Dose-response relationship between patients’ liver injury markers on
admission and the severity of COVID-19: A meta-analysis
Abstract
Aim:An increasing number of studies have reported a higher frequency of
liver injury in COVID-19. Several meta-analyses of the associations
between liver injury and COVID-19 had been published, but the
dose-response relationship has not been conducted. Therefore, we
performed a dose-response meta-analysis to explore this relationship.
Methods: PubMed, Web of Science, EMBASE, and four additional Chinese
databases were used to collect studies from December 1, 2019 to October
26, 2020. Key information was extracted, and the corresponding model was
selected on the basis of the heterogeneity test. The pooled RR, OR, and
WMD values were then calculated. Sensitivity analysis and publication
bias were also assessed to further demonstrate the stability and
reliability of the results. Results: Among the 13298 studies that were
initially retrieved, 54 studies met our inclusion criteria and included
9907 participants. There was a dose-response relationship between ALT
(OR from 1.0 for ≤40 U/L to 1.556[1.130–2.142] for 40–80 U/L and
1.635[1.176–2.273] for >80 U/L), AST (OR from 1.0 for
≤40 U/L to 1.635[1.180–2.266] for 40–80 U/L and
2.019[1.387–2.938] for >80 U/L) and severe COVID-19.
Higher ALT, AST, and TBil were associated with need for ICU admission
(WMD 6.45[4.08–8.81], 8.80[6.02–11.57], 2.03[0.91–3.14]),
and death due to COVID-19 (WMD 3.22[0.08–6.35],
12.06[6.26–17.85], 2.70[0.72–4.68]). There was no publication
bias in this meta-analysis. Conclusion: There were dose-response
relationships between ALT, AST, and COVID-19 severity. ALT and AST
levels in COVID-19 patients on admission should be considered to be
clinical warning indicators, which could provide basis for preventing
serious COVID-19 and associated deaths