Pre-existing Liver Diseases and On-Admission Liver-Related Laboratory Tests in COVID-19: A Prognostic Accuracy Meta-Analysis With Systematic Review
Szilárd Váncsa, Péter Hegyi, Noémi Zádori, Lajos Szakó, Nóra Vörhendi, Klementina Ocskay, M. Földi, Fanni Dembrovszky, Zsuzsa Réka Dömötör, Kristóf Jánosi, Zoltán Rakonczay, Petra Hartmann, Tamara Horváth, Bálint Erőss, Szabolcs Kiss, Zsolt Szakács, Dávid Németh, Péter Hegyi, Gabriella Pár
Abstract
Background We aimed to perform a systematic search and meta-analysis to evaluate the prognostic value of on-admission liver function tests and pre-existing liver diseases on the clinical course of coronavirus disease 2019 (COVID-19). Methods The study was registered on PROSPERO (CRD42020182902). We searched five databases between 01/01/2020 and 23/04/2020. Studies that reported on liver-related comorbidities and/or laboratory parameters in patients with COVID-19 were included. The main outcomes were COVID-19 severity, intensive care unit (ICU) admission, and in-hospital mortality. Analysis of predictive models hierarchical summary receiver-operating characteristic (HSROC) was conducted with a 95% confidence interval (CI). Results Fifty studies were included in the meta-analysis. High specificity was reached by acute liver failure associated by COVID-19 (0.94, CI: 0.71–0.99), platelet count (0.94 CI: 0.71–0.99) in the case of mortality; chronic liver disease (CLD) (0.98, CI: 0.96–0.99), platelet count (0.82, CI: 0.72–0.89) in the case of ICU requirement; CLD (0.97, CI: 0.95–0.98), chronic hepatitis B infection (0.97, CI: 0.95–0.98), platelet count (0.86, CI: 0.77–0.91), alanine aminotransferase(ALT) (0.80, CI: 0.66–0.89) and aspartate aminotransferase(AST) (0.84, CI: 0.77–0.88) activities considering severe COVID-19. High sensitivity was found in the case of C-reactive protein(CRP) for ICU requirement (0.92, CI: 0.80–0.97) and severe COVID-19 (0.91, CI: 0.82–0.96). Conclusion On-admission platelet count, ALT, AST activity and CRP concentration, and presence of acute and chronic liver diseases predicted severe course of COVID-19. To highlight, preexisting liver diseases or acute liver injury associated by SARS-CoV-2 infection plays an important role in the prediction of mortality.