Department of Internal Medicine I.
Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Eur J Gastroenterol Hepatol. 2021 Sep 1;33(9):1194-1200. doi: 10.1097/MEG.0000000000001827.
Coronavirus disease-19 (COVID-19) infection is a global health threat. To inform the liver community on the potential relevance of COVID-19, we performed a systematic review and meta-analysis of published data on liver injury in patients with COVID-19 infection.
We searched PubMed and Google Scholar through 22 March according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled data were analyzed by using random-effects meta-analyses.
A total of 14 studies combining data from 2.871 patients were identified. The prevalence of pre-existing liver disease was reported at 3.1%. The pooled prevalence of elevated aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were 26% [95% confidence interval (CI), 20-32%] and 19% (95% CI, 14-26%), respectively. Only two studies reported the prevalence of elevated liver function tests according to normal ward versus ICU and here the frequency of elevated levels of AST was 50% and 62% versus ALT 40.8% and thus quantitatively higher in ICU-treated patients. Mean levels of absolute AST levels were 33 U/L (95% CI, 30.21-36.09), while mean ALT levels were 31 U/L (95% CI, 27.52-34.57). Cholestatic liver function tests were only incompletely reported in 510 patients. Here, mean levels of alkaline phosphatase were 71 U/L across three studies, and mean levels of gamma-glutamyl transferase were 40.6 U/L across four studies.
Emerging data on LFTs in COVID-19 are heterogeneous indicating mild LFTs involvement in every fourth to fifth patients with numerical more prevalent AST over ALT elevations. Prospective studies are needed to define the clinical relevance of liver injury in COVID-19.
新型冠状病毒病（COVID-19）感染是一项全球性的健康威胁。为了让肝脏领域的专家了解 COVID-19 可能带来的影响，我们对 COVID-19 感染患者的肝损伤相关研究进行了系统评价和荟萃分析。
我们根据系统评价和荟萃分析的首选报告项目，在 2023 年 3 月 22 日之前在 PubMed 和 Google Scholar 上进行了搜索。采用随机效应荟萃分析对汇总数据进行分析。
共确定了 14 项研究，这些研究综合了 2871 例患者的数据。报道的既往肝脏疾病患病率为 3.1%。天门冬氨酸氨基转移酶（AST）和丙氨酸氨基转移酶（ALT）水平升高的汇总患病率分别为 26%（95%置信区间，20%-32%）和 19%（95%置信区间，14%-26%）。只有两项研究报告了根据普通病房和 ICU 来划分的肝功能检查异常的患病率，AST 水平升高的频率分别为 50%和 62%，而 ALT 为 40.8%。因此，ICU 治疗的患者 AST 水平更高。AST 绝对值的平均水平为 33 U/L（95%置信区间，30.21-36.09），而 ALT 的平均水平为 31 U/L（95%置信区间，27.52-34.57）。仅有 510 例患者的胆汁淤积性肝功能检查结果不完整。其中，3 项研究中碱性磷酸酶的平均水平为 71 U/L，4 项研究中γ-谷氨酰转移酶的平均水平为 40.6 U/L。
COVID-19 患者的 LFT 数据不断涌现，存在异质性，表明每四到五例患者中就有一例出现轻度 LFT 受累，AST 升高比 ALT 升高更为常见。需要前瞻性研究来确定 COVID-19 中肝损伤的临床意义。
