key: cord-276328-08ava9ni
authors: Kunutsor, Setor K.; Laukkanen, Jari A.
title: Hepatic manifestations and complications of COVID-19: A systematic review and meta-analysis
date: 2020-06-21
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.043
sha: 
doc_id: 276328
cord_uid: 08ava9ni

nan

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), was declared a global public health emergency on 30 January 2020. Emerging data suggests that COVID-19 has extrapulmonary manifestations and complications, subsequently leading to multiorgan failure and death. Common cardiovascular and renal complications reported to be associated with COVID-19 include myocardial injury, heart failure, acute kidney injury and electrolyte disturbances. (1, 2) In addition to the observation that older patients, males and those with pre-existing comorbidities such as cardiovascular disease, diabetes, chronic kidney disease and chronic liver disease are at highest risk for severe illness or death, (3, 4) COVID-19 complications have been shown to correlate with the disease severity or mortality. (5, 6) Emerging data also suggests COVID-19 contributes to adverse hepatic manifestations such as acute hepatic injury. Wang and colleagues in their recent published study to investigate characteristics and prognostic factors in 339 elderly patients with COVID-19, a high proportion of severe and critical cases were observed as well as a high fatality rate. Over hospital stays ranging from 2 to 28 days, the pooled incidence was 69.1% (67.3-70.9) for elevated ALT (2 studies); 34.8% (16.2-56.0) for elevated AST; 11.2% (6.4-17.1) for acute hepatic injury (15 studies) and 7.9% (5.9-10.2) for hypoproteinaemia (n=2 studies) ( Figure 1A) . Subgroup analyses suggested that the incidence of acute hepatic injury was higher in Chinese populations and groups with a higher prevalence of pre-existing chronic liver disease; however, the incidence of acute hepatic injury was similar in older (≥60 years) or younger age (<60 years) groups ( Figure 1B) . Patients with pre-existing liver dysfunction appear to have worse outcomes in COVID-19, (8) which has been attributed to their immunocompromised status. 

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