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Hepatology International
Published in: Hepatology International 5/2020

01-09-2020 | SARS-CoV-2 | Review Article

Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis

Authors: Yanyan Wu, Hongyu Li, Xiaozhong Guo, Eric M. Yoshida, Nahum Mendez-Sanchez, Giovanni Battista Levi Sandri, Rolf Teschke, Fernando Gomes Romeiro, Akash Shukla, Xingshun Qi

Published in: Hepatology International | Issue 5/2020

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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.
Appendix
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Literature
1.
2.
Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020;5(4):536–544
3.
Wu Y, Li H, Xu X, Zheng K, Qi X, Guo X. Clinical characteristics and outcomes of 2019 novel coronavirus pneumonia: a meta-analysis (Article in Chinese). Zhonghua Gan Zang Bing Za Zhi 2020;28(3):240–246PubMed
4.
Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int 2020;40(5):998–1004PubMed
5.
Chinese Digestion Association, Chinese Medical Doctor Association; Chinese Society of Hepatology, Chinese Medical Association. The protocol for prevention, diagnosis and treatment of liver injury in coronavirus disease 2019 (Article in Chinese) Zhonghua Gan Zang Bing Za Zhi 2020;28(3):217–21
6.
Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020;181(2):271–280.e8PubMedPubMedCentral
7.
8.
Hu LL, Wang WJ, Zhu QJ, Yang L. Novel coronavirus pneumonia related liver injury: etiological analysis and treatment strategy (Article in Chinese). Zhonghua Gan Zang Bing Za Zhi 2020;28(2):97–99PubMed
9.
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8(4):420–422PubMedPubMedCentral
10.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382(8):727–733PubMedPubMedCentral
11.
Yang L, Wang W, Wang X, Zhao J, Xiao L, Gui W, et al. Creg in hepatocytes ameliorates liver ischemia/reperfusion injury in a TAK1-dependent manner in mice. Hepatology 2019;69(1):294–313PubMed
12.
Boettler T, Newsome PN, Mondelli MU, Maticic M, Cordero E, Cornberg M, et al. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep 2020;2(3):100113
13.
Méndez-Sánchez N, Valencia-Rodríguez A, Qi X, Yoshida EM, Romero-Gómez M, George J, et al. What has the COVID-19 pandemic taught us so far? Addressing the problem from a hepatologist's perspective. J Clin Transl Hepatol 2020;8(2):0024
14.
15.
Li C, Li M, Gan L, Zhang Y, Lei C. Heart and liver damages in coronavirus sisease-2019 (Article in Chinese). Guangdong Med J 2020;41(9):874–877
16.
Li D, Long Y, Huang P, Guo W, Wu S, Zhou Q, et al. Clinical characteristics of 80 patients with COVID-19 in Zhuzhou City (Article in Chinese). Chin J Infect Control 2020;19(3):1–7
17.
Qi D, Yan X, Tang X, Yan X, Tang X, Peng J, et al. Epidemiological and clinical features of 2019-nCoV acute respiratory disease cases in Chongqing municipality, China: a retrospective, descriptive, multiple-center study. Lancet Respir Med 2020. https://​ssrn.​com/​abstract=​3546122. Accessed 6 Apr 2020
18.
19.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–1720PubMed
20.
21.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497–506PubMedPubMedCentral
22.
23.
Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020;69(6):1002–1009PubMed
24.
Wen K, Li W, Zhang D, Zhang A, Zhang T, Zhao P, et al. Epidemiological and clinical characteristics of 46 newly-admitted coronavirus disease 2019 cases in Beijing (Article in Chinese). Zhonghua Chuan Ran Bing Za Zhi 2020. http://​rs.​yiigle.​com/​yufabiao/​1182702.​htm. Accessed 6 Apr 2020
25.
Yang K, Ren M, Xiao L, Liu Y, Shi D, Lu H, et al. Epidemiological and clinical characteristics of 57 cases of new coronavirus pneumonia in non-epidemic areas (Article in Chinese). J Third Milit Med Univ 2020; 1–5
26.
Cheng K, Wei M, Shen H, Wu C, Chen D, Xiong W, et al. Clinical characteristics of 463 patients with common and severe type coronavirus disease 2019 (Article in Chinese). Shanghai Med J 2020; 1–15
27.
Liu C, Jiang ZC, Shao CX, Zhang HG, Yue HM, Chen ZH, et al. Preliminary study of the relationship between novel coronavirus pneumonia and liver function damage: a multicenter study (Article in Chinese). Zhonghua Gan Zang Bing Za Zhi 2020;28(2):148–152
28.
Liu M, He P, Liu HG, Wang XJ, Li FJ, Chen S, et al. Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia (Article in Chinese). Zhonghua Jie He He Hu Xi Za Zhi 2020;43(3):209–214
29.
Xu M, Li M, Zhan W, Han T, Liu L, Zhang G, et al. Clinical analysis of 23 cases of 2019 novel coronavirus infection in Xinyang City, Henan Province (Article in Chinese). Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020;32(2):421–425
30.
Qian ZP, Mei X, Zhang YY, Zou Y, Zhang ZG, Zhu H, et al. Analysis of baseline liver biochemical parameters in 324 cases with novel coronavirus pneumonia in Shanghai area (Article in Chinese). Zhonghua Gan Zang Bing Za Zhi 2020;28(3):229–233
31.
32.
33.
Zhong S, Lin F, Shi L. The clinical characteristics and outcome of 62 patients with COVID-19 (Article in Chinese). Med J Chin People's Liber Army 2020;45(4):370–374
34.
Xiang T, Liu J, Xu F, Cheng N, Liu Y, Qian K, et al. Analysis of clinical characteristics of 49 patients with Novel Coronavirus Pneumonia in Jiangxi province (Article in Chinese). Chin J Respir Crit Care Med 2020;19(2):1–7
35.
Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y. Clinical features and treatment of COVID-19 patients in Northeast Chongqing. J Med Virol 2020;92(7):797–806PubMed
36.
Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 2020;368:m606PubMedPubMedCentral
37.
Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80(4):388–393PubMedPubMedCentral
38.
39.
Ma Y, Xia S, Wang M, Zhang S, Du W, Chen Q, et al. Clinical features of children with SARS-CoV-2 infection: an analysis of 115 cases (Article in Chinese). Zhongguo Dang Dai Er Ke Za Zhi 2020;22(4):1–4
40.
Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020;323(15):1488–1494
41.
Zhou Y, Zhu C, Wan X, Feng C. Clinical characteristics and laboratory results of 3886 patients with fever and cough (Article in Chinese). Lab Med Clin 2020;17(11):1541–1545
42.
43.
Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J 2020;55(5):2000524PubMedPubMedCentral
44.
Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect 2020;80(6):639–645PubMedPubMedCentral
45.
Xie H, Zhao J, Lian N, Lin S, Xie Q, Zhuo H. Clinical characteristics of non-ICU hospitalized patients with coronavirus disease 2019 and liver injury: a retrospective study. Liver Int 2020;40(6):1321–1326PubMed
46.
Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020;115(5):766–773PubMed
47.
48.
49.
Zheng F, Tang W, Li H, Huang YX, Xie YL, Zhou ZG. Clinical characteristics of 161 cases of corona virus disease 2019 (COVID-19) in Changsha. Eur Rev Med Pharmacol Sci 2020;24(6):3404–3410PubMed
50.
Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Respir Res 2020;21(1):74PubMedPubMedCentral
51.
52.
Fang XW, Mei Q, Yang TJ, Zhang L, Yang Y, Wang YZ, et al. Clinical characteristics and treatment strategies of 79 patients with COVID-19 (Article in Chinese). Chin Pharmacol Bull 2020;36(04):453–459
53.
Li GM, Pan X. Features of liver injury in patients with coronavirus disease 2019 in Bozhou, China (Article in Chinese). J Clin Hepatol 2020;36(4):772–774
54.
Wang XF, Zhou ZQ, Yang HH, Tian F, Wang CF, Cui GZ, et al. Extrapulmonary organ damage and clinical significance in patients with coronavirus disease 2019 (Article in Chinese). Zhejiang Med 2020;42(5):485–488 (+96)
55.
Yuan J, Sun YY, Zuo YJ, Chen TY, Cao Q, Yuan GD, et al. A retrospective analysis of the clinical characteristica of 223 NCP patients in Chongqing  (Article in Chinese). J Southwest Univ (Natural Science Edition) 2020;42(3):17–24
56.
Bai P, He W, Zhang X, Liu S, Jin J. Analysis of clinical features of 58 patients with severe or critical 2019 novel coronavirus pneumonia (Article in Chinese). Zhonghua Ji Zhen Yi Xue Za Zhi 2020;4:483–487
57.
Huang R, Zhu L, Xue L, Liu L, Yan X, Wang J, et al. Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: a retrospective, multi-center study. Lancet Respira Med 2020. https://​ssrn.​com/​abstract=​3548785. Accessed 25 Mar 2020
58.
59.
60.
Lan NT, Thu NT, Barrail-Tran A, Duc NH, Lan NN, Laureillard D, et al. Randomised pharmacokinetic trial of rifabutin with lopinavir/ritonavir-antiretroviral therapy in patients with HIV -associated tuberculosis in Vietnam. PLoS One 2014;9(1):e84866PubMedPubMedCentral
61.
Larson AM. Acetaminophen hepatotoxicity. Clin Liver Dis 2007;11(3):525–548 (vi)PubMed
62.
Guan GW, Gao L, Wang JW, Wen XJ, Mao TH, Peng SW, et al. Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia (Article in Chinese). Zhonghua Gan Zang Bing Za Zhi 2020;28(2):100–106
63.
Prompetchara E, Ketloy C, Palaga T. Immune responses in COVID-19 and potential vaccines: lessons learned from SARS and MERS epidemic. Asian Pac J Allergy Immunol 2020;38(1):1–9PubMed
64.
Zhang XJ, Cheng X, Yan ZZ, Fang J, Wang XZ, Wang WJ, et al. An ALOX12-12-HETE-GPR31 signaling axis is a key mediator of hepatic ischemia-reperfusion injury. Nat Med 2018;24(1):73–83PubMed
65.
Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, et al. Features and outcomes of 899 patients with drug-induced liver injury: the DILIN prospective study. Gastroenterology 2015;148(7):1340–1352e7PubMed
66.
Giner GV, Oltra M, Rueda D. Esteban MJ, Redón J. Severe acute hepatitis related to hydroxychloroquine in a woman with mixed connnective tissue disease. Clin Rheumatol 2007;26:971–972
67.
Chen D, Yang F, Luo Z, Xie H, Dong H, Jia L. Current status and bottle-necks of global pharmaceutical developments against COVID-19 (Article in Chinese). Chin Pharmacol Bull 2020;36(4):1–11
68.
Cottin J, Pierre S, Pizzoglio V, Simon C, Durrieu G, Bleyzac N, et al. Methylprednisolone-related liver injury: a descriptive study using the French pharmacovigi-lance database. Clin Res Hepatol Gastroenterol 2020; p. S2210-7401(19)30270-0
69.
Mantovani A, Beatrice G, Dalbeni A. Coronavirus disease 2019 and prevalence of chronic liver disease: a meta-analysis. Liver Int 2020;40(6):1316–1320PubMed
70.
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64(1):73–84PubMed
71.
Li Y, De Stefano V, Li H, Zheng K, Bai Z, Guo X, et al. Epidemiology of Budd-Chiari syndrome: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2019;43(4):468–474PubMed
Metadata
Title
Incidence, risk factors, and prognosis of abnormal liver biochemical tests in COVID-19 patients: a systematic review and meta-analysis
Authors
Yanyan Wu
Hongyu Li
Xiaozhong Guo
Eric M. Yoshida
Nahum Mendez-Sanchez
Giovanni Battista Levi Sandri
Rolf Teschke
Fernando Gomes Romeiro
Akash Shukla
Xingshun Qi
Publication date
01-09-2020
Publisher
Springer India
Published in
Hepatology International / Issue 5/2020
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI
https://doi.org/10.1007/s12072-020-10074-6

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