Elevated Liver Biochemistries in Hospitalized Chinese Patients with Severe COVID‐19: Systematic Review and Meta‐analysis

Kovalic, Alexander J.; Huang, Glen; Thuluvath, Paul J.; Satapathy, Sanjaya K.

BACKGROUND & 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 & RESULTS: This novel 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 (CAD), cerebrovascular disease, and chronic obstructive pulmonary disease (COPD) as compared to mild cases. A significant association between severe/critical COVID‐19 infections with elevations in aspartate aminotransferase (AST) (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 (ALT) 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 CAD, cerebrovascular disease, and COPD, 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.