Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis
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ORIGINAL ARTICLE
Coronavirus disease (COVID‑19) and the liver: a comprehensive systematic review and meta‑analysis Praveen Kumar‑M1 · Shubhra Mishra2 · Daya Krishna Jha2 · Jayendra Shukla2 · Arup Choudhury2 · Ritin Mohindra3 · Harshal S. Mandavdhare2 · Usha Dutta2 · Vishal Sharma2 Received: 8 May 2020 / Accepted: 25 June 2020 © Asian Pacific Association for the Study of the Liver 2020
Abstract Background Liver function derangements have been reported in coronavirus disease (COVID-19), but reported rates are variable. Methods We searched PubMed and Embase with terms COVID and SARS-COV-2 from December 1, 2019 till April 5, 2020. We estimated overall prevalence, stratified prevalence based on severity, estimated risk ratio (RR), and estimated standardized mean difference (SMD) of liver function parameters in severe as compared to non-severe COVID. Random effect method utilizing inverse variance approach was used for pooling the data. Results In all, 128 studies were included. The most frequent abnormalities were hypoalbuminemia [61.27% (48.24–72.87)], elevations of gamma-glutamyl transferase (GGT) [27.94% (18.22–40.27)], alanine aminotransferase (ALT) [23.28% (19.92– 27.01)], and aspartate aminotransferase (AST) [23.41% (18.84–28.70)]. Furthermore, the relative risk of these abnormalities was higher in the patients with severe COVID-19 when compared to non-severe disease [Hypoalbuminemia—2.65 (1.38–5.07); GGT—2.31 (1.6–3.33); ALT—1.76 (1.44–2.15); AST—2.30 (1.82–2.90)]. The SMD of hypoalbuminemia, GGT, ALT, and AST elevation in severe as compared to non-severe were − 1.05 (− 1.27 to − 0.83), 0.76 (0.40–1.12), 0.42 (0.27–0.56), and 0.69 (0.52–0.86), respectively. The pooled prevalence and RR of chronic liver disease as a comorbidity was 2.64% (1.73–4) and 1.69 (1.05–2.73) respectively.
M. Praveen Kumar and Shubhra Mishra have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12072-020-10071-9) contains supplementary material, which is available to authorized users. * Vishal Sharma [email protected]
Harshal S. Mandavdhare [email protected]
Praveen Kumar‑M [email protected]
Usha Dutta [email protected]
Shubhra Mishra [email protected]
1
Daya Krishna Jha [email protected]
Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2
Jayendra Shukla [email protected]
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Arup Choudhury [email protected] Ritin Mohindra [email protected]
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Vol.:(0123456789)
Hepatology International
Conclusion The most frequent abnormality in liver functions was hypoalbuminemia followed by derangements in gammaglutamyl transferase and aminotransferases, and these abnormalities were more frequent in
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