Krishnamoorthy Yuvaraj, Karunakaran Monica, Ganesh Karthika, Hariharan Vishnu Shankar
Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, Tamil Nadu, India.
Department of Anaesthesiology and Pain Management, SRM Institute of Medical Sciences, Tamil Nadu, India.
Heliyon. 2023 Sep 20;9(9):e20338. doi: 10.1016/j.heliyon.2023.e20338. eCollection 2023 Sep.
Acute liver injury (ALI), a complication often seen in COVID-19 patients, can lead to severe liver damage, multi-organ failure, acute vascular events, and can potentially escalate to patient mortality. Given this, we initiated a meta-analysis to investigate the correlation between ALI and adverse outcomes in COVID-19 patients.
We conducted an exhaustive search of databases, including Medline, Embase, PubMed Central, ScienceDirect, Google Scholar, and the Cochrane Library, from the November 2019 until January 2022. The quality of the included studies was evaluated using the Newcastle Ottawa (NO) scale. Our meta-analysis was carried out using a random-effects model and results were presented as pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs).
Our analysis incorporated 20 studies involving a total of 13,850 participants, predominantly from China and the United States. According to the NO scale, the majority of these studies were categorized as low-quality. Patients with ALI faced approximately 7 times higher odds of severe COVID-19 symptoms (pooled OR = 7.09; 95%CI: 4.97 to 10.12) and over 5 times higher odds of mortality (pooled OR = 5.50; 95%CI: 3.37 to 8.99) when compared to those without ALI.
Our findings affirm that ALI is a potent predictor of adverse outcomes, including severity and mortality, among COVID-19 patients. Recognizing and promptly addressing ALI in COVID-19 patients could be pivotal in improving prognosis and tailoring individualized patient management strategies. This underscores the need for clinicians to be vigilant about liver complications in the COVID-19 patients and integrate appropriate interventions in the treatment paradigm.
急性肝损伤（ALI）是新冠病毒病（COVID-19）患者常见的并发症，可导致严重肝损伤、多器官功能衰竭、急性血管事件，并可能导致患者死亡。鉴于此，我们开展了一项荟萃分析，以研究COVID-19患者中ALI与不良结局之间的相关性。
我们对2019年11月至2022年1月期间的数据库进行了全面检索，包括Medline、Embase、PubMed Central、ScienceDirect、谷歌学术和Cochrane图书馆。使用纽卡斯尔渥太华（NO）量表评估纳入研究的质量。我们的荟萃分析采用随机效应模型进行，结果以合并比值比（OR）及其相应的95%置信区间（CI）表示。
我们的分析纳入了20项研究，共13850名参与者，主要来自中国和美国。根据NO量表，这些研究中的大多数被归类为低质量。与无ALI的患者相比，ALI患者出现严重COVID-19症状的几率高约7倍（合并OR = 7.09；95%CI：4.97至10.12），死亡几率高5倍多（合并OR = 5.50；95%CI：3.37至8.99）。
我们的研究结果证实，ALI是COVID-19患者不良结局（包括严重程度和死亡率）的有力预测指标。认识到并及时处理COVID-19患者的ALI可能是改善预后和制定个体化患者管理策略的关键。这突出了临床医生需要对COVID-19患者的肝脏并发症保持警惕，并在治疗模式中纳入适当的干预措施。
