Liver Chemistries in Patients with Severe or Non-Severe COVID-19: a Meta-Analysis

Background and AimsCumulating observations have indicated that patients with coronavirus disease (COVID-19) undergo different patterns of liver impairment. We performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19. MethodsWe searched PubMed, Google Scholar, Embase, Cochrane Library, medRxiv, bioRxiv, and three Chinese electronic databases through April 18, 2020, in accordance with the Preferred Reporting Items for Meta-Analyses. We analyzed pooled data on liver chemistries stratified by COVID-19 severity using a fixed or random-effects model. ResultsIn the meta-analysis of 37 studies, which included a total of 6,235 patients, the pooled mean alanine aminotransferase (ALT) was 36.4 IU/L in the severe COVID-19 cases and 27.8 IU/L in the non-severe cases (95% confidence interval [CI]: - 9.4 to - 5.1, p < 0.0001). The pooled mean aspartate aminotransferase (AST) was 46.8 IU/L in the severe cases and 30.4 IU/L in the non-severe cases (95% CI: - 15.1 to - 10.4, p < 0.0001). Furthermore, regardless of disease severity, the AST level is often higher than the ALT level. Compared with the non-severe cases, the severe cases tended to have higher {gamma}-glutamyltransferase levels but lower albumin levels. ConclusionsIn this meta-analysis, we comprehensively described three patterns of liver impairment related to COVID-19, namely hepatocellular injury, cholestasis, and hepatocellular disfunction, according to COVID-19 severity. Patients with abnormal liver test results are at higher risk of progression to severe disease. Close monitoring of liver chemistries provides an early warning against disease progression. Lay SummaryData on abnormal liver chemistries related to coronavirus disease (COVID-19) are cumulating but are potentially confusing. We performed a meta-analysis of 37 studies that included a total of 6,235 patients with COVID-19. We noted that patients with abnormal liver test results are at higher risk of progression to severe disease and close monitoring of liver chemistries provides early warning against disease progression.