Int J Med Sci 2021; 18(5):1285-1296. doi:10.7150/ijms.51174

Research Paper

Is liver involvement overestimated in COVID-19 patients? A meta-analysis

Gang Li1*, Yitian Yang2*, Danyang Gao3, Yongxing Xu4✉, Jianwen Gu5✉, Pengfei Liu6✉

1. Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing 100191, China.
2. Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
3. Department of Anesthesiology, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing 100038, China.
4. Department of Nephrology, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China.
5. The Leading Group on COVID-19 Prevention and Control, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing 100101, China.
6. Department of Anesthesiology, Capital Medical University affiliated Beijing Shijitan Hospital, Beijing 100038, China.
*These authors contribute equally to this work.

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Citation:
Li G, Yang Y, Gao D, Xu Y, Gu J, Liu P. Is liver involvement overestimated in COVID-19 patients? A meta-analysis. Int J Med Sci 2021; 18(5):1285-1296. doi:10.7150/ijms.51174. Available from https://www.medsci.org/v18p1285.htm

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Abstract

Background: Considering transaminase more than the upper limit of normal value as liver injury might overestimate the prevalence of liver involvement in COVID-19 patients. No meta-analysis has explored the impact of varied definitions of liver injury on the reported prevalence of liver injury. Moreover, few studies reported the extent of hypertransaminasemia stratified by COVID-19 disease severity.

Methods: A literature search was conducted using PubMed and Embase. The pooled prevalence of liver injury and hypertransaminasemia was estimated.

Results: In total, 60 studies were included. The overall prevalence of liver injury was 25%. Compared to subgroups with the non-strict definition of liver injury (33%) and subgroups without giving detailed definition (26%), the subgroup with a strict definition had a much lower prevalence of liver injury (9%). The overall prevalence of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation was 19% and 22%. The prevalence of elevated ALT and AST were significantly higher in severe COVID-19 cases compare to non-severe cases (31% vs 16% and 44% vs 11%). In critically ill and fatal cases, no difference was found in the prevalence of elevated ALT (24% vs 30%) or AST (54% vs 49%). Sensitivity analyses indicated that the adjusted prevalence of ALT elevation, AST elevation, and liver injury decreased to 14%, 7%, and 12%.

Conclusion: The overall prevalence of liver injury and hypertransaminasemia in COVID-19 patients might be overestimated. Only a small fraction of COVID-19 patients have clinically significant liver injury. The prevalence of hypertransaminasemia was significantly higher in severe COVID-19 cases compare to non-severe cases. Hence, in severe COVID-19 patients, more attention should be paid to liver function tests.

Keywords: COVID-19, hypertransaminemia, liver injury, alanine aminotransferase, aspartate aminotransferase, meta-analysis