Pre-existing Liver Diseases and On-Admission Liver-Related Laboratory Tests in COVID-19: A Prognostic Accuracy Meta-Analysis With Systematic Review

Váncsa, Szilárd; Zádori, Noémi; Szakó, Lajos; Vörhendi, Nóra; Ocskay, Klementina; Földi, M.; Dembrovszky, Fanni; Dömötör, Zsuzsa Réka; Janosi, K; Rakonczay, Zoltán; Hartmann, Petra; Horváth, Tamara; Erőss, Bálint; Kiss, Szabolcs; Szakács, Zsolt; Németh, Dávid; Hegyi, Péter; Pár, Gabriella

doi:10.3389/fmed.2020.572115

Cited by 22 publications

(18 citation statements)

References 82 publications

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“…Bernal-Monterde and colleagues did find a strong relationship between longitudinal changes in GGT levels and to a minor extent total bilirubin levels and suggests that elevated biomarkers indicate cholestatic liver injury and may have a negative impact on survival [192]. However, in the meta-analysis by Vancsa et al ALP was not a significant prognostic biomarker of mortality in patients with acute liver injury related to COVID-19 [188].…”

Section: Deranged Lfts In Covid Patients and Mortalitymentioning

confidence: 96%

“…AST and ALT, biomarkers of hepatocellular damage were significantly increased in a retrospective study including 675 COVID-19 patients, and individuals with AST > 3 times the upper limit of normal had the greatest risk of death [187]. In a meta-analysis and systematic review AST (OR = 5.39) and ALT (OR = 2.49) levels were associated with a high rate of mortality [188]. Besides, in another retrospective study comprising 544 COVID-19 patients where there were elevated AST and ALT levels, the AST/ALT ratio > 1 was concomitant with increased mortality [189] [Table 2].…”

Section: Deranged Lfts In Covid Patients and Mortalitymentioning

confidence: 99%

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Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis

McGrowder

Miller

Cross

et al. 2021

Preprint

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Globally, over the past several months millions of persons contracted the coronavirus disease 2019 (COVID-19) resulting in significant mortality. Health care systems are negatively impacted including the care of individuals with cancers and other chronic diseases such as chronic active hepatitis, cirrhosis and hepatocellular carcinoma. There are various probable pathogenic mechanisms that have been presented to account for liver injury in COVID-19 patients such as hepatotoxicity cause by therapeutic drugs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the bile duct cells and hepatocytes, hypoxia and systemic inflammatory response. Liver biochemistry tests such as AST, ALT, GGT and ALP are deranged in COVID-19 patients with liver injury. Hepatocellular damage results in the elevation of serum AST and ALT levels in early onset disease while a cholestatic pattern that develops as the disease progress causes higher levels of ALP, GGT, direct and total bilirubin. These liver biochemistry tests are prognostic markers of disease severity and should be carefully monitored in COVID-19 patients. We conducted a systematic review of abnormal liver biochemistry tests in COVID-19 and the possible pathogenesis involved. Significant findings regarding the severity, hepatocellular pattern, incidence and related clinical outcomes in COVID-19 patients are highlighted.

show abstract

Section: Deranged Lfts In Covid Patients and Mortalitymentioning

confidence: 96%

Section: Deranged Lfts In Covid Patients and Mortalitymentioning

confidence: 99%

Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis

McGrowder

Miller

Cross

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…AST and ALT, biomarkers of hepatocellular damage were significantly increased in a retrospective study including 675 COVID-19 patients, and individuals with AST > 3 times the upper limit of normal had the greatest risk of death [ 161 ]. In a meta-analysis and systematic review, AST (OR = 5.39) and ALT (OR = 2.49) levels were associated with a high rate of mortality [ 162 ]. Moreover, in another retrospective study comprising 544 COVID-19 patients where there were elevated AST and ALT levels, the AST/ALT ratio > 1 was concomitant with increased mortality ( Table 2 ) [ 163 ].…”

Section: Deranged Lfts In Covid Patients and Mortalitymentioning

confidence: 99%

Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis

et al. 2021

View full text Add to dashboard Cite

Globally, millions of persons have contracted the coronavirus disease 2019 (COVID-19) over the past several months, resulting in significant mortality. Health care systems are negatively impacted including the care of individuals with cancers and other chronic diseases such as chronic active hepatitis, cirrhosis and hepatocellular carcinoma. There are various probable pathogenic mechanisms that have been presented to account for liver injury in COVID-19 patients such as hepatotoxicity cause by therapeutic drugs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of the bile duct cells and hepatocytes, hypoxia and systemic inflammatory response. Liver biochemistry tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) are deranged in COVID-19 patients with liver injury. Hepatocellular damage results in the elevation of serum AST and ALT levels in early onset disease while a cholestatic pattern that develops as the disease progress causes higher levels of ALP, GGT, direct and total bilirubin. These liver biochemistry tests are prognostic markers of disease severity and should be carefully monitored in COVID-19 patients. We conducted a systematic review of abnormal liver biochemistry tests in COVID-19 and the possible pathogenesis involved. Significant findings regarding the severity, hepatocellular pattern, incidence and related clinical outcomes in COVID-19 patients are highlighted.

show abstract

“…In the majority of studies, there are few details of the diagnosis or extent of pre-existing liver conditions making it difficult to assess the impact of COVID-19 on patients with different types of liver disease ( 49 , 51 ). Overall, it is reported that an underlying CLD is associated with a worse outcome of COVID-19 ( 69 , 70 ). Patients with cirrhosis are known to be at increased risk of decompensation or development of acute-on chronic liver failure if infected with bacterial, fungal or viral infection, and so it is likely that cirrhosis will be a risk factor for severe COVID-19 ( 68 , 71 ).…”

Section: Resultsmentioning

confidence: 99%

COVID-19 in Children With Liver Disease

et al. 2021

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Background: The global pandemic caused by novel Coronavirus SARS-CoV-2 disease (COVID-19) is a major threat to the general population and for patients with pre-existing chronic conditions. We report data concerning SARS-CoV-2 infection in children with chronic liver disease (CLD).Methods: A literature review using the online database PubMed was performed to summarize available findings on the association between pre-existing liver disease and COVID-19 infection in children.Results: Children with COVID-19 have preserved effector and immunosuppressive components resulting in a milder disease compared to adults. The most common hepatic manifestation is an elevation of hepatic transaminases. Liver damage may be directly caused by viral infection of liver cells, by medications or by the chronic hypoxia seen in COVID-19 patients. A multicenter study reported that the majority of children with a CLD remained healthy during the outbreak. Similarly, studies reported that children on immunosuppressive treatment, including patients with autoimmune liver disease (AILD) and liver transplantation (LT), maintained good health during the outbreak without experiencing major complications even if infected with COVID-19.Conclusion: COVID-19-related liver injury presents with a mild elevation of transaminases, although its clinical significance is unclear. Children with CLD, including those with AILD and post-LT, do not have an increased risk for severe disease course of SARS-CoV-2 infection with little or no liver dysfunction. These data highlight the necessity to ensure normal standards of care while adhering to national Covid-19 guidelines, and particularly to maintain immunosuppressive medication to prevent relapse or rejection. Further research is required to evaluate the differences in clinical course between immunosuppressed adults and children and in particular whether asymptomatic infection is a concern.

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Pre-existing Liver Diseases and On-Admission Liver-Related Laboratory Tests in COVID-19: A Prognostic Accuracy Meta-Analysis With Systematic Review

Cited by 22 publications

References 82 publications

Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis

Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis

Abnormal Liver Biochemistry Tests and Acute Liver Injury in COVID-19 Patients: Current Evidence and Potential Pathogenesis

COVID-19 in Children With Liver Disease

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