Liver Chemistries In Patients With COVID-19 Who Survived Or Died

OBJECTIVESAlthough abnormal liver chemistries are linked to a higher risk of coronavirus disease 2019(COVID-19)-related death,liver manifestations may be diverse and even confusing.Thus,we performed a meta-analysis of published liver manifestations and described the liver damage in patients with COVID-19 who died or survived.METHODSWe searched PubMed,Google Scholar,medRxiv,bioRxiv,the Cochrane Library,Embase,and three Chinese electronic databases(Chinese National Knowledge Infrastructure,CQVIP,and Wanfang Data)through April 22,2020.The inclusion criteria were as follows:(1)study population:adult patients with COVID-19 who died or survived;(2)study design:case report,case series,retrospective cohort study,prospective cohort study,randomized controlled trial,and case-control study;and(3)language:studies published in English or Chinese.The exclusion criteria were as follows:(1)pregnant women or pediatric patients;(2)patients who lacked nucleic acid data or serological evidence of SARS-CoV2 infection;asymptomatic patients with SARS-CoV2 infection;(3)study design:commentary,editorial,review article,or meta-analysis;(4)results:studies that only reported the percentages of the indexes related to liver chemistries rather than the mean or average values,and single-arm studies(e.g.,only the data of mortality cases were reported,excluding data from survival cases,and vice versa).We analyzed pooled data on liver chemistries stratified by the main clinical outcome of COVID-19,using a fixed or random-effects model.R statistical platform version 3.2.3(R Foundation for Statistical Computing)was used for the statistical analysis.RESULTSIn our meta-analysis of 19 studies,which included a total of 4,103 patients,the pooled mean alanine aminotransferase and aspartate aminotransferase levels were respectively 31.7 and 51.0 IU/L in the patients with COVID-19 who died and 27.7 and 32.9 IU/L in those discharged alive(both p<0.0001).Compared with the patients discharged alive,those who died tended to have lower albumin levels but longer prothrombin time and higher international standardized ratio.Albumin levels,prothrombin time,and international standardized ratio were 30.1 g/L,14.4 second,and 1.24,respectively,for the died while 35.0 g/L,12.7 second,and 1.06 for the discharged alive,all p<0.0001.CONCLUSIONSComprehensive differences in liver chemistries related to hepatocellular injury,cholestasis,and hepatocellular disfunction exist in the patients with COVID-19 who survived or died.Patients with abnormal liver chemistries are at higher risk of worse outcome.Close monitoring of liver chemistries provides an early warning against COVID-19-related death.