Liver injury could be associated with severe disease in COVID-19 patients: A meta-analysis

Objective: To assess the association between liver injury and the severity of Corona Virus Disease 2019 (COVID-19) disease Methods: Articles including severe vs non-severe or dead vs surviving COVID-19 patients were identified by searching the electronic database including PubMed, Embase and the Cochrane Library database The meta-analysis was carried out using software RevMan 5 3 A fixed- or random-effects model was used depending on the heterogeneity between studies Furthermore, publication bias was evaluated by the visual inspection of funnel plot Results: Thirty-six studies involving 7083 patients were taken into analysis The incidence of patients with chronic liver disease was not significantly associated with an enhanced risk of severe COVID-19 (OR: 1 36, 95% CI: 0 89-2 07, P = 16) The total bilirubin (TB), lactate dehydrogenase (LDH), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were found to be obviously elevated in COVID-19 patients with severe group [TB: MD: 1 68, 95% CI: 1 17-2 19, P \u003c 0001;LDH: MD: 122 66, 95% CI: 86 50-158 81, P \u003c 0001;ALT: MD = 5 73, 95% CI (4 32, 7 14), P \u003c 0001;AST: MD = 9 41, 95% CI (6 51, 12 31), P \u003c 0001] and mortality group [TB: MD: 3 90, 95% CI: 2 63-5 18, P \u003c 0001;LDH: MD: 246 30, 95% CI: 176 78-315 82, P \u003c 0001;ALT: MD = 5 64, 95% CI (0 52, 10 75), P = 03;AST: MD = 12 93, 95% CI (4 95, 20 91), P = 002] Albumin was significantly lower in COVID-19 patients with severe group (MD: -4 48, 95% CI: -6 51, -2 44, P \u003c 0001) and mortality group (MD: -4 80, 95% CI: -5 94, -3 67, P \u003c 0001) Based on visual inspection of funnel plots, no evidence of publication bias was found Conclusions: According to our results, liver injury may be an important sign of COVID-19 associated to a severe form of disease, which can guide the clinicians in recognizing critically ill patients earlier and faster However, due to the limitations of this study, more high-quality research is required