AUTHOR=Boregowda Umesha , Aloysius Mark M. , Perisetti Abhilash , Gajendran Mahesh , Bansal Pardeep , Goyal Hemant 

TITLE=Serum Activity of Liver Enzymes Is Associated With Higher Mortality in COVID-19: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00431

DOI=10.3389/fmed.2020.00431

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Abnormal liver chemistries are common findings in patients with COVID-19. It is unclear whether abnormal liver chemistries can predict the severity of COVID-19. Therefore, we compared the serum liver chemistries such as hepatic transaminases, total bilirubin, albumin, and prothrombin time to evaluate whether they can predict severity and mortality in COVID-19.</p><p><bold>Methods:</bold> An electronic search was performed on PubMed/Medline, EMBASE, and Google Scholar for studies comparing liver chemistries in severe and mild COVID-19. The literature search was performed using keywords “COVID-19,” “Liver,” Aspartate Aminotransferase (AST),” and “Alanine Aminotransferase (ALT),” “AST,” and “ALT,” in various combinations of “AND/OR” from December 1, 2019, till May 8, 2020. The pooled weighted mean difference (WMD) and 95% confidence interval (CI) were calculated for each component of liver chemistries.</p><p><bold>Results:</bold> Twenty-two studies were eligible, with 3,256 patients (54.57% males). Seventeen studies compared liver chemistries for severe vs. mild COVID-19, whereas five studies compared liver chemistries in survival vs. non-survival groups. The pooled WMD of AST and ALT in severe vs. mild COVID-19 were 12.23 (95% CI; 8.07, 16.39; <italic>p</italic> &lt; 0.01) and 8.07 (95% CI 2.55, 11.91; <italic>p</italic> &lt; 0.01), respectively. The pooled WMD for AST in survivors vs. non-survivors analysis was 8.82 (<italic>n</italic> = 789; 95% CI; 2.27, 15.37; <italic>p</italic> &lt; 0.01) and that of ALT was 4.70 (<italic>n</italic> = 340; 95% CI 0.04,9.35; <italic>p</italic> = 0.05).</p><p><bold>Conclusion:</bold> Our meta-analysis shows that deranged liver chemistries may indicate severe COVID-19 and could also predict mortality. Larger studies are needed to evaluate the relationship between derangement in liver chemistries and mortality in COVID-19.</p>