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

Abstract

BackgroundThe 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.MethodsA 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.ResultsForty-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, I2 = 99.2%), aspartate aminotransferase (WMD = 13.98 U/L, 95% CI: 12.13–15.83, I2 = 98.2%), gamma-glutamyl transpeptidase (WMD = 20.67 U/L, 95% CI: 14.24–27.10, I2 = 98.8%), total bilirubin (WMD = 2.98 μmol/L, 95% CI: 1.98–3.99, I2 = 99.4%), and prothrombin time (WMD = 0.84 s, 95% CI: 0.46–1.23, I2 = 99.4%) were significantly higher and that of albumin was lower (WMD = −4.52 g/L, 95% CI: −6.28 to −2.75, I2 = 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, I2 = 71.6%).ConclusionsHepatocellular 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.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, Identifier: CRD42022325206.

Asymptomatic COVID-19 presenting with features of mixed pattern acute liver injury in a young healthy female, a case report

“…Upon literature review, a recent meta-analysis by Yang et al reported that patients with gastrointestinal symptoms had higher AST and ALT than those without the G.I. symptoms, as seen in our case [7] . The most common pattern of liver damage in COVID-19 patients is hepatocellular injury.…”

“…One of the commonly reported complications includes acute liver injury with a prevalence of 19 % (range: 1–53 %) [2] , [6] , and the clinical manifestation can range from being asymptomatic to acute liver failure with signs of decompensation [4] . The severity of liver damage usually correlates with the severity of COVID-19 infection [7] , underlying chronic liver disease like alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis, autoimmune hepatitis, chronic viral hepatitis, and hepatocellular carcinoma [4] , [8] , [9] , [10] . The underlying pathophysiology of COVID-19-induced liver injury is not clear; however, the proposed mechanism is related to direct cytopathic viral effect, cytokine storm leading to immune-mediated hepatitis, hypoxic injury, drug-induced liver toxicity, and underlying chronic liver diseases [2] , [3] , [7] , [8] as mentioned in Fig.…”

“…It is also well known that SARS-Cov-2 attaches to ACE2 receptor found in pulmonary, biliary ad hepatic epithelia. Furthermore, detecting the virus in stools suggests universal hepatic involvement via first pass effect irrespective of the elevation of liver or biliary enzymes [7] . Our patient presented with nausea, vomiting, clinically evident jaundice, direct hyperbilirubinemia, and high levels of transaminases, as mentioned in table:1.…”

“…The most common pattern of liver damage in COVID-19 patients is hepatocellular injury. However, the cholestatic and mixed pattern is also seen, especially due to certain drugs like systemic corticosteroids, antivirals like remdesivir, immunoregulatory factors like Tocilizumab and antibiotics used in COVID-19 management [6] , [7] . The mixed pattern of liver injury and severity of liver damage seen in our patient without any chronic liver disease, triggering drug or severe COVID 19 infection has not been reported in the literature.…”

An Updated Systematic Review and Meta-Analysis of the Association between the De Ritis Ratio and Disease Severity and Mortality in Patients with COVID-19

“…Several mechanisms may account for the onset and progression of liver damage in COVID-19 [16,[70][71][72]. For example, SARS-CoV-2 RNA and viral particles have been de-Life 2023, 13, 1324 9 of 13 tected in the liver parenchyma of patients with COVID-19 [73][74][75].…”