Laboratory hematologic features of COVID-19 associated liver injury: A systematic review

Table 3 Studies comparing coronavirus disease 2019 patients with severe vs non-severe disease

Ref.	Country	Patients with severe disease (% of total)	Setting	Definition of SEVERE disease	Definition of liver Injury	Evaluated parameters	Summary of main findings	NOS
Cai et al[67]	China	58 (19.5)	Hospitalized patients	Radiography supporting severe disease	ALT OR AST > 3 times ULN or GGT or TBIL > 2 times ULN	WBC, ANC, ALC, DDIM	LFT significantly elevated in severe cohort at admission	8
Jiang et al[68]	China	27 (20.6)	Hospitalized patients	Chinese National Health Committee criteria (see ref[82])	AST OR ALT OR ALP OR TBIL > 5 times ULN	WBC, ANC, ALC, PLTS, HGB	Liver injury in 81% of severe cohort over course of hospitalization; slow recovery from liver injury compared to other cohorts	7
Lei et al[69]	China	48 Severe cohort	Hospitalized patients	National Health Commission of the People’s Republic of China and National Administration of Traditional Chinese Medicine of the People’s Republic of China criteria (see ref[83])	CT showing liver hypodensity and pericholecystic fat stranding	WBC, ALC, PLTS	Severity of COVID-19 disease correlated with liver function	7
	China	48 Critical cohort	Hospitalized patients	Health Commission of the People’s Republic of China and National Administration of Traditional Chinese Medicine of the People’s Republic of China criteria (see ref[83])	CT showing liver hypodensity and pericholecystic fat stranding	WBC, ALC, PLTS	Severity of COVID-19 disease correlated with liver function
Liao et al[70]	China	29 (15.1)	Hospitalized patients	National Guidelines for 2019 novel coronavirus-associated pneumonia (the fifth revised version)	AST OR ALT OR TBIL over ULN	WBC, ANC, ALC, HGB, DDIM	Liver injury in high percentages of patients from both groups; correlated with inflammatory cytokine levels	7
Yang et al[71]	China	215 (72.9)	Hospitalized patients	WHO criteria (see ref[8] from[68])	AST > 1.5 times ULN	WBC, ANC, ALC, PLT, DDIM, PT	AST and GGT levels correlated with disease severity	7

ALC: Absolute lymphocyte count; ALT: Alanine transaminase; ANC: Absolute neutrophil count; AST: Aspartate transaminase; COVID-19: Coronavirus disease 2019; CT: Computerized tomography; DDIM: D-dimer; GGT: Gamma-glutamyltransferase; HGB: Hemoglobin; NOS: Newcastle-Ottawa Score; PLT: Platelet count; PT: Prothrombin time; TBIL: Total bilirubin; WBC: White blood cell count; WHO: World Health Organization; ULN: Upper limit of normal.