Liver Chemistries in COVID-19 Patients with Survival or Death: A Meta-Analysis

  1. Qing-Qing Xing
  2. Xuan Dong
  3. Yan-Dan Ren
  4. Wei-Ming Chen
  5. Dan-Yi Zeng
  6. Yan-Yan Cai
  7. Mei-Zhu Hong
  8. Jin-Shui Pan

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Abstract

Background and Aims

Although abnormal liver chemistries are linked to higher risk of death related to coronavirus disease (COVID-19), liver manifestations may be diverse and even confused. Thus, we performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19 patients with death or survival.

Methods

We searched PubMed, Google Scholar, medRxiv, bioRxiv, Cochrane Library, Embase, and three Chinese electronic databases through April 22, 2020. We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19 using a fixed or random-effects model.

Results

In the meta-analysis of 18 studies, which included a total of 2,862 patients, the pooled mean alanine aminotransferase (ALT) was 30.9 IU/L in the COVID-19 patients with death and 26.3 IU/L in the COVID-19 patients discharged alive (p < 0.0001). The pooled mean aspartate aminotransferase (AST) level was 45.3 IU/L in the COVID-19 patients with death while 30.1 IU/L in the patients discharged alive (p < 0.0001). Compared with the discharged alive cases, the dead cases tended to have lower albumin levels but longer prothrombin time, and international standardized ratio.

Conclusions

In this meta-analysis, according to the main clinical outcome of COVID-19, we comprehensively described three patterns of liver impairment related to COVID-19, hepatocellular injury, cholestasis, and hepatocellular disfunction. Patients died from COVID-19 tend to have different liver chemistries from those are discharged alive. Close monitoring of liver chemistries provides an early warning against COVID-19 related death.

Lay Summary

Abnormal liver chemistries are linked to higher risk of death related to coronavirus disease (COVID-19). We performed a meta-analysis of 18 studies that included a total of 2,862 patients with COVID-19. We noted that patients died from COVID-19 tend to have different liver chemistries from those are discharged alive and close monitoring of liver chemistries provides early warning against COVID-19 related death.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.26.20080580: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Studies selection: The following databases were searched from December 1, 2019 to April 22, 2020, including PubMed, Google Scholar, medRxiv, bioRxiv, Embase, Cochrane Library, and three Chinese electronic databases (Chinese National Knowledge Infrastructure CQVIP, and Wanfang Data).
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    Details of searching PubMed were listed in the Supplementary file.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, our study has a few limitations. As mentioned earlier, cholestasis-related indices were remarkably under-reported, which hindered us from getting more precise pooled data. Second, all the enrolled studies came from mainland China, which restricted a more precise estimation of abnormal liver chemistries in the context of diverse other ethnics. However, this conversely helps to abate the heterogeneity caused by the physiological differences.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.04.26.20080580v1 on medRxiv