Mundra Paul, Kailani Zeena, Yaghoobi Mohammad, Matthews Priscilla, Tobis Matthew, Sadeghian Shadi, Albashir Siwar
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Can Liver J. 2024 Dec 19;7(4):470-489. doi: 10.3138/canlivj-2024-0010. eCollection 2024 Dec.
Post-acute COVID-19 syndrome (PACS; long COVID) is characterized by persistent or delayed symptoms at least 4 weeks from acute COVID-19 infection. Given the well-documented incidence of liver injury in acute COVID-19, this systematic review aims to assess the odds of liver injury in earlier experiencers of PACS.
Observational studies published prior to March 2022 were screened for data describing liver injury (defined per primary study) in patients with PACS.
A total of 2,117 abstracts and 35 full texts were screened, of which 26 met the inclusion criteria. The mean time since acute COVID infection across all studies was 195.5 days. Seven studies included COVID-negative control groups. Twenty-three studies measured lab findings, and nine studies measured imaging or elastography. Five studies were eligible for meta-analysis of odds ratios, which did not demonstrate a statistically significant difference in odds for liver injury in patients with PACS compared with COVID-negative patients (OR 2.22 [95% CI 0.51-9.61; = 0.28]). Newcastle-Ottawa Scale assessments for all studies found 24 of 26 studies with high to very high risk of bias. ROBINS-E assessments for studies included in the meta-analysis found five of five studies with high to very high risk of bias.
Overall, our findings demonstrate no statistical difference in odds ratios of liver injury in patients with PACS compared with COVID-negative controls. As such, routine assessment and monitoring of liver injury in patients with PACS may not be required; however, higher quality data with lower risk of bias are required to make recommendations of higher certainty.
新冠后急性综合征（PACS；长期新冠）的特征是在急性新冠感染至少4周后出现持续或延迟的症状。鉴于急性新冠感染中肝损伤的发生率已得到充分记录，本系统评价旨在评估PACS早期患者发生肝损伤的几率。
筛选2022年3月之前发表的观察性研究，以获取描述PACS患者肝损伤（根据主要研究定义）的数据。
共筛选了2117篇摘要和35篇全文，其中26篇符合纳入标准。所有研究中自急性新冠感染后的平均时间为195.5天。七项研究纳入了新冠阴性对照组。23项研究测量了实验室检查结果，9项研究测量了影像学或弹性成像。五项研究符合比值比的荟萃分析条件，结果显示与新冠阴性患者相比，PACS患者发生肝损伤的几率无统计学显著差异（比值比2.22 [95%置信区间0.51 - 9.61；P = 0.28]）。对所有研究的纽卡斯尔 - 渥太华量表评估发现，26项研究中有24项存在高至非常高的偏倚风险。对荟萃分析中纳入研究的ROBINS - E评估发现，五项研究中有五项存在高至非常高的偏倚风险。
总体而言，我们的研究结果表明，与新冠阴性对照组相比，PACS患者肝损伤的比值比无统计学差异。因此，可能不需要对PACS患者进行肝损伤的常规评估和监测；然而，需要具有更低偏倚风险的更高质量数据来做出确定性更高的建议。
