AUTHOR=Yang Ruiqi , Feng Jihua , Wan Huan , Zeng Xiaona , Ji Pan , Zhang Jianfeng 

TITLE=Liver injury associated with the severity of COVID-19: A meta-analysis

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1003352

DOI=10.3389/fpubh.2023.1003352

ISSN=2296-2565

ABSTRACT=<sec><title>Background</title><p>The current 2019 novel coronavirus disease (COVID-19) pandemic is a major threat to global health. It is currently uncertain whether and how liver injury affects the severity of COVID-19. Therefore, we conducted a meta-analysis to determine the association between liver injury and the severity of COVID-19.</p></sec><sec><title>Methods</title><p>A systematic search of the PubMed, Embase, and Cochrane Library databases from inception to August 12, 2022, was performed to analyse the reported liver chemistry data for patients diagnosed with COVID-19. The pooled odds ratio (OR), weighted mean difference (WMD) and 95% confidence interval (95% CI) were assessed using a random-effects model. Furthermore, publication bias and sensitivity were analyzed.</p></sec><sec><title>Results</title><p>Forty-six studies with 28,663 patients were included. The pooled WMDs of alanine aminotransferase (WMD = 12.87 U/L, 95% CI: 10.52–15.23, <italic>I</italic><sup>2</sup> = 99.2%), aspartate aminotransferase (WMD = 13.98 U/L, 95% CI: 12.13–15.83, <italic>I</italic><sup>2</sup> = 98.2%), gamma-glutamyl transpeptidase (WMD = 20.67 U/L, 95% CI: 14.24–27.10, <italic>I</italic><sup>2</sup> = 98.8%), total bilirubin (WMD = 2.98 μmol/L, 95% CI: 1.98–3.99, <italic>I</italic><sup>2</sup> = 99.4%), and prothrombin time (WMD = 0.84 s, 95% CI: 0.46–1.23, <italic>I</italic><sup>2</sup> = 99.4%) were significantly higher and that of albumin was lower (WMD = −4.52 g/L, 95% CI: −6.28 to −2.75, <italic>I</italic><sup>2</sup> = 99.9%) in severe cases. Moreover, the pooled OR of mortality was higher in patients with liver injury (OR = 2.72, 95% CI: 1.18–6.27, <italic>I</italic><sup>2</sup> = 71.6%).</p></sec><sec><title>Conclusions</title><p>Hepatocellular injury, liver metabolic, and synthetic function abnormality were observed in severe COVID-19. From a clinical perspective, liver injury has potential as a prognostic biomarker for screening severely affected patients at early disease stages.</p></sec><sec><title>Systematic review registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>, Identifier: CRD42022325206.</p></sec>