Abstract
Background and aims: Several recent studies have reported an abnormal liver chemistry profile among patients with coronavirus disease 2019 (COVID-19), although its clinical significance remains unknown.
Approach and results: This systematic review and meta-analysis identified six studies of 586 patients delineating liver chemistries among patients with severe/critical illness versus mild cases of COVID-19 infection. Patients with severe/critical illness with COVID-19 infection have increased prevalence of coronary artery disease, cerebrovascular disease, and chronic obstructive pulmonary disease as compared with mild cases. A significant association between severe/critical COVID-19 infections with elevations in aspartate aminotransferase (pooled mean difference [MD], 11.70 U/L; 95% confidence interval [CI], 2.97, 20.43; P = 0.009), elevated total bilirubin (pooled MD, 0.14 mg/dL; 95% CI, 0.06, 0.22; P = 0.0005), and decreased albumin (pooled MD, -0.68 g/L; 95% CI, -0.81, -0.55; P < 0.00001) was noted. There was also a trend toward elevated alanine aminotransferase levels among these severe cases (pooled MD, 8.84 U/L; 95% CI, -2.28, 19.97; P = 0.12); however, this did not reach statistical significance. More severe/critically ill cases were associated with leukocytosis, neutrophilia, lymphopenia, elevated creatinine kinase, elevated lactate dehydrogenase (LDH), and elevated prothrombin time (PT).
Conclusions: Comorbidities, including coronary artery disease, cerebrovascular disease and chronic obstructive pulmonary disease, are more prevalent in hospitalized Chinese patients with severe/critical illness from COVID-19, and these patients are more likely to manifest with abnormal liver chemistries. Further prospective studies are crucial to understand the pathophysiologic mechanisms underlying the hepatic manifestations of the novel COVID-19 infection and its clinical significance.
【초록키워드】 COVID-19, coronavirus disease, Meta-analysis, Coronavirus disease 2019, Hospitalized, Prospective Study, Infection, Comorbidities, LDH, systematic review, lactate dehydrogenase, lymphopenia, Coronary artery disease, Prevalence, Critically ill, COVID-19 infection, Patient, albumin, Aspartate aminotransferase, Clinical significance, liver, mechanism, prothrombin, pulmonary disease, association, Leukocytosis, Lactate, creatinine, chronic obstructive pulmonary disease, Bilirubin, Cerebrovascular disease, manifestation, Prothrombin time, obstructive pulmonary disease, Coronary artery, alanine aminotransferase, creatinine kinase, total bilirubin, 95% CI, 95% confidence interval, COVID-19 infections, statistical significance, mild cases, aspartate, Elevation, Alanine, Severe case, mean difference, neutrophilia, elevations, elevated lactate dehydrogenase, prevalent, reported, elevated, chronic obstructive, Chinese patient, mild case, pathophysiologic, with COVID-19, 【제목키워드】 review, Chinese,