The liver injury and gastrointestinal symptoms in patients with Coronavirus Disease 19: A systematic review and meta-analysis

Wang, Haizhou; Qiu, Peishan; Liu, Jing; Wang, Fan; Zhao, Qiu

doi:10.1016/j.clinre.2020.04.012

Cited by 55 publications

(54 citation statements)

References 39 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

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“…In another study, the average age of which was lower (41 years) compared to these studies, a lower rate (%16) of liver test disorders was detected (14). In addition, in a meta-analysis of 3024 diseases conducted in China where 21 studies were analyzed, there was a signi cant relationship between disease severity and liver enzymes disruption (12).…”

Section: Discussionmentioning

confidence: 90%

“…Rarely, liver enzyme levels may be very high. Besides, it has been reported in the literature that there is a signi cant relationship between increased disease severity and impairment of liver enzymes (5,6,(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the frequency of gastrointestinal symptoms and liver test disorder in patients during the Covid-19 outbreak in the Military Unit: A single-center pilot study.

Avcı

Akhan

Ardahanli

et al. 2020

Preprint

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BackgroundAlthough Covid-19 is often a disease presenting with respiratory symptoms, gastrointestinal (GI) symptoms can also be seen. Also, there may be disruptions in liver enzyme during the disease. In our study, we aimed to investigate the extent of the military co-epidemic during the Covid-19 epidemic process and the frequency of GI symptoms and liver test disorders.MethodsThe demographic, radiological, laboratory, and clinical analysis of the soldiers diagnosed Covid-19 with real-time polymerase chain reaction, was carried out retrospectively in March, April, and May of 2020.ResultsCovid-19 was detected in 17 (0.7%) of the 2152 soldiers coming from different cities to perform their military service, in the following days after being recruited, in 9 (0.4%) of the soldiers. While 1 (0.3%) of 320 senior military and 2 (3.6%) soldiers from 56 other soldiers who came to the unit from other units were also diagnosed with Covid-19.The mean age was 21.2 ± 1.8. In Torax CT, only 4 (13.7%) patients had pneumonia. At the time of diagnosis, 6.8% of the patients had GI symptoms and 13.7% of them had liver enzyme disruption. None of the patients experienced respiratory failure, intensive care, and death, and all patients recovered.ConclusionIn the literature, our study is the first study to investigate the Covid-19 outbreak in the military unit in the world and the frequency of GI symptoms and liver enzyme disruptions in these patients. In our study, Covid-19 was milder in the young population and we found that GI symptom and liver test disorder were observed less frequently. Covid-19 outbreak can be taken under control by fast and accurate triage and suitable isolation for those with suspected disease, in environments where many people such as military units will live close together. Especially in patients with GI symptoms, Covid-19 should always be kept in mind and early isolation of patients can prevent the spread of the epidemic in such crowded environments.

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“…Siete revisiones sistemáticas con metaanálisis publicadas entre el 9 y el 28 de mayo de 2020 analizaron las manifestaciones hepáticas de COVID-19 al ingreso de los pacientes. [4][5][6][7][8][9][10] Kukla y colaboradores analizaron el impacto de tres Coronaviridae en 43 estudios (con presencia de SARS-CoV-1 en 23 estudios y 1,894 pacientes; MERS en nueve estudios y 156 pacientes, y SARS-CoV-2 en estudios y 2,541 pacientes), encontrando alteraciones hepáticas en las tres enfermedades virales con hallazgos histopatológicos inespecíficos. 5 A diferencia de SARS-CoV-1 y 2, el MERS requiere de la enzima dipeptidil peptidasa-4 como receptor funcional, y hasta el momento no hay evidencia de que la infección cause daño hepático directo.…”

Section: Alteraciones Hepáticas En Pacientes Infectados Por Covid-19/unclassified

“…10 Por su parte, Wang y otros revisaron 21 estudios (3,024 pacientes), donde de 2.6 a 53% tuvo enzimas hepáticas (AST e ALT) anormales. 7 Tanto Parohan y colaboradores como Youssef y su equipo de investigación realizaron sendos metaanálisis independientes con la información de 20 estudios retrospectivos (3,248 pacientes). Ambos metaanálisis demostraron que los pacientes con hipoalbuminemia, elevación de AST, ALT y bilirrubina total cursaron con enfermedad grave en mayor frecuencia.…”

Section: Alteraciones Hepáticas En Pacientes Infectados Por Covid-19/unclassified

Enfermedad hepática y trasplante durante la pandemia COVID-19/SARS-CoV-2

Leal-Leyte¹,

Zamora-Valdés²,

Méndez-Sánchez³

2020

Revista Mexicana De Trasplantes

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La pandemia por SARS-CoV-2/COVID-19 ha afectado todas las áreas de la atención médica, particularmente la atención de enfermedades crónicas. La enfermedad hepática crónica es altamente prevalente en nuestro país y representa una de las principales causas de mortalidad general. Objetivo: En esta revisión, analizamos la literatura disponible hasta el 5 de junio de 2020 sobre el impacto de SARS-CoV-2/COVID-19 en enfermedades hepáticas y en la actividad de trasplante hepático. Material y métodos: Realizamos una búsqueda en PubMed con los términos «liver» (hígado), «hepatic» (hepático), o «transplant» (trasplante) y «COVID-19» o «SARS-CoV-2» contenidos en el título o el resumen de la categoría «Journal Articles» durante el último año. Los artículos fueron analizados por dos revisores de forma independiente. Resultados: Encontramos 276 resultados, de los cuales 54 artículos cumplieron con los criterios de inclusión. La mayor parte de la información disponible proviene de recomendaciones de expertos o consensos. Los organismos reguladores de donación y trasplante han desarrollado algoritmos específicos para su región con el objetivo de guiar la actividad de trasplantes durante la pandemia. Los programas, en general, han reportado disminución en sus actividades. Los resultados de infección por SARS-CoV-2 en receptores de trasplante hepático no son concluyentes y la evaluación del donante para la infección es ampliamente recomendada. Conclusión: La pandemia por SARS-CoV-2/COVID-19 ha modificado las prácticas de todos los programas de trasplante alrededor del mundo. La comunidad de trasplantes se encuentra frente a un escenario difícil con evidencia científica escasa que guíe la toma de decisiones sobre el futuro y la atención óptima de pacientes con enfermedad hepática terminal en necesidad de trasplante, durante y después de la pandemia.

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The liver injury and gastrointestinal symptoms in patients with Coronavirus Disease 19: A systematic review and meta-analysis

Cited by 55 publications

References 39 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

Evaluation of the frequency of gastrointestinal symptoms and liver test disorder in patients during the Covid-19 outbreak in the Military Unit: A single-center pilot study.

Enfermedad hepática y trasplante durante la pandemia COVID-19/SARS-CoV-2

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