AUTHOR=Váncsa Szilárd , Hegyi Péter Jeno , Zádori Noémi , Szakó Lajos , Vörhendi Nóra , Ocskay Klementina , Földi Mária , Dembrovszky Fanni , Dömötör Zsuzsa Réka , Jánosi Kristóf , Rakonczay Zoltán , Hartmann Petra , Horváth Tamara , Erőss Bálint , Kiss Szabolcs , Szakács Zsolt , Németh Dávid , Hegyi Péter , Pár Gabriella 

TITLE=Pre-existing Liver Diseases and On-Admission Liver-Related Laboratory Tests in COVID-19: A Prognostic Accuracy Meta-Analysis With Systematic Review

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.572115

DOI=10.3389/fmed.2020.572115

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> We aimed to perform a systematic search and meta-analysis to evaluate the prognostic value of on-admission liver function tests and pre-existing liver diseases on the clinical course of coronavirus disease 2019 (COVID-19).</p><p><bold>Methods:</bold> The study was registered on PROSPERO (CRD42020182902). We searched five databases between 01/01/2020 and 04/23/2020. Studies that reported on liver-related comorbidities and/or laboratory parameters in patients with COVID-19 were included. The main outcomes were COVID-19 severity, intensive care unit (ICU) admission, and in-hospital mortality. Analysis of predictive models hierarchical summary receiver-operating characteristic (HSROC) was conducted with a 95% confidence interval (CI).</p><p><bold>Results:</bold> Fifty studies were included in the meta-analysis. High specificity was reached by acute liver failure associated by COVID-19 (0.94, 95% CI: 0.71–0.99) and platelet count (0.94, 95% CI: 0.71–0.99) in the case of mortality; chronic liver disease (CLD) (0.98, 95% CI: 0.96–0.99) and platelet count (0.82, 95% CI: 0.72–0.89) in the case of ICU requirement; and CLD (0.97, 95% CI: 0.95–0.98), chronic hepatitis B infection (0.97, 95% CI: 0.95–0.98), platelet count (0.86, 95% CI: 0.77–0.91), and alanine aminotransferase (ALT) (0.80, 95% CI: 0.66–0.89) and aspartate aminotransferase (AST) (0.84, 95% CI: 0.77–0.88) activities considering severe COVID-19. High sensitivity was found in the case of C-reactive protein (CRP) for ICU requirement (0.92, 95% CI: 0.80–0.97) and severe COVID-19 (0.91, 95% CI: 0.82–0.96).</p><p><bold>Conclusion:</bold> On-admission platelet count, ALT and AST activities, CRP concentration, and the presence of acute and CLDs predicted the severe course of COVID-19. To highlight, pre-existing liver diseases or acute liver injury associated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection plays an important role in the prediction of mortality.</p>