Liver injury is associated with severe Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of retrospective studies

Parohan, Mohammad; Yaghoubi, Sajad; Seraj, Asal

doi:10.1101/2020.04.09.20056242

Cited by 56 publications

(67 citation statements)

References 53 publications

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“…We have also compared our results with previous meta‐analysis (Table 3). 4,5,119‐125 This is the first study to report the liver involvement of all adults, pregnant patients and paediatric patients with COVID‐19. We have analysed in‐depth about the liver involvement in COVID‐19, including elevated liver chemistries at initial presentation, during illness and the impact of this on the outcome.…”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Kulkarni

Kumar

Tevethia

et al. 2020

Aliment Pharmacol Ther

222

310

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Summary Background The incidence of elevated liver chemistries and the presence of pre‐existing chronic liver disease (CLD) have been variably reported in COVID‐19. Aims To assess the prevalence of CLD, the incidence of elevated liver chemistries and the outcomes of patients with and without underlying CLD/elevated liver chemistries in COVID‐19. Methods A comprehensive search of electronic databases from 1 December 2019 to 24 April 2020 was done. We included studies reporting underlying CLD or elevated liver chemistries and patient outcomes in COVID‐19. Results 107 articles (n = 20 874 patients) were included for the systematic review. The pooled prevalence of underlying CLD was 3.6% (95% CI, 2.5‐5.1) among the 15 407 COVID‐19 patients. The pooled incidence of elevated liver chemistries in COVID‐19 was 23.1% (19.3‐27.3) at initial presentation. Additionally, 24.4% (13.5‐40) developed elevated liver chemistries during the illness. The pooled incidence of drug‐induced liver injury was 25.4% (14.2‐41.4). The pooled prevalence of CLD among 1587 severely infected patients was 3.9% (3%‐5.2%). The odds of developing severe COVID‐19 in CLD patients was 0.81 (0.31‐2.09; P = 0.67) compared to non‐CLD patients. COVID‐19 patients with elevated liver chemistries had increased risk of mortality (OR‐3.46 [2.42‐4.95, P < 0.001]) and severe disease (OR‐2.87 [95% CI, 2.29‐3.6, P < 0.001]) compared to patients without elevated liver chemistries. Conclusions Elevated liver chemistries are common at presentation and during COVID‐19. The severity of elevated liver chemistries correlates with the outcome of COVID‐19. The presence of CLD does not alter the outcome of COVID‐19. Further studies are needed to analyse the outcomes of compensated and decompensated liver disease.

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Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Kulkarni

Kumar

Tevethia

et al. 2020

Aliment Pharmacol Ther

222

310

View full text Add to dashboard Cite

show abstract

“…Generally only ALT/AST levels were frequently reported, with scarce information on LDH, previous infections, glucose or CRP. These data were also missing in a recent meta-analysis by Parohan et al, who concluded that the incidence of liver injury may be higher in patients with severe COVID-19 infection [64]. Similarly Xu et al [11] summarized the reports of liver injury caused by SARS-CoV, MERS-CoV and SARS-CoV-but were unable to define the mechanisms of liver injury associated with SARS-CoV-2 infection.…”

Section: Covid-19 Patients and Liver Injurymentioning

confidence: 99%

COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

Kukla

Skonieczna-Żydecka

Kotfis

et al. 2020

JCM

103

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The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.

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“…[ 3 , 7 , 8 ] Previous meta-analyses also explored the association between gastrointestinal manifestations and the severity of COVID-19 infection. [ 9 – 11 ] But some results in these meta-analyses were inconsistent and the association between specific digestive symptoms, such as abdominal pain and constipation, and COVID-19 prognosis remains unclear. Furthermore, these meta-analyses drew conclusions based on limited sample sizes and almost all evidence from China.…”

Section: Introductionmentioning

confidence: 99%

Association of digestive symptoms with severity and mortality of COVID-19

Zhang¹,

Ma²,

Zhang³

et al. 2020

Medicine

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Background: Gastrointestinal manifestations are common in patients with COVID-19, but the association between specific digestive symptoms and COVID-19 prognosis remains unclear. This study aims to assess whether digestive symptoms are associated with COVID-19 severity and mortality. Methods: We will search PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to September, 2020, to identify studies that compared the prevalence of at least one specific digestive symptom between severe and non-severe COVID-19 patients or between non-survivors and survivors. Two independent reviewers will assess the risk of bias of the included cohort studies using the modified Newcastle-Ottawa Scale. Meta-analyses will be conducted to estimate the pooled prevalence of individual symptoms using the inverse variance method with the random-effects model. We will conduct subgroup analyses, sensitivity analyses, and meta-regression analyses to explore the sources of heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess the quality of the evidence. Results: The results of this study will be published in a peer-reviewed journal. Conclusion: Our meta-analysis will comprehensively evaluate the association between different digestive symptoms and the severity and mortality of patients infected with COVID-19. This study will provide evidence to help determine whether special protective measures and treatment options are needed for patients with digestive system comorbidities during the COVID-19 pandemic. INPLASY registration number: INPLASY202090055.

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Liver injury is associated with severe Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of retrospective studies

Cited by 56 publications

References 53 publications

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

Association of digestive symptoms with severity and mortality of COVID-19

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