Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Hepatol Int. 2020 Sep;14(5):711-722. doi: 10.1007/s12072-020-10071-9. Epub 2020 Jul 4.
Liver function derangements have been reported in coronavirus disease (COVID-19), but reported rates are variable.
We searched PubMed and Embase with terms COVID and SARS-COV-2 from December 1, 2019 till April 5, 2020. We estimated overall prevalence, stratified prevalence based on severity, estimated risk ratio (RR), and estimated standardized mean difference (SMD) of liver function parameters in severe as compared to non-severe COVID. Random effect method utilizing inverse variance approach was used for pooling the data.
In all, 128 studies were included. The most frequent abnormalities were hypoalbuminemia [61.27% (48.24-72.87)], elevations of gamma-glutamyl transferase (GGT) [27.94% (18.22-40.27)], alanine aminotransferase (ALT) [23.28% (19.92-27.01)], and aspartate aminotransferase (AST) [23.41% (18.84-28.70)]. Furthermore, the relative risk of these abnormalities was higher in the patients with severe COVID-19 when compared to non-severe disease [Hypoalbuminemia-2.65 (1.38-5.07); GGT-2.31 (1.6-3.33); ALT-1.76 (1.44-2.15); AST-2.30 (1.82-2.90)]. The SMD of hypoalbuminemia, GGT, ALT, and AST elevation in severe as compared to non-severe were - 1.05 (- 1.27 to - 0.83), 0.76 (0.40-1.12), 0.42 (0.27-0.56), and 0.69 (0.52-0.86), respectively. The pooled prevalence and RR of chronic liver disease as a comorbidity was 2.64% (1.73-4) and 1.69 (1.05-2.73) respectively.
The most frequent abnormality in liver functions was hypoalbuminemia followed by derangements in gamma-glutamyl transferase and aminotransferases, and these abnormalities were more frequent in severe disease. The systematic review was, however, limited by heterogeneity in definitions of severity and liver function derangements. Graphical depiction of the summary of meta-analytic findings a) pooled prevalence of abnormalities b) Risk ratio of abnormality in severe versus non-severe COVID-19 c) standardized mean difference (SMD) between severe and non-severe group and d) pooled prevalence for parameters based on severity stratification for bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), albumin, globulin and acute hepatic injury (AHI) . Also estimates for overall/total liver disease (TLD) and chronic liver disease (CLD) amongst COVID-19 patients are depicted in a, b, d. For d) In addition to severity stratification, Overall (all studies for a particular estimate) and combined (only those studies which reported severity) estimates are provided.
在冠状病毒病（COVID-19）中已报道肝功能异常，但报道的发生率各不相同。
我们使用术语 COVID 和 SARS-COV-2 从 2019 年 12 月 1 日至 2020 年 4 月 5 日在 PubMed 和 Embase 上进行了搜索。我们根据严重程度对总体患病率进行分层，估计了严重 COVID-19 与非严重 COVID-19 相比的肝功能参数的相对风险比（RR）和标准化均数差（SMD）。利用逆方差方法的随机效应方法用于汇总数据。
总共纳入了 128 项研究。最常见的异常是低白蛋白血症[61.27%（48.24-72.87）]，γ-谷氨酰转移酶（GGT）升高[27.94%（18.22-40.27）]，丙氨酸氨基转移酶（ALT）[23.28%（19.92-27.01）]和天冬氨酸氨基转移酶（AST）[23.41%（18.84-28.70）]。此外，与非严重 COVID-19 相比，严重 COVID-19 患者这些异常的相对风险更高[低白蛋白血症-2.65（1.38-5.07）；GGT-2.31（1.6-3.33）；ALT-1.76（1.44-2.15）；AST-2.30（1.82-2.90）]。与非严重 COVID-19 相比，严重 COVID-19 患者低白蛋白血症、GGT、ALT 和 AST 升高的 SMD 分别为-1.05（-1.27 至-0.83）、0.76（0.40-1.12）、0.42（0.27-0.56）和 0.69（0.52-0.86）。慢性肝病作为合并症的合并患病率和 RR 分别为 2.64%（1.73-4）和 1.69（1.05-2.73）。
肝脏功能最常见的异常是低白蛋白血症，其次是 GGT 和氨基转移酶异常，这些异常在严重疾病中更为常见。然而，系统评价受到严重程度和肝功能异常定义的异质性限制。meta 分析结果的汇总图示描述 a）异常的总体患病率 b）严重与非严重 COVID-19 相比异常的风险比 c）严重与非严重组之间的标准化均数差（SMD）d）基于严重程度分层的胆红素、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（GGT）、白蛋白、球蛋白和急性肝损伤（AHI）参数的汇总患病率。此外，还描绘了 COVID-19 患者中总/总肝病（TLD）和慢性肝病（CLD）的估计值，a、b、d。对于 d）除了严重程度分层外，还提供了总体（特定估计值的所有研究）和合并（仅报告严重程度的研究）估计值。
