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Abstract

viewing of these articles and therefore were included in our pooled meta-analysis.Second, our outlined search strategy will encompass all studies reporting raw data on liver biochemistries as aspartate aminotransferase or alanine aminotransferase, which was our primary focus.Third, we recognize the significant heterogeneity across certain pooled analyses among the studies. We have listed this specifically in the Discussion section regarding limitations of this article.Fourth, we certainly recognize the limited sample size among the data available at the time of this metaanalysis. See further discussion below as well as within our article.Fifth, as discussed in the Methods section, we chose to assess the degree of bias using the Newcastle-Ottawa Scale, which is a well-validated tool to assess the risk of bias across nonrandomized studies.Sixth, we did not use a designated research protocol in the formulation of this article. However, we have conducted this article according to the standards for systematic reviews and meta-analyses and current journal guidelines.Seventh, although it is true that the current Cochrane Handbook for Systematic Reviews of Interventions states the power of the Egger's test is low when there are fewer than 10 studies, we chose to include this and corresponding funnel plots in our analysis to provide at least some barometer of publication bias.Overall, this systematic review and meta-analysis was done early (before March 22, 2020) when almost all the COVID-19 pandemic data originated from China. We have acknowledged the limitations of our study in the Discussion section. Limited sample size and heterogeneity of the studies are a reflection of early studies coming out of China. Despite these limitations, the external validity of this systematic review and meta-analysis remains strong. Since our article was submitted, many other meta-analyses have been performed and have confirmed our findings. (1)(2)(3) We sincerely hope that more studies from Europe and North America will shed additional information on liver-test abnormalities and COVID-19 infections.