International Journal of Medical Laboratory Research (IJMLR)

A SYSTEMATIC REVIEW OF PANDEMIC COVID-19 BASED ON LIVER ENZYMES

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V Rathod, U Kousar, C Leelambika, P Shankar

 

ABSTRACT: Background and Aim: This article aims to analyze liver enzymes in relation to COVID-19 patients by performing a systematic review of articles which describe the changes in liver enzymes in COVID 19.  Abnormalities of liver enzymes associated with Covid-19 has been well documented by a number of articles since the start of the pandemic and could be used to monitor the disease progression .hence, this review was done to understand better the effect of covid 19 on liver enzymes. Methods: A systematic review to describe existing literature with regard to liver enzyme changes in SARS CoV-2 disease to understand the pattern of variations in  ALT and  AST. Articles for Literature review were accessed from the PubMed and other sources.On the day of admission and during hospitalization, LFT was done in COVID-19 patients. Median age 47 years (Inter Quarantile Range 33-61). The age group and cut off values for LFT is based on the Institutional board of the “National Health Commission of China”. Result: We reviewed original articles from 15 International Journals related to COVID-19 and liver enzymes and found that the liver enzymes (ALT, AST) are significantly elevated in pre-existing and non-pre-existing liver disorder in COVID-19 patients. In the present study we have analysed 2811 patients (which were described in the reviewed original articles) with both pre and non-pre-existing liver injury. Out of 2811 patients the AST was elevated in 471 patients and ALT was elevated in 530 patients.Among them 2,279 patients are with pre-existing liver disease, where AST elevated in 371(25.53%) and ALT was elevated in 401(23.87%) patients. 532 patients are with non-pre-existing liver disease, where AST elevated in 100 (26.6%) and ALT in 129 (21.7%) patients. Conclusion: Liver enzymes are elevated both in the pre-existing and non-existing liver disease in COVID-19 patients. Although  increase in ALT and AST was more noticed in patients with pre-existing liver disease, a significant percentage of  patients without any pre-existing liver abnormalities also showed a  high transaminase value.

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KEY WORDS: Alanine transaminase (ALT) Aspartate amino transaminase (AST).

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REFERENCES:

1. Woo PC, Huang Y, Lau SK, Yuen KY. Coronavirus genomics and bioinformatics analysis. viruses. 2010;2,8:1804-20.

2. Mao R, Liang J, Shen J, Ghosh S, Zhu LR, Yang H, Wu KC, Chen MH. Implications of COVID-19 for patients with pre-existing digestive diseases. The lancet Gastro-enterology and hepatology. 2020;5,5:426-8.

3. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020;382,18:1708-20.

4. Garrido I, Liberal R, Macedo G. Review article: COVID-19 and liver disease—what we know on 1st May 2020. Aliment PharmacolTher. 2020;52(2):267–75. Garrido I, Liberal R, Macedo G. COVID‐19 and liver disease‐what we know on 1st May 2020. Alimentary Pharmacology & Therapeutics. 2020.

5. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis GV, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland. 2004;203,2:631-7.

6. Wang D, Ju XL, Xie F, Lu Y, Li FY, Huang HH, et al. [Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China]. Zhonghuaerkezazhi = Chinese J Pediatr [Internet]. 2020 Apr 2;58(4):269–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32118389Wang D, Ju XL, Xie F, Lu Y, Li FY, Huang HH, Fang XL, Li YJ, Wang JY, Yi B, Yue JX. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghuaerkezazhi= Chinese journal of pediatrics. 2020;58,4:269-74:E011-.

7. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, Shi Z, Hu Z, Zhong W, Xiao G. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell research. 2020;30,3:269-71.

8. Duan ZP, Chen Y, Zhang J, Zhao J, Lang ZW, Meng FK, Bao XL. Clinical characteristics and mechanism of liver injury in patients with severe acute respiratory syndrome. Zhonghuaganzangbingzazhi= Zhonghuaganzangbingzazhi= Chinese journal of hepatology. 2003;11,8:493-6.

9. Li L, Li S, Xu M, Yu P, Zheng S, Duan Z, Liu J, Chen Y, Li J. Risk factors related to hepatic injury in patients with corona virus disease 2019. medRxiv. 2020.

10. Cai Q, Huang D, Ou P, Yu H, Zhu Z, Xia Z, et al. COVID‐19 in a designated infectious diseases hospital outside Hubei Province, China. Allergy [Internet]. 2020 Jul 17;75(7):1742–52. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/all.14309Cai Q, Huang D, Ou P, Yu H, Zhu Z, Xia Z, Su Y, Ma Z, Zhang Y, Li Z, He Q. COVID‐19 in a designated infectious diseases hospital outside Hubei Province, China. Allergy. 2020; 75 ,7:1742-52

11. Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, et al. Clinical Features of COVID-19-Related Liver Functional Abnormality. ClinGastroenterolHepatol [Internet]. 2020 Jun;18(7):1561–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1542356520304821Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, Zhang Y, Huang S, Liu Z, Cheng J. Clinical features of COVID-19-related liver damage. Clinical Gastroenterology and Hepatology. 2020; 1561-6.

12. Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, Zhou J, Shi G, Fang N, Fan J, Cai J. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. biorxiv. 2020.

13. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. The lancet Gastroenterology &hepatology. 2020;5,5:428-30.

14. Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. The Lancet. Gastroenterology &Hepatology. 2020;5,6:529-30.

15. Boeckmans J, Rodrigues RM, Demuyser T, Piérard D, Vanhaecke T, Rogiers V. COVID-19 and drug-induced liver injury: a problem of plenty or a petty point?. Archives of Toxicology. 2020:1-3.

16. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Yu T. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395,10223:507-13.

17. Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, Hao SR, Jia HY, Cai H, Zhang XL, Yu GD. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69,6:1002-9.

18. Hui DS, Azhar EI, Kim YJ, Memish ZA, Oh MD, Zumla A. Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission. The Lancet Infectious Diseases. 2018;18,8:e217-27.

19. Cao W, Shi L, Chen L, Xu XM, Wu ZR. Clinical features and laboratory inspection of novel coronavirus pneumonia (COVID-19) in Xiangyang. Hubei. medRxiv. 2020;2020,23.20026963.

20. Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, Wang D, Liu C, Meng Y, Cui L, Yu J. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID‐19). Journal of internal medicine. 2020;288,1:128-38.

21. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020;395,10229:1054-62.

22. Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, Lang C, Huang D, Sun Q, Xiong Y, Huang X. Clinical features and treatment of COVID‐19 patients in northeast Chongqing. Journal of medical virology. 2020;92,7:797-806.

23. Zhang Y, Zheng L, Liu L, Zhao M, Xiao J, Zhao Q. Liver impairment in COVID‐19 patients: A retrospective analysis of 115 cases from a single centre in Wuhan city, China. Liver International. 2020.

24. Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, Wang X, Hu C, Ping R, Hu P, Li T. Clinical features of 85 fatal cases of COVID-19 from Wuhan. A retrospective observational study. American journal of respiratory and critical care medicine. 2020;201,11:1372-9.

25. Xie H, Zhao J, Lian N, Lin S, Xie Q, Zhuo H. Clinical characteristics of non‐ICU hospitalized patients with coronavirus disease 2019 and liver injury: a retrospective study. Liver international. 2020;40,6:1321-6.

26. Huang Y, Zhou H, Yang R, Xu Y, Feng X, Gong P. Clinical characteristics of 36 non-survivors with COVID-19 in Wuhan, China. medRxiv. 2020.

27. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, Wang Z, Li J, Li J, Feng C, Zhang Z. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Science China Life Sciences. 2020;63,3:364-74.

28. Ji D, Qin E, Xu J, Zhang D, Cheng G, Wang Y, Lau G. Non-alcoholic fatty liver diseases in patients with COVID-19: A retrospective study. Journal of Hepatology. 2020;73,2:451-3.

29. Feng G, Zheng KI, Yan QQ, Rios RS, Targher G, Byrne CD, Van Poucke S, Liu WY, Zheng MH. COVID-19 and liver dysfunction: current insights and emergent therapeutic strategies. Journal of clinical and translational hepatology. 2020;8,1:18.

30. Chen ZM, Fu JF, Shu Q. New coronavirus: new challenges for pediatricians. 2020;16,3:222–222.

31. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. The Lancet Infectious Diseases. 2020;20,6:689–96

32. Chen L, Liu HG, Liu W, Liu J, Liu K, Shang J, Deng Y, Wei S. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Zhonghuajie he hehu xi zazhi= Zhonghuajiehe he huxizazhi= Chinese journal of tuberculosis and respiratory diseases. 2020;43:E005-.

33. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, Fan Y, Zheng C. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet Infectious Diseases. 2020; 20,4:425–34

34. Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, Gao YD. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020; 75,7:1730–41

35. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, Lee M. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. Jama. 2020;323,16:1612-4.

36. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, Iotti G. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. Jama. 2020;323,16:1574-81.

37. Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, Li Z, Zhou G, Gou J, Qu J, Sun Y. COVID-19: abnormal liver function tests. Journal of hepatology. 2020.

38. Gu T, Chu Q, Yu Z, Fa B, Li A, Xu L, Wu R, He Y. History of coronary heart disease increased the mortality rate of patients with COVID-19: a nested case–control study. BMJ open. 2020;10,9:e038976.