Copyright
©The Author(s) 2023.
World J Gastroenterol. Apr 28, 2023; 29(16): 2397-2432
Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2397
Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2397
Table 1 Liver function tests and factors associated significantly with clinical outcomes in COVID-19
Author/yr | Type of study (n of patients) | Factor | Outcome - statistical significance (severity/mechanical ventilation/ICU/mortality) |
Krishnan et al[321], 2022, United States | Retrospective (n = 3830) | TBIL1 | |
2–5 × ULN | Mortality risk significantly increased 6-fold (P < 0.001) | ||
> 5 × ULN | Mortality risk increased 7.86-fold (P = 0.005) | ||
AST1 | |||
2–5 × ULN | All-cause mortality HR, 1.49; P < 0.001 | ||
> 5 × ULN | All-cause mortality HR, 2.19; P = 0.005 | ||
ALP1 | |||
1–2 × ULN | All-cause mortality risk increased 1.42-fold (P = 0.009) | ||
> 2–5 × ULN | All-cause mortality risk increased 1.81-fold (P = 0.032) | ||
Inflammatory markers | |||
CRP | aHR, 1.04 associated with mortality (P = 0.001) | ||
Ferritin | aHR, 1.0 associated with mortality (P = 0.001) | ||
IL-6 | aHR, 1.0 associated with mortality (P = 0.001) | ||
neutrophil count | aHR, 1.0 associated with mortality (P = 0.008) | ||
D-Dimer | aHR, 1.03 associated with mortality (P = 0.004) | ||
LDH | aHR, 1.0 associated with mortality (P < 0.001) | ||
AST, ALT, TBIL | Significantly increased for those who received MV (P < 0.0001) | ||
Kodavoor et al[180], 2022, India | Retrospective (n = 708) | AST1 | aOR 1.007, per 1 IU/L increase for SD |
AST1 | aHR 1.002 per 1 IU/L increase for mortality | ||
Sensitivity/specificity | 90.6%/67% to predict mortality | ||
PPV/NPV | 17.5%/95.73% to predict mortality | ||
Albumin1 | aOR 0.217 per 1 g/dL increase for SD | ||
aHR 0.396 per 1 g/dL increase for mortality | |||
Lombardi et al[230], 2022, Italy | Retrospective (n = 382) | Transaminases1 | |
> 2 × ULN | OR 2.6, 95%CI: 1.3–6.7 for SD | ||
FIB-4 score < 1.451 | (OR 0.4; P = 0.04) protective factor for mortality | ||
Hartl et al[326], 2022, Austria | Retrospective (n = 900) | AST1 | aHR: 1.47; P = 0.043 for mortality |
TBIL1 | aHR: 2.20; P = 0.009 for mortality | ||
Siddiqui et al[229], 2022, United States | Retrospective (n = 1935) | Abnormal LFTs | |
Liver injury defined as: (AST/ALT > 3 × ULN or ALP/TBIL > 2 × ULN) | RR, 4.26; P < 0.0001 risk for mortality | ||
Mild elevated enzymes | RR, 5.52; P < 0.0001 for ICU admission | ||
(Levels lower than LI) | RR, 11.01; P < 0.0001 for MV | ||
RR, 2.16; P < 0.0001 for mortality | |||
RR, 2.48; P < 0.0001 ICU admission | |||
Cirrhotics | RR, 3.76; P < 0.0001 for MV | ||
RR, 2.19; P = 0.0022 for mortality | |||
Cai et al[20], 2020, China | Retrospective (n = 417) | Hepatocellular LI | OR, 2.73; P = 0.02 for severe disease |
Mixed LI | OR, 4.44; P < 0.001 for severe disease | ||
LI1 | aOR, 9.04; P < 0.001 for severe disease | ||
Huang et al[191], 2020, China | Retrospective (n = 675) | AST1 3-fold ULN | aOR, 19.27; P < 0.0001 for mortality |
aOR, 116.72; P < 0.0001 for MV | |||
Lei et al[192], 2020, China | Retrospective (n = 5771) | AST1 40-120 U/L | aOR, 4.81; P < 0.001 for all-cause mortality |
AST1 > 120 U/L | aOR, 14.87; P < 0.001 for all-cause mortality | ||
Ding et al[22], 2020, China | Retrospective (n = 2073) | Abnormal AST1 | aHR, 1.39; P = 0.027 for mortality |
Abnormal DBIL1 | aHR, 1.66; P = 0.001 for mortality | ||
LI during hospitalization1 | aHR, 4.63; P < 0.001 for in-hospital mortality | ||
LI at admission1 | aHR 1.87; P = 0.003 for in-hospital mortality | ||
Mixed LI1 | aHR, 4.77; P < 0.001 for in-hospital mortality | ||
Cholestatic LI1 | aHR, 3.99; P = 0.008 for in-hospital mortality | ||
Phipps et al[23], 2020, United States | Retrospective (n = 3381) | Ferritin1 | OR, 2.40; P < 0.001 for SLI |
IL-61 | OR, 1.45; P = 0.009 for SLI | ||
Peak ALT1 | OR, 1.14; P = 0.044 for mortality | ||
Older age1 | OR, 1.07; P < 0.001 for mortality | ||
DM1 | OR, 1.30; P = 0.045 for mortality | ||
Medetalibeyoglu et al[221], 2020, Turkey | Retrospective (n = 554) | AST/ALT > 1 | AUC = 0.713, P = 0.001 marker of mortality risk |
AUC = 0.636, P = 0.001 for ICU admission | |||
Chen et al[199], 2020, China | Retrospective (n = 502) | Grade of Liver damage1 | aHR, 1.377; P = 0.049 risk factor for mortality |
Mishra et al[200], 2021, United States | Retrospective (n = 348) | AST1 (1 unit increase) IU/L Peak AST1 (1 unit increase) | OR, 1.011; P = 0.006 for mortality |
Peak ALT1 (1 unit increase) | OR, 1.007; P < 0.001 for mortality | ||
TBIL1 (1 unit increase) mg/dL | OR, 1.005; P = 0.003 for mortality | ||
Alb1 (1 unit increase) g/dL | OR, 1.997; P = 0.04 | ||
Male1 | OR, 0.5; P = 0.01 | ||
BMI > 40 kg/m2 | OR, 1.94; P = 0.001 | ||
LI1 | OR, 2.17; P = 0.003 | ||
OR, 1.79; P = 0.008 | |||
Chew et al[190], 2021, United States | Retrospective (n = 834) | Ischemic disease state1 | OR, 2.4; P = 0.001 for mortality |
Hypecoagulable1 | OR, 1.7; P = 0.02 for mortality | ||
Hyperinflammatory1 | OR, 1.9; P = 0.02 for mortality | ||
Ponziani et al[327], 2021, Italy | Retrospective (n = 515) | ALP1 peak value | aOR, 1.007; P = 0.005 for mortality |
CRP1 | aOR, 1.007; P = 0.008 for mortality | ||
Piano et al[246], 2020, Italy | Retrospective (n = 565) | Abnormal LFTs1 | OR, 3.53; P < 0.001 for ICU admission/death |
Yip et al[287], 2021, China | Retrospective (n = 1040) | ALT/AST1 ≥ 2 × ULN | aOR, 7.92; P < 0.001 for ICU/MV/death |
Marjot et al[237], 2021, multinational | Retrospective (n = 785) | Age1 | OR, 1.02; P = 0.011 for mortality |
Cirrhotics CTP-A1 | OR, 1.90; P = 0.040 for mortality | ||
Cirrhotics CTP-B1 | OR, 4.14; P < 0.001 for mortality | ||
Cirrhotics CTP-C1 | OR, 9.32; P < 0.001 for mortality | ||
ArLD1 | OR, 1.79; P = 0.040 for mortality | ||
Lee et al[328], 2020, South Korea | Retrospective (n = 1005) | Age1 | aHR = 4.96; P < 0.001 for mortality |
Liver cirrhosis1 | aHR = 2.86; P = 0.042 fro mortality | ||
DM1 | aHR = 2.29; P < 0.001 for mortality | ||
COPD1 | aHR = 4.52; P = 0.001 for mortality | ||
Singh et al[236], 2020, United States | Retrospective (n = 2780) | CLD1 | RR, 2.8; P < 0.001 risk of mortality |
propensity matching | RR, 3.0; P = 0.001 risk of mortality | ||
Cirrhotics1 | RR, 4.6; P < 0.001 risk of mortality | ||
Hashemi et al[232], 2020, United States | Retrospective (n = 363) | CLD1 | aOR 1.77; P = 0.04 for ICU admission |
aOR, 2.08; P = 0.0092 for IMV | |||
Cirrhotics1 | aOR, 12.5; P = 0.009 mortality risk | ||
Sarin et al[235], 2020, Asian | Retrospective (n = 228 CLD) | Cirrhotics1 | |
AST/ALT > 1.4 | HR = 1.4; P = 0.02 for mortality | ||
Obesity | OR = 8.1; P = 0.002 for LI | ||
Decompensated | OR = 2.5; P = 0.05 for mortality | ||
CTP score > 8 | HR = 19.2; P < 0.001 for mortality | ||
DM in CLD non-cirrhotics | OR = 2.1; P = 0.01 for LI | ||
Wang et al[51], 2020, China | Retrospective (n = 657) | Male gender1 | OR, 2.038; P < 0.001 for LI |
hsCRP ≥ 10 mg/L | OR, 1.733; p = 0.014 for LI | ||
NLR ≥ 5 | OR, 2.154; P < 0.001 for LI | ||
Zhang et al[183], 2020, China | Retrospective (n = 218) | Male1 | OR, 6.203; P < 0.001 risk for LI |
Neutrophil percentage1 | OR, 1.004; P = 0.003 risk for LI | ||
CRP1 | P < 0.001 in LI patients | ||
D-dimer1 | OR, 1.486; P < 0.001 risk for LI | ||
Shauly-Aharonov et al[329], 2021, Israel | Retrospective (n = 37121) | Age | OR = 1.1 for every year increase; P < 0.001) risk for severity |
Male gender | OR = 1.34; P = 0.012 risk for severity | ||
BMI | OR = 1.02 for 1 kg/m2 increase; P = 0.025 risk for severity | ||
Kovalic et al[208], 2020, United States | Meta-analysis (n = 24299) | CLD1 | Pooled OR, 1.48; P = 0.001 for severity |
Pooled OR, 1.78; P = 0.02 for mortality | |||
Kulkarni et al[6], 2020, India | Meta-analysis Multinational (n = 20874) | Increased LFTs | OR, 3.46; P < 0.001 for mortality |
OR, 2.87; P < 0.001 for severe disease | |||
Sharma et al[207], 2021, United States | Meta-analysis (n = 12882) | AST1 | Pooled OR, 2.98; P < 0.00001 for poor outcomes |
ALT1 | Pooled OR, 1.73; P < 0.0001 for poor outcomes | ||
Del Zompo et al[323], 2020, Italy | Meta-analysis (n = 20724) | ALT1 | OR 1.54, 95%CI: 1.17-2.03 for severity |
ALT1 | OR 1.48, 95%CI: 1.12-1.96 for mortality | ||
AST1 | OR 3.17, 95%CI: 2.10-4.77 for severity | ||
AST1 | OR 4.39, 95%CI: 2.68-7.18 for mortality | ||
TBIL1 | OR 2.32, 95%CI: 1.18-4.58 for severity | ||
TBIL1 | OR 7.75, 95%CI: 2.28-26.40 for mortality |
- Citation: Liatsos GD. SARS-CoV-2 induced liver injury: Incidence, risk factors, impact on COVID-19 severity and prognosis in different population groups. World J Gastroenterol 2023; 29(16): 2397-2432
- URL: https://www.wjgnet.com/1007-9327/full/v29/i16/2397.htm
- DOI: https://dx.doi.org/10.3748/wjg.v29.i16.2397