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Elevated Liver Biochemistries in Hospitalized Chinese Patients With Severe COVID-19: Systematic Review and
Alexander J Kovalic1, Glen Huang2, Paul J Thuluvath3,4
1Department of Internal Medicine, Novant Forsyth Medical Center, Winston-Salem, NC.
Insights
Severe COVID-19 infection is linked to abnormal liver chemistry, including elevated liver enzymes and bilirubin. This highlights the importance of monitoring liver function in critically ill patients with coronavirus disease 2019.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Abnormal liver chemistry profiles have been observed in patients with coronavirus disease 2019 (COVID-19).
- The clinical significance of these hepatic manifestations in COVID-19 remains largely unknown.
- Comorbidities like cardiovascular and respiratory diseases are more common in severe COVID-19 cases.
Purpose of the Study:
- To systematically review and meta-analyze existing studies on liver chemistries in COVID-19 patients.
- To compare liver function test results between severe/critical and mild COVID-19 cases.
- To investigate the association between COVID-19 severity and abnormal liver function.
Main Methods:
- Systematic review and meta-analysis of six studies.
- Inclusion of 586 patients with COVID-19 infection.
- Comparison of liver chemistries (aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin) and other laboratory markers between severe/critical and mild illness groups.
Main Results:
- Severe/critical COVID-19 cases showed significantly elevated aspartate aminotransferase, total bilirubin, and decreased albumin compared to mild cases.
- A trend towards elevated alanine aminotransferase was observed in severe cases, but did not reach statistical significance.
- Severe illness was also associated with leukocytosis, neutrophilia, lymphopenia, elevated creatinine kinase, lactate dehydrogenase (LDH), and prolonged prothrombin time (PT).
Conclusions:
- Hospitalized patients with severe/critical COVID-19, particularly those with comorbidities, exhibit a higher likelihood of abnormal liver chemistries.
- These findings underscore the association between COVID-19 severity and hepatic dysfunction.
- Further prospective research is essential to elucidate the underlying pathophysiological mechanisms and clinical implications of these hepatic manifestations in COVID-19.
Background And 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 And Results:
This 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, cerebrovascular disease, and chronic obstructive pulmonary disease as compared with mild cases. A significant association between severe/critical COVID-19 infections with elevations in aspartate aminotransferase (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 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 coronary artery disease, cerebrovascular disease and chronic obstructive pulmonary disease, 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.
