Prevalence of chronic liver disease in patients with COVID-19 and their clinical outcomes: a systematic review and meta-
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REVIEW ARTICLE
Prevalence of chronic liver disease in patients with COVID‑19 and their clinical outcomes: a systematic review and meta‑analysis Alexander J. Kovalic1 · Sanjaya K. Satapathy2 · Paul J. Thuluvath3,4 Received: 6 June 2020 / Accepted: 18 July 2020 © Asian Pacific Association for the Study of the Liver 2020
Abstract Abnormal liver enzymes are seen in 20% of hospitalized patients with COVID-19. The etiology of elevated liver enzymes is thought to be multifactorial including medications and underlying liver disease. The true prevalence and clinical significance of underlying chronic liver diseases (CLD) in COVID-19 remains poorly defined. In this systematic review and meta-analysis, we included 74 clinical studies that were identified after a thorough literature search across three databases. The prevalence of CLD patients (73 studies, 24,299 patients) was 3% among all COVID-19 patients. The prevalence of CLD patients was similar in COVID-19 positive and negative population (pooled OR 0.79 [95% CI 0.60, 1.05], p = 0.10). The presence of CLD was significantly associated with more severe COVID-19 infection (pooled OR 1.48 [95% CI 1.17, 1.87], p = 0.001) and overall mortality (pooled OR 1.78 [95% CI 1.09, 2.93], p = 0.02). Additionally, there was a non-significant trend noted for increased ICU admissions and need for invasive mechanical ventilation among COVID-19 patients with CLD. To date, the clinical importance of chronic liver diseases among COVID-19 infection has remained undefined. In this novel systematic review and meta-analysis, the presence of underlying chronic liver disease was significantly associated with more severe COVID-19 infections and mortality. Keywords Liver · Cirrhosis · Chronic liver disease · Coronavirus · COVID-19 · Severe · Critical · ICU · Mechanical ventilation · Mortality Abbreviations ALD Alcoholic liver disease CI Confidence interval CLD Chronic liver disease COVID-19 Novel coronavirus FiO2 Inhaled oxygen concentration Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12072-020-10078-2) contains supplementary material, which is available to authorized users. * Paul J. Thuluvath [email protected] 1
Department of Internal Medicine, Novant Forsyth Medical Center, Winston‑Salem, NC, USA
2
Division of Hepatology, Department of Internal Medicine, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, NY, USA
3
Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
4
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
HBV Hepatitis B virus HCC Hepatocellular carcinoma HCV Hepatitis C virus ICU Intensive care unit NAFLD Nonalcoholic fatty liver disease OR Odds ratio PaO2 Partial pressure arterial oxygen concentration SpO2 Oxygen saturation WHO World Health Organization
Introduction Abnormal liver enzymes (20%) and elevated bilirubin (16.7%) are
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