Prognostic value of liver biochemical parameters for COVID-19 mortality

Ye, Lin; Chen, Bin; Wang, Yitong; Yang, Yi; Zeng, Jiling; Deng, Guangtong; Deng, Yuhao; Zeng, Furong

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) has brought great challenges to global public health. However, a comprehensive analysis of the relationship between liver biochemical parameters and COVID-19 mortality is quite limited. METHODS: We searched the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, Scopus, Wanfang and China National Knowledge Infrastructure database until May 5, 2020. STATA software was used for the statistical analyses. RESULTS: A total of 25 studies involving 5971 COVID-19 patients were included in our analysis. Compared with non-survivors, survivors had lower levels of aspartate aminotransferase (AST) (weighted mean difference [WMD] = -16.71 U/L, 95%CI = [-21.03, -12.40], P < 0.001), alanine transaminase (ALT) (WMD = -5.20U/L, 95%CI = [-8.00, -2.41], P < 0.001), total bilirubin (TBIL) (WMD = 4.40μmol/L, 95%CI = [-5.11, -3.70], P < 0.001) and lactic dehydrogenase (LDH) (WMD = -252.44U/L, 95%CI = [-289.57, -215.30], P < 0.001), and higher albumin (ALB) level (WMD = 4.47 g/L, 95%CI = [3.47, 5.47], P < 0.001). Besides, survivors had lower proportions of these abnormally increased parameters (AST: OR = 0.25, 95%CI = [0.15, 0.41], P < 0.001; ALT: OR = 0.49, 95%CI = [0.37, 0.64], P < 0.001; TBIL: (OR = 0.20, 95%CI = [0.12, 0.34], P < 0.001; LDH, OR = 0.09, 95%CI = [0.06, 0.14], P < 0.001), and lower proportion of abnormally decreased ALB (OR = 0.16, 95%CI = [0.07, 0.38], P < 0.001). Meta-analysis based on standard mean difference and sensitivity analysis did not change the conclusions. Egger test did not detect the presence of publication bias. CONCLUSIONS: Liver biochemical parameters were strongly correlated with COVID-19 mortality. Measurement of these liver biochemical parameters might assist clinicians to evaluate the prognosis of COVID-19.