COVID-19 and liver injury: a meta-analysis.

COVID-19 and liver injury: a meta-analysis.

Publication date: Jul 03, 2020

The number of cases with coronavirus disease 2019 (COVID-19) has exceeded seven million worldwide. However, the data describing the global prevalence of liver injury associated with COVID-19 is lacking secondary to the novelty of this ongoing pandemic. Therefore, we conducted a meta-analysis to determine the association between COVID-19 and liver injury.

A systematic literature search of indexed databases including, PubMed, Medline, and Embase databases from inception to 14 April 2020, was used to identify studies that reported data of liver chemistry in patients diagnosed with COVID 19. The overall prevalence of abnormal liver chemistry and relevant 95% confidence interval was used to estimate the pooled results studies.

Sixty-four studies with 11 245 patients with COVID-19 were included. The pattern of abnormal liver enzymes was notable for higher aspartate aminotransferase (AST) than alanine aminotransferase (ALT) levels. The overall global prevalence of elevated AST, ALT, total bilirubin, gamma-glutamyltransferase (GGT), and alkaline phosphatase was 23.2, 21.2, 9.7, 15.0, and 4.0%, respectively. The prevalence of elevated AST was substantially higher among those with severe cases (45.5%) compared to non-severe cases (15.0%). Co-existing chronic liver disease presented up to 37.6% of patients with COVID-19.

A fourth of COVID-19 patients had elevated liver enzymes and associated with disease severity. Our study may be used as a guide for clinicians and epidemiologists to proactively identify other sources of injury and illness in patients diagnosed with COVID-19. Intensive monitoring for liver injury may be needed in cases with severe COVID-19.

Concepts Keywords
Alanine Aminotransferase Alkaline phosphatase
Alkaline Phosphatase Elevated transaminases
ALT Bilirubin
Aminotransferase Clinical medicine
Aspartate Liver function tests
AST Medicine
Bilirubin Hepatology
Confidence Interval Medical specialties
Coronavirus Injury illness
Elevated Liver Enzymes Chronic liver
Embase Liver injury A
Epidemiologists Systematic search
Gamma Glutamyltransferase Alanine transaminase
Liver Aspartate transaminase
Medline Liver biopsy
Meta Analysis


Type Source Name
drug DRUGBANK L-Alanine
drug DRUGBANK Alkaline Phosphatase
disease MESH liver disease

Original Article

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