospitalization, which they speculate may be due to the inclusion of patients with pre-existing liver disease.…”

COVID-19 and liver dysfunction: Epidemiology, association and potential mechanisms

“…COVID-19 patients with gastrointestinal symptoms may have an increased risk of liver injury (OR=2•71, 95% CI: 1•52–4•83) [63] . Liver injury diagnosis mainly depends on biochemical indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), albumin (ALB), and prothrombin time (PT) [64] .…”

CURB-65 plus hypoalbuminemia: a new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia

“…P-value analyses were two-sided and a p-value of less than 0.05 was considered statistically significant. The Positive Predictive Values (PPV) and the (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

“…Several studies have identified a close correlation between hypoalbuminemia and mortality in CAP patients, whereas little is known as for SARS-CoV-2 pneumonia [21][22][23][24][25][26][27]. In fact, it has been recently demonstrated that an albumin level <3.5 g/dL was associated with worse outcome and coagulopathy [26][27].…”