COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

Kukla, Michał; Skonieczna-Żydecka, Karolina; Kotfis, Katarzyna; Maciejewska, Dominika; Łoniewski, Igor; Lara, Luis F.; Pazgan−Simon, Monika; Stachowska, Ewa; Kaczmarczyk, Mariusz; Koulaouzidis, Anastasios; Marlicz, Wojciech

doi:10.3390/jcm9051420

Cited by 100 publications

(116 citation statements)

References 79 publications

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“…We have also compared our results with previous meta‐analysis (Table 3). 4,5,119‐125 This is the first study to report the liver involvement of all adults, pregnant patients and paediatric patients with COVID‐19. We have analysed in‐depth about the liver involvement in COVID‐19, including elevated liver chemistries at initial presentation, during illness and the impact of this on the outcome.…”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Kulkarni

Kumar

Tevethia

et al. 2020

Aliment Pharmacol Ther

219

310

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Summary Background The incidence of elevated liver chemistries and the presence of pre‐existing chronic liver disease (CLD) have been variably reported in COVID‐19. Aims To assess the prevalence of CLD, the incidence of elevated liver chemistries and the outcomes of patients with and without underlying CLD/elevated liver chemistries in COVID‐19. Methods A comprehensive search of electronic databases from 1 December 2019 to 24 April 2020 was done. We included studies reporting underlying CLD or elevated liver chemistries and patient outcomes in COVID‐19. Results 107 articles (n = 20 874 patients) were included for the systematic review. The pooled prevalence of underlying CLD was 3.6% (95% CI, 2.5‐5.1) among the 15 407 COVID‐19 patients. The pooled incidence of elevated liver chemistries in COVID‐19 was 23.1% (19.3‐27.3) at initial presentation. Additionally, 24.4% (13.5‐40) developed elevated liver chemistries during the illness. The pooled incidence of drug‐induced liver injury was 25.4% (14.2‐41.4). The pooled prevalence of CLD among 1587 severely infected patients was 3.9% (3%‐5.2%). The odds of developing severe COVID‐19 in CLD patients was 0.81 (0.31‐2.09; P = 0.67) compared to non‐CLD patients. COVID‐19 patients with elevated liver chemistries had increased risk of mortality (OR‐3.46 [2.42‐4.95, P < 0.001]) and severe disease (OR‐2.87 [95% CI, 2.29‐3.6, P < 0.001]) compared to patients without elevated liver chemistries. Conclusions Elevated liver chemistries are common at presentation and during COVID‐19. The severity of elevated liver chemistries correlates with the outcome of COVID‐19. The presence of CLD does not alter the outcome of COVID‐19. Further studies are needed to analyse the outcomes of compensated and decompensated liver disease.

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Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Kulkarni

Kumar

Tevethia

et al. 2020

Aliment Pharmacol Ther

219

310

View full text Add to dashboard Cite

show abstract

“…Liver injury primarily presented with aberrant elevation in alanine aminotransferase, aspartate aminotransferase and bilirubin levels [ 35 ]. The severity of COVID-19 has been suggested to be positively correlated with liver dysfunction in available data, where liver damage in mild cases of COVID-19 appears to be transient [ 35 ], with elevation in liver enzymes normalizing upon discharge or subsequent follow-up [ 39 ]. Liver involvement was also reported in SARS [ 40 ] and MERS [ 41 ] patients.…”

Section: Narrative Reviewmentioning

confidence: 99%

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

Leung

Chan

et al. 2020

Emerging Microbes & Infections

183

132

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The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.

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“…Thus, it appears reasonable that sympathetic activation in comorbidities may exert negative homeostasis effects in COVID‐19 also through renal effects. Moreover, liver injuries have also been reported in COVID‐19 patients [41] and sympathetic activation may also be detrimental for liver function [42].…”

Section: Sympathetic Overactivity May Exert Significant Detrimental Ementioning

confidence: 99%

Sympathetic activation: a potential link between comorbidities and COVID‐19

et al. 2020

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In coronavirus disease 2019 (COVID‐19), higher morbidity and mortality are associated with age, male gender, and comorbidities, such as chronic lung diseases, cardiovascular pathologies, hypertension, kidney diseases, diabetes mellitus, and obesity. All of the above conditions are characterized by increased sympathetic discharge, which may exert significant detrimental effects on COVID‐19 patients, through actions on the lungs, heart, blood vessels, kidneys, metabolism, and/or immune system. Furthermore, COVID‐19 may also increase sympathetic discharge, through changes in blood gases (chronic intermittent hypoxia, hyperpnea), angiotensin‐converting enzyme (ACE)1/ACE2 imbalance, immune/inflammatory factors, or emotional distress. Nevertheless, the potential role of the sympathetic nervous system has not yet been considered in the pathophysiology of COVID‐19. In our opinion, sympathetic overactivation could represent a so‐far undervalued mechanism for a vicious circle between COVID‐19 and comorbidities.

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COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

Cited by 100 publications

References 79 publications

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Systematic review with meta‐analysis: liver manifestations and outcomes in COVID‐19

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

Sympathetic activation: a potential link between comorbidities and COVID‐19

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