Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and
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REVIEW ARTICLE
Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID‑19 patients: a systematic review and meta‑analysis Yanyan Wu1,2 · Hongyu Li1 · Xiaozhong Guo1 · Eric M. Yoshida3 · Nahum Mendez‑Sanchez4 · Giovanni Battista Levi Sandri5 · Rolf Teschke6 · Fernando Gomes Romeiro7 · Akash Shukla8 · Xingshun Qi1 Received: 6 May 2020 / Accepted: 9 July 2020 © Asian Pacific Association for the Study of the Liver 2020
Abstract Background and aims Coronavirus disease 2019 (COVID-19) pandemic is ongoing. Except for lung injury, it is possible that COVID-19 patients develop liver injury. Thus, we conducted a systematic review and meta-analysis to explore the incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases were searched. The incidence of abnormal liver biochemical tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and albumin (ALB), was pooled. Risk ratio (RR) was calculated to explore the association of abnormal liver biochemical tests with severity and prognosis of COVID-19 patients. Results Forty-five studies were included. The pooled incidence of any abnormal liver biochemical indicator at admission and during hospitalization was 27.2% and 36%, respectively. Among the abnormal liver biochemical indicators observed at admission, abnormal ALB was the most common, followed by GGT, AST, ALT, TBIL, and ALP (39.8%, 35.8%, 21.8%, 20.4%, 8.8%, and 4.7%). Among the abnormal liver biochemical indicators observed during hospitalization, abnormal ALT was more common than AST and TBIL (38.4%, 28.1%, and 23.2%). Severe and/or critical patients had a significantly higher pooled incidence of abnormal liver biochemical indicators at admission than mild and/or moderate patients. Non-survivors had a significantly higher incidence of abnormal liver biochemical indicators than survivors (RR = 1.34, p = 0.04). Conclusions Abnormal liver biochemical tests are common in COVID-19 patients. Liver biochemical indicators are closely related to the severity and prognosis of COVID-19 patients. Keywords COVID-19 · SARS-CoV-2 · Hepatic · Liver · Incidence · Risk Abbreviations COVID-19 Coronavirus disease 2019 SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 ACE2 Angiotensin converting enzyme 2 MOF Multiple organ failure ARDS Acute respiratory distress syndrome NOS Newcastle-Ottawa scale Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12072-020-10074-6) contains supplementary material, which is available to authorized users.
RR Risk ratio MD Mean difference CI Confidence interval ALT Alanine aminotransferase AST Aspartate aminotransferase ALP Alkaline phosphatase GGT Gamma-glutamyl transpeptidase TBIL Total bilirubin ALB Albumin SIRS Systemic inflammatory
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