Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing 100191, China.
Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
Int J Med Sci. 2021 Jan 18;18(5):1285-1296. doi: 10.7150/ijms.51174. eCollection 2021.
Considering transaminase more than the upper limit of normal value as liver injury might overestimate the prevalence of liver involvement in COVID-19 patients. No meta-analysis has explored the impact of varied definitions of liver injury on the reported prevalence of liver injury. Moreover, few studies reported the extent of hypertransaminasemia stratified by COVID-19 disease severity. A literature search was conducted using PubMed and Embase. The pooled prevalence of liver injury and hypertransaminasemia was estimated. In total, 60 studies were included. The overall prevalence of liver injury was 25%. Compared to subgroups with the non-strict definition of liver injury (33%) and subgroups without giving detailed definition (26%), the subgroup with a strict definition had a much lower prevalence of liver injury (9%). The overall prevalence of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation was 19% and 22%. The prevalence of elevated ALT and AST were significantly higher in severe COVID-19 cases compare to non-severe cases (31% vs 16% and 44% vs 11%). In critically ill and fatal cases, no difference was found in the prevalence of elevated ALT (24% vs 30%) or AST (54% vs 49%). Sensitivity analyses indicated that the adjusted prevalence of ALT elevation, AST elevation, and liver injury decreased to 14%, 7%, and 12%. The overall prevalence of liver injury and hypertransaminasemia in COVID-19 patients might be overestimated. Only a small fraction of COVID-19 patients have clinically significant liver injury. The prevalence of hypertransaminasemia was significantly higher in severe COVID-19 cases compare to non-severe cases. Hence, in severe COVID-19 patients, more attention should be paid to liver function tests.
将转氨酶超过正常值上限视为肝损伤可能会高估 COVID-19 患者肝脏受累的患病率。目前还没有荟萃分析探讨不同肝损伤定义对报告的肝损伤患病率的影响。此外，很少有研究报告根据 COVID-19 疾病严重程度分层的高转氨酶血症的严重程度。
使用 PubMed 和 Embase 进行了文献检索。估计了肝损伤和高转氨酶血症的总患病率。共纳入 60 项研究。肝损伤的总患病率为 25%。与非严格定义肝损伤亚组（33%）和无详细定义亚组（26%）相比，严格定义亚组的肝损伤患病率明显较低（9%）。丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）升高的总患病率分别为 19%和 22%。与非重症 COVID-19 病例相比，重症 COVID-19 病例中 ALT 和 AST 升高的患病率显著更高（31% vs. 16%和 44% vs. 11%）。在危重症和死亡病例中，ALT 升高（24% vs. 30%）或 AST 升高（54% vs. 49%）的患病率无差异。敏感性分析表明，ALT 升高、AST 升高和肝损伤的调整后患病率分别降至 14%、7%和 12%。
COVID-19 患者肝损伤和高转氨酶血症的总患病率可能被高估。只有一小部分 COVID-19 患者有临床显著的肝损伤。与非重症 COVID-19 病例相比，重症 COVID-19 病例中高转氨酶血症的患病率显著更高。因此，在重症 COVID-19 患者中，应更加关注肝功能检查。
