Liver disease and outcomes among COVID-19 hospitalized patients - A systematic review and meta-analysis

Ashish Sharma; Pragya Jaiswal; Yasameen Kerakhan; Lakshmi Saravanan; Zeba Murtaza; Azka Zergham; Nagaraj-Sanchitha Honganur; Aelia Akbar; Aran Deol; Benedict Francis; Shakumar Patel; Deep Mehta; Richa Jaiswal; Jagmeet Singh; Urvish Patel; Preeti Malik

doi:10.1016/j.aohep.2020.10.001

Liver disease and outcomes among COVID-19 hospitalized patients - A systematic review and meta-analysis

Ann Hepatol. 2021 Mar-Apr:21:100273. doi: 10.1016/j.aohep.2020.10.001. Epub 2020 Oct 16.

Authors

Ashish Sharma¹, Pragya Jaiswal², Yasameen Kerakhan³, Lakshmi Saravanan⁴, Zeba Murtaza⁵, Azka Zergham⁶, Nagaraj-Sanchitha Honganur⁷, Aelia Akbar⁸, Aran Deol⁹, Benedict Francis¹⁰, Shakumar Patel¹¹, Deep Mehta¹², Richa Jaiswal², Jagmeet Singh¹³, Urvish Patel¹⁴, Preeti Malik¹⁵

Affiliations

¹ Department of Internal Medicine, Yuma Regional Medicine, Yuma, AZ, USA.
² Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA.
³ Department of Internal Medicine, Abrazo Central Campus, Phoenix, AZ, USA.
⁴ American University of Antigua, Jabberwock Road, Osbourn, Antigua & Barbuda, USA.
⁵ Department of Neurosciences and Internal Medicine, University of California School of Medicine, San Diego, CA, USA.
⁶ Department of Internal Medicine, Larkin Community Hospital, FL, USA.
⁷ Department of Internal Medicine and Cardiology, University of Illinois, Chicago, IL, USA.
⁸ Department of Internal Medicine, Loyola University, Chicago, IL, USA.
⁹ Department of Internal Medicine, Swedish Covenant Hospital, Chicago, IL, USA.
¹⁰ Department of Internal Medicine, Jackson Park Hospital, Chicago, IL, USA.
¹¹ Department of Internal Medicine, Hackensack Ocean Medical Center, Brick Township, NJ, USA.
¹² Clinical Research Program, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
¹³ Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
¹⁴ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
¹⁵ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA. Electronic address: pmalik.ma@gmail.com.

Abstract

Introduction and objectives: The coronavirus disease 2019 (COVID-19) pandemic has been a challenge globally. In severe acute respiratory syndrome (SARS) epidemic 60% of patients had hepatic injury, due to phylogenetic similarities of the viruses it is assumed that COVID-19 is associated with acute liver injury. In this meta-analysis, we aim to study the occurrence and association of liver injury, comorbid liver disease and elevated liver enzymes in COVID-19 confirmed hospitalizations with outcomes.

Materials and methods: Data from observational studies describing comorbid chronic liver disease, acute liver injury, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020 was extracted following PRISMA guidelines. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality. Odds ratio (OR) and 95% confidence interval (95% CI) were obtained.

Results: 24 studies with 12,882 confirmed COVID-19 patients were included. Overall prevalence of CM-CLD was 2.6%, COVID-19-ALI was 26.5%, elevated AST was 41.1% and elevated ALT was 29.1%. CM-CLD had no significant association with poor outcomes (pooled OR: 0.96; 95% CI: 0.71-1.29; p=0.78). COVID-19-ALI (1.68;1.04-2.70; p=0.03), elevated AST (2.98; 2.35-3.77; p<0.00001) and elevated ALT (1.85;1.49-2.29; p<0.00001) were significantly associated with higher odds of poor outcomes.

Conclusion: Our meta-analysis suggests that acute liver injury and elevated liver enzymes were significantly associated with COVID-19 severity. Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19 and causes of liver injury during COVID-19 infection.

Keywords: 2019-nCoV; Acute liver injury; Biomarkers; COVID-19; Chronic liver disease; Coronavirus disease; Outcomes; SARS-CoV-2.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

COVID-19 / epidemiology*
Comorbidity
Global Health
Hospital Mortality / trends
Humans
Intensive Care Units / trends
Liver Diseases / epidemiology*
Pandemics*
Prevalence
SARS-CoV-2