Prognostic value of liver biochemical parameters for COVID-19 mortality

Abstract

Introduction Coronavirus Disease 2019 (COVID-19) has brought great challenges to global public health. However, a comprehensive analysis of the relationship between liver biochemical parameters and COVID-19 mortality is quite limited. Methods We searched the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, Scopus, Wanfang and China National Knowledge Infrastructure database until May 5, 2020. STATA software was used for the statistical analyses. Results A total of 25 studies involving 5971 COVID-19 patients were included in our analysis. Compared with non-survivors, survivors had lower levels of aspartate aminotransferase (AST) (weighted mean difference [WMD] = -16.71 U/L, 95%CI = [-21.03, -12.40], P < 0.001), alanine transaminase (ALT) (WMD = -5.20U/L, 95%CI = [-8.00, -2.41], P < 0.001), total bilirubin (TBIL) (WMD = 4.40μmol/L, 95%CI = [-5.11, -3.70], P < 0.001) and lactic dehydrogenase (LDH) (WMD = -252.44U/L, 95%CI = [-289.57, -215.30], P < 0.001), and higher albumin (ALB) level (WMD = 4.47 g/L, 95%CI = [3.47, 5.47], P < 0.001). Besides, survivors had lower proportions of these abnormally increased parameters (AST: OR = 0.25, 95%CI = [0.15, 0.41], P < 0.001; ALT: OR = 0.49, 95%CI = [0.37, 0.64], P < 0.001; TBIL: (OR = 0.20, 95%CI = [0.12, 0.34], P < 0.001; LDH, OR = 0.09, 95%CI = [0.06, 0.14], P < 0.001), and lower proportion of abnormally decreased ALB (OR = 0.16, 95%CI = [0.07, 0.38], P < 0.001). Meta-analysis based on standard mean difference and sensitivity analysis did not change the conclusions. Egger test did not detect the presence of publication bias. Conclusions Liver biochemical parameters were strongly correlated with COVID-19 mortality. Measurement of these liver biochemical parameters might assist clinicians to evaluate the prognosis of COVID-19.

The Lactate/Albumin Ratio As A Prognostic Factor For Short Time Mortality In Critically Ill COVID-19 Patients

“…Also, older age, male sex, comorbidity, and obesity can impact survival in patients with COVID-19. 3,4,[24][25][26][27][28] We found significant differences between the survivors and the non-survivors in terms of age, gender, lymphocyte, NT-proBNP, LDH, ferritin, CRP, and procalcitonin, as showed by recently published studies.…”

“…1,2 Due to the COVID-19 is associated with a high risk of mortality and morbidity in critically ill patients, lots of clinical studies have focused on the identification of prognostic factors to reduce COVID-19 associated mortality. 3,4 The level of serum lactate is the most commonly used biomarker for the management of critically ill patients in the emergency department and intensive care unit (ICU). 5 Hyperlactatemia or elevated levels of serum lactate may be caused by different clinical settings including sepsis, liver diseases, shock, and cancer.…”

Characteristics and in-hospital outcomes of COVID-19 patients with abnormal liver biochemical tests

“…Notably, a minority of them may progress into liver failure[ 7 ]. Some studies suggested that abnormal liver biochemical tests, especially elevated aspartate aminotransferase (AST), be closely associated with severe outcome[ 2 , 8 ] and death[ 9 , 10 ] in COVID-19 patients. Contrarily, others indicated no significant correlation of abnormal liver biochemical tests with mortality[ 11 ] or disease severity[ 12 ].…”

Gender Characteristics of the Novel Coronavirus Infection (COVID-19) in Middle-Aged Adults

“…The increased transaminase activity in patients with COVID-19 is thought to be a predictor of a poor outcome of the disease [29][30][31][32][33]. The causes of liver dysfunction in COVID-19 may vary: it can be either direct damage to hepatocytes by the SARS-CoV-2 virus or a cytokine storm result.…”