Correlation of the transaminases alteration with the clinical severity of patients with COVID- 19: A meta-analysis of the first global outbreak

Abstract

Introduction: Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since December 2019 the infection is spreading globally with a huge contagious capacity posing in threat human health. In addition to common respiratory symptoms, some patients with COVID-19 experience gastrointestinal symptoms, and multiple alteration of liver enzymes. The prevalence of the alteration of the transaminases was eventually higher in patients with a more severe clinical course and abnormalities were observed only in few patients. Aim: The object of our study was to evaluate the association of the increased levels of transaminases (ALT and AST) with the severity of COVID-19 disease. Materials and Methods: We conducted a systematic review and a meta-analysis of the all studies published in English, assessing the transaminases levels in hospitalized patients with COVID-19. PubMed, Scopus and Medrxiv were searched to identify relevant articles published until 08/06/2020. Results: We review 4528 initial articles and only 36 met our inclusion criteria. Our analyses showed a significant increase of AST in non-survivors 1.39 (95% CI 1.23-1.59, I2=0) compared to survivors, in patients with severe disease 1.43 (95% CI 1.31-1.55, I2= 85%) compared to non-severe, and in patients admitted to ICU 1.56 (95% CI 1.41-1.73, I2= 16%) compared to one who weren't. As for the ALT the analyses showed same results, anyhow, there were no significant differences in the comparison between survivors and non-survivors. Conclusions: Patients infected with SARS-CoV-2 with a severe form, typically tend to have mildly moderately elevated ALT and/or AST compared to patient with a moderate form.