Liver Chemistries in Patients with Severe or Non-Severe COVID-19: a Meta-Analysis

Background & Aims: Cumulating observations have indicated that COVID-19 patients undergo different patterns of abnormal liver chemistries. We performed a meta-analysis of published liver manifestations and tried to describe the liver damage. Methods: We searched PubMed, google scholar, Embase, Cochrane Library, medRxiv, bioRxiv, and three Chinese electronic databases through April 18, 2020 according to the Preferred Reporting Items for Meta-Analyses. We analyzed pooled data on liver chemistries stratified by the severity of COVID-19 using a fixed or random effects model. Results: In a meta-analysis of 37 studies, comprising 6,235 patients, the pooled mean of ALT was 36.4 IU/L in the severe cases of COVID-19 while 27.8 IU/L in the non-severe cases (95% CI: -9.4- -5.1, p<0.0001). Pooled average of AST was 46.8 IU/L in the severe cases while 30.4 IU/L in the non-severe cases (95% CI: -15.1- -10.4, p<0.0001). Compared with the non-severe cases, the severe cases tended to have higher γ-Glutamyltransferase while lower albumin. Conclusions: In this meta-analysis, we comprehensively described three patterns of liver impairment related to COVID-19, including hepatocellular injury, cholestasis, and synthetic disfunction, according to the severity of the COVID-19. Patients with abnormal liver tests are at higher risks of progressing to severe disease. Close monitoring on liver chemistries helps to early warn against disease progression.