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49Background and Aims: Cumulating observations have indicated that patients with 50 coronavirus disease undergo different patterns of liver impairment. We 51 performed a meta-analysis of published liver manifestations and described the liver 52 damage in Methods: We searched PubMed, Google Scholar, Embase, Cochrane Library, 54 medRxiv, bioRxiv, and three Chinese electronic databases through April 18, 2020, in 55 accordance with the Preferred Reporting Items for Meta-Analyses. We analyzed 56 pooled data on liver chemistries stratified by COVID-19 severity using a fixed or 57 random-effects model. 58Results: In the meta-analysis of 37 studies, which included a total of 6,235 patients, 59 the pooled mean alanine aminotransferase (ALT) was 36.4 IU/L in the severe 60 COVID-19 cases and 27.8 IU/L in the non-severe cases (95% confidence interval [CI]: 61 −9.4 to −5.1, p < 0.0001). The pooled mean aspartate aminotransferase (AST) was 62 46.8 IU/L in the severe cases and 30.4 IU/L in the non-severe cases (95% CI: −15.1 to 63 −10.4, p < 0.0001). Furthermore, regardless of disease severity, the AST level is often 64higher than the ALT level. Compared with the non-severe cases, the severe cases 65 tended to have higher γ-glutamyltransferase levels but lower albumin levels. 66Conclusions: In this meta-analysis, we comprehensively described three patterns of 67 liver impairment related to COVID-19, namely hepatocellular injury, cholestasis, and 68 hepatocellular disfunction, according to COVID-19 severity. Patients with abnormal 69 liver test results are at higher risk of progression to severe disease. Close monitoring 70 of liver chemistries provides an early warning against disease progression. 71 72
Although abnormal liver chemistries are linked to a higher risk of coronavirus disease 2019 (COVID-19)-related death, liver manifestations may be diverse and even confusing. Thus, we performed a meta-analysis of published liver manifestations and described the liver damage in patients with COVID-19 who died or discharged alive. We searched PubMed, Google Scholar, medRxiv, bioRxiv, the Cochrane Library, Embase, and three Chinese electronic databases through April 22, 2020. We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19, using a fixed or random-effects model. In our meta-analysis of 19 studies, which included a total of 4,103 patients, the pooled mean alanine aminotransferase and aspartate aminotransferase levels were, respectively, 31.7 IU/L and 51.0 IU/L in the patients with COVID-19 who died and 27.7 IU/L and 32.9 IU/L in those discharged alive (both P < 0.0001). Compared with the patients discharged alive, those who died tended to have lower albumin levels but longer prothrombin time and higher international normalized ratio. Conclusion: In this meta-analysis, according to the main clinical outcome of COVID-19, we comprehensively describe three patterns of liver impairment related to COVID-19: hepatocellular injury, cholestasis, and hepatocellular disfunction. The patients who died from COVID-19 tended to have different liver chemistries from those discharged alive. Special caution should be given to the patients with a relatively higher index of liver chemistries. (Hepatology Communications 2020;0:1-12). C oronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a nonsegmented positive-sense RNA virus with an envelope belonging to the family Coronaviridae. The coronavirus is widely distributed in humans and other mammals. In the past 20 years, the coronavirus has caused several localized epidemics and even global pandemics, such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and the ongoing COVID-19 pandemic. Worldwide, the spread and upward trend of COVID-19 have accelerated dramatically. According to the situation report released by the World Health Organization (WHO), as of April 25, 2020, 2,719,897 COVID-19 cases were confirmed globally, with a fatality rate of 6.9%. (1) In response to the emerging threat, the WHO declared a Public Health Emergency of International Concern
49Background and Aims: Although abnormal liver chemistries are linked to higher 50 risk of death related to coronavirus disease , liver manifestations may be 51 diverse and even confused. Thus, we performed a meta-analysis of published liver 52 manifestations and described the liver damage in COVID-19 patients with death or 53 survival. 54Methods: We searched PubMed, Google Scholar, medRxiv, bioRxiv, Cochrane 55 Library, Embase, and three Chinese electronic databases through April 22, 2020. We 56 analyzed pooled data on liver chemistries stratified by the main clinical outcome of 57 COVID-19 using a fixed or random-effects model. 58Results: In the meta-analysis of 18 studies, which included a total of 2,862 patients,
BACKGROUND Primary liver cancer (PLC) is a major contributor to cancer-related deaths. Data on global and country-specific levels and trends of PLC are essential for understanding the effects of this disease and helping policymakers to allocate resources. AIM To investigate the association between the burden of PLC and socioeconomic development status. METHODS Cancer mortality and incidence rates were obtained from the Global Burden of Disease (GBD) 2019, and the data were stratified by country and territory, sex, and the Socio-demographic Index (SDI) level. The association between the attributable etiology of PLC and socioeconomic development status, represented using the SDI, was described. The attributable etiology of PLC included hepatitis B, hepatitis C, alcohol use, and nonalcoholic steatohepatitis. The association between the attributable etiology of PLC and SDI was further stratified by sex and geographical location. A confidence analysis was also performed based on bootstrap draw. RESULTS The age-standardized incidence rate of PLC was 6.5 [95% confidence intervals (CI): 5.9-7.2] per 100000 person-years, which decreased by -27.5% (-37.0 to -16.6) from 1990 to 2019. Several countries located in East Asia, South Asia, West Africa, and North Africa shouldered the heaviest burden of PLC in 2019. In terms of incidence rates, the first leading underlying cause of PLC identified was hepatitis B, followed by hepatitis C, alcohol use, and nonalcoholic steatohepatitis. Regarding stratification using the SDI, the incidence rate of PLC was the highest for high and middle SDI locations. Further, the leading attributable etiologies of PLC were hepatitis B for the middle and high middle SDI locations while hepatitis C and nonalcoholic steatohepatitis for the high SDI locations. CONCLUSION The pronounced association between socioeconomic development status and PLC burden indicates socioeconomic development status affects attributable etiologies for PLC. GBD 2019 data are valuable for policymakers implementing PLC cost-effective interventions.
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