Abstract
Background: Abnormal liver chemistries are common findings in patients with COVID-19. It is unclear whether abnormal liver chemistries can predict the severity of COVID-19. Therefore, we compared the serum liver chemistries such as hepatic transaminases, total bilirubin, albumin, and prothrombin time to evaluate whether they can predict severity and mortality in COVID-19.Methods: An electronic search was performed on PubMed/Medline, EMBASE, and Google Scholar for studies comparing liver chemistries in severe and mild COVID-19. The literature search was performed using keywords “COVID-19,” “Liver,” Aspartate Aminotransferase (AST),” and “Alanine Aminotransferase (ALT),” “AST,” and “ALT,” in various combinations of “AND/OR” from December 1, 2019, till May 8, 2020. The pooled weighted mean difference (WMD) and 95% confidence interval (CI) were calculated for each component of liver chemistries.Results: Twenty-two studies were eligible, with 3,256 patients (54.57% males). Seventeen studies compared liver chemistries for severe vs. mild COVID-19, whereas five studies compared liver chemistries in survival vs. non-survival groups. The pooled WMD of AST and ALT in severe vs. mild COVID-19 were 12.23 (95% CI; 8.07, 16.39; p < 0.01) and 8.07 (95% CI 2.55, 11.91; p < 0.01), respectively. The pooled WMD for AST in survivors vs. non-survivors analysis was 8.82 (n = 789; 95% CI; 2.27, 15.37; p < 0.01) and that of ALT was 4.70 (n = 340; 95% CI 0.04,9.35; p = 0.05).Conclusion: Our meta-analysis shows that deranged liver chemistries may indicate severe COVID-19 and could also predict mortality. Larger studies are needed to evaluate the relationship between derangement in liver chemistries and mortality in COVID-19.
Highlights
Abnormal liver chemistries are common findings in patients with COVID-19
It is postulated that the virus enters the human body by binding to the angiotensin-converting enzyme receptor-2 (ACE-2) with the help of spike protein on its cell membrane [3]
The pooled weighted mean difference (WMD) of albumin in mild vs. severe COVID-19 was −5.89 (n = 1,408; 95% confidence interval (CI) −9.31, −2.46; p < 0.01) (Figure 4), indicating low albumin may be associated with severe COVID19
Summary
Abnormal liver chemistries are common findings in patients with COVID-19. It is unclear whether abnormal liver chemistries can predict the severity of COVID-19. The disease rapidly spread throughout the world, becoming a pandemic, and as of May 11, 2020, there were > 4 million cases worldwide with >278,000 deaths [1]. Newonset loss of taste or smell has gained attention as important symptoms of COVID-19 [6, 7]. The reason for these extrapulmonary symptoms could be the presence of ACE-2 receptors of SARS-CoV-2, in the gastrointestinal tract, liver, and pancreas
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