目的:本研究旨在对循环肝酶和总胆红素水平与严重和非严重COVID-19的相关性进行汇总分析。
背景:持续的冠状病毒爆发是全球健康的重要威胁。代表感染严重急性呼吸系统综合症冠状病毒-2(SARS-CoV-2)的患者肝功能衰竭风险更大的流行病学数据。
方法:使用Medline全面搜索电子数据库,ISIWebofScience,EMBASE,和Cochrane图书馆截至2020年7月。每个相关研究的结果使用随机效应模型进行汇总。异质性分析采用Q检验和I2统计学方法。还评估了敏感性分析。
结果:本研究共纳入24项研究(4,246例患者)。我们发现COVID-19严重程度与ALT水平升高存在显着关联[SMD:1.40U/L;95%CI(0.93,1.88);P<0.05,I2=96.5%,P异构性=0.000],AST[SMD:2.11U/L;95%CI(1.40,2.83);P<0.05,I2=97.9%,P异构性=0.000],LDH[SMD:3.88U/L;95%CI(2.70,5);P<0.05,I2=98.7%,P异质性=0.000]和TBil[SMD:1.08mol/L;95%CI(0.44,1.72);P=0.001,I2=97.7,P异质性=0.000],然而,重度和非重度COVID-19患者的ALP值[SMD:0.31;95%CI(-1.57,2.20);P=0.74]不显著。此外,男性肝酶升高更多[OR:1.52,(95%CI1.26,1.83),P<0.05:COVID-19感染较女性严重。
结论:SARS-CoV-2感染引起的肝功能指标的改变提示了在疾病早期筛查重症患者的潜在预后生物标志物。
OBJECTIVE: The current study aimed to report a pooled analysis of the association of the circulating levels of liver enzymes and total bilirubin with severe and non-severe COVID-19.
BACKGROUND: The ongoing coronavirus outbreak is an important threat to health worldwide. Epidemiological data representing greater risk of liver failure in patients infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).
METHODS: Electronic databases were comprehensively searched using Medline, ISI Web of Science, EMBASE, and the Cochrane Library up to July 2020. Outcomes from each relevant study were pooled using a random-effects model. Heterogeneity was analyzed by Q test and I2 statistics. Sensitivity analysis was also evaluated.
RESULTS: A total of 24 studies were included (4,246 patients) in this study. We found a significant association of COVID-19 severity with increased levels of ALT [SMD: 1.40 U/L; 95% CI (0.93, 1.88); P < 0.05, I2 = 96.5%, P Heterogenity = 0.000 ], AST [SMD: 2.11 U/L; 95% CI (1.40, 2.83); P < 0.05, I2 = 97.9%, P Heterogenity = 0.000], LDH [SMD: 3.88 U/L; 95% CI (2.70, 5); P < 0.05, I2 = 98.7%, P Heterogenity = 0.000] and TBil [SMD: 1.08 mol/L; 95% CI (0.44, 1.72); P = 0.001, I2 = 97.7, P Heterogenity = 0.000], whereas, ALP values [SMD: 0.31; 95% CI (-1.57, 2.20); P = 0.74] was not significant between severe and non-severe COVID-19 patients. Moreover, elevated liver enzymes were found more in males [OR: 1.52, (95% CI 1.26, 1.83), P < 0.05] with severe COVID-19 infection than in females.
CONCLUSIONS: The alterations of liver function indexes caused by SARS-CoV-2 infection suggested a potential prognosis biomarker for screening of severe patients at early stages of the disease.