Year 2021 / Volume 113 / Number 2
Review
Impact of liver injury on the severity of COVID-19: a systematic review with meta-analysis

125-135

DOI: 10.17235/reed.2020.7397/2020

Javier Ampuero, Yolanda Sánchez, María Rosario García-Lozano, Douglas Maya-Miles, Manuel Romero Gómez,

Abstract
Background and aims: SARS-CoV-2 is mainly a respiratory virus that has relevant systemic effects. We assessed the impact of baseline liver function (aspartate aminotransferase [AST], alanine aminotransferase [ALT], bilirubin) on COVID-19-related outcomes, including mortality, intensive care unit (ICU) admissions, and non-fatal severe complications. Methods: after a systematic review of the relevant studies the odds ratio (OR), mean difference, sensitivity, specificity, and both positive and negative likelihood ratios were calculated for the prediction of relevant COVID-19 outcomes by performing a meta-analysis using fixed and random effects models. A Fagan nomogram was used to assess clinical usefulness. Heterogeneity was explored by sensitivity analysis and univariate meta-regression. Results: twenty-six studies were included (22 studies and 5,271 patients for AST, 20 studies and 5,440 subjects for ALT, and nine studies and 3,542 patients for bilirubin). The outcomes assessed by these studies were: survival (n = 8), ICU admission (n = 4), and non-fatal severe complications (n = 16). AST > upper limit of normal (ULN) (OR: 3.10 [95 % CI, 2.61-3.68]), ALT > ULN (OR: 2.15 [95 % CI, 1.43-3.23]), and bilirubin > ULN (OR: 2.78 [95 % CI, 1.88-4.13]) were associated with an increased prevalence of severe complications with a specificity of 78 %, 77 %, and 94 %, respectively. The mean difference between mild and severe COVID-19 was 10.7 U/l (95 % CI, 5.8-15.6) for AST, 8 U/l (95 % CI, 1.0-15) for ALT, and 0.3 mg/dl (95 % CI, 0.16-0.45) for bilirubin. Conclusions: patients showing liver injury had a significantly higher risk of developing severe COVID-19 as compared to those with normal liver function tests at admission. We should include the assessment of AST, ALT, and total bilirubin (TB) routinely in the workup of patients affected by SARS-CoV-2 in order to predict those at risk of developing COVID-19-related outcomes.
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DOI: 10.17235/reed.2020.7034/2020

Letter

Biopsy for hepatocellular carcinoma: only occasionally

DOI: 10.17235/reed.2020.6935/2020

Letter

Secondary gastric lymphoma - Do we know its endoscopic findings?

DOI: 10.17235/reed.2020.6868/2020

Letter

Luetic gastritis: an uncommon cause of gastritis

DOI: 10.17235/reed.2020.6870/2020

Letter

Digestive involvement in a patient with Lambert-Eaton syndrome

DOI: 10.17235/reed.2020.6846/2019

Digestive Diseases Image

Groove pancreatitis: a rare cause of severe gastric dilation

DOI: 10.17235/reed.2020.6765/2019

Editorial

Small but great steps

DOI: 10.17235/reed.2019.6758/2019

Letter

Gastric ulcer due to mucormycosis in a critical patient

DOI: 10.17235/reed.2020.6636/2019

Letter

An atypical bronchogenic cyst with yeast over-infection

DOI: 10.17235/reed.2020.6560/2019

Original

A new pattern in hepatitis A virus infection in an urban population

DOI: 10.17235/reed.2020.6526/2019

Letter

Misplacement of a nasogastric feeding tube: a case report

DOI: 10.17235/reed.2020.6512/2019

Letter

Primary gastric choriocarcinoma

DOI: 10.17235/reed.2020.6478/2019

Digestive Diseases Image

Metastatic melanoma of the gallbladder: an uncommon finding

DOI: 10.17235/reed.2020.6407/2019

Letter

Ischemic gastritis due to oral iron

DOI: 10.17235/reed.2019.6401/2019

Case Report

Ectopic hepatocellular carcinoma arising from the peritoneum

DOI: 10.17235/reed.2019.6408/2019

Letter

Hepatic epithelioid angiomyolipoma: contribution of a new case

DOI: 10.17235/reed.2019.6388/2019

Digestive Diseases Image

Concurrent hepatic and renal angiomyolipomas in tuberous sclerosis complex

DOI: 10.17235/reed.2020.6376/2019

Letter

Twisting of sleeve gastrectomy: two ways of clinic presentation

DOI: 10.17235/reed.2019.6366/2019

Digestive Diseases Image

An unusual endoscopic presentation of diffuse duodenal gastric heterotopia

DOI: 10.17235/reed.2020.6372/2019

Original

Quality of life study in asymptomatic patients with hepatitis C

DOI: 10.17235/reed.2019.6339/2019

Case Report

Emphysematous esophagitis with gastric perforation

DOI: 10.17235/reed.2019.6322/2019

Review

Psoriasis and fatty liver: a harmful synergy

DOI: 10.17235/reed.2019.6263/2019

Letter

Endoscopically diagnosed systemic mastocytosis

DOI: 10.17235/reed.2019.6246/2019

Digestive Diseases Image

Cervical arthrodesis penetrated into the esophagus detected by gastroscopy

DOI: 10.17235/reed.2019.6222/2019

Special Article

The quality of abdominal ultrasound: a much-needed consensus

DOI: 10.17235/reed.2019.6177/2019

Letter

Gastric serrated adenoma

DOI: 10.17235/reed.2019.6145/2018

Letter

A giant liver abscess due to Fasciola hepatica infection

DOI: 10.17235/reed.2019.6136/2018

Digestive Diseases Image

A rare heterotopic gastric mucosa appearing between the muscularis mucosae and submucosa

DOI: 10.17235/reed.2019.6134/2018

Special Article

Quality indicators in gastroscopy. Gastroscopy procedure

DOI: 10.17235/reed.2019.6023/2018

Special Article

Consensus document on exclusion diets in irritable bowel syndrome (IBS)

DOI: 10.17235/reed.2018.5941/2018

Digestive Diseases Image

Secondary gastroduodenal plasmacytoma in a patient with multiple myeloma

DOI: 10.17235/reed.2019.5923/2018

Letter

Sometimes things are what they seem

DOI: 10.17235/reed.2019.5911/2018

Letter

Primary squamous cell carcinoma of the stomach: a rare entity

DOI: 10.17235/reed.2018.5900/2018

Editorial

Lung transplantation and esophageal dysfunction

DOI: 10.17235/reed.2018.5693/2018

Digestive Diseases Image

String sign of Kantor in a patient with Crohn’s disease

DOI: 10.17235/reed.2018.5598/2018

Digestive Diseases Image

Painless jaundice as an initial presentation of lung adenocarcinoma

DOI: 10.17235/reed.2018.5587/2018

Letter

An esophageal cyst containing heterotopic gastric glands

DOI: 10.17235/reed.2018.5530/2018

Digestive Diseases Image

Dysphagia and hematemesis caused by an intramural esophageal dissection

DOI: 10.17235/reed.2018.5471/2018

Editorial

On the centenary of The Spanish Journal of Gastroenterology (REED)

DOI: 10.17235/reed.2017.5427/2017

Letter

Giant hepatobiliary cystadenoma: clinic-pathological findings

DOI: 10.17235/reed.2018.5414/2017

Letter to the Editor

Post-transplant lymphoproliferative disease after liver transplantation

DOI: 10.17235/reed.2017.5387/2017

Letter to the Editor

EUS-guided ethanol ablation therapy for gastric stromal tumors

DOI: 10.17235/reed.2017.5361/2017

Letter to the Editor

Complicated peribiliary cysts in patient without any prior liver disease

DOI: 10.17235/reed.2017.5350/2017

Letter to the Editor

Inverted Meckel’s diverticulum in an adult patient diagnosed via capsule endoscopy

DOI: 10.17235/reed.2018.5347/2017

Letter to the Editor

Severe obscure gastrointestinal bleeding successfully treated with idarucizumab

DOI: 10.17235/reed.2018.5298/2017

Letter to the Editor

GETTEMO position statement on bariatric endoscopic techniques as a voluntary medicine

DOI: 10.17235/reed.2017.5144/2017

Letter to the Editor

A patient with Castleman’s disease mimicking acute pancreatitis

DOI: 10.17235/reed.2017.5120/2017

Letter to the Editor

Acute gastric dilatation after dietary violation

DOI: 10.17235/reed.2017.5111/2017

Original

Gastroenterology - Evolution of specialty choice in recent years

DOI: 10.17235/reed.2017.4977/2017

Digestive Diseases Image

Metastasis of dermatofibrosarcoma diagnosed by capsule endoscopy

DOI: 10.17235/reed.2018.4900/2017

Letter to the Editor

Chronic diarrhea, weight loss and heart failure. Features of the same disease?

DOI: 10.17235/reed.2017.4874/2017

Letter to the Editor

A rare cause of intestinal bleeding: duodenal metastasis from endometrial cancer

DOI: 10.17235/reed.2017.4822/2017

Letter to the Editor

Gangliocytic paraganglioma: an unusual cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2017.4808/2016

Letter to the Editor

Pancreatic neuroendocrine tumors

DOI: 10.17235/reed.2017.4725/2016

Original

Usefulness of an intra-gastric balloon before bariatric surgery

DOI: 10.17235/reed.2017.4624/2016

Digestive Diseases Image

Debut of an unusual liver cirrhosis

Letter to the Editor

Giant esophageal diverticulum as a new clinical indication for endoscopic gastrostomy

DOI: 10.17235/reed.2017.4528/2016

Letter to the Editor

Liver metastasis from colorectal cancer 12 years after liver transplantation

DOI: 10.17235/reed.2017.4507/2016

Letter to the Editor

Intramural gastric hematoma in the context of an acute pancreatitis

DOI: 10.17235/reed.2017.4494/2016

Letter to the Editor

Sister Mary Joseph’s nodule as initial pancreatic cancer manifestation

DOI: 10.17235/reed.2016.4479/2016

Letter to the Editor

Alopecia areata as a paraneoplastic syndrome of gastric cancer

DOI: 10.17235/reed.2016.4455/2016

Original

Practical aspects of high resolution esophageal manometry

DOI: 10.17235/reed.2016.4441/2016

Letter to the Editor

Management of non-surgical pneumoperitoneum

DOI: 10.17235/reed.2016.4215/2016

Case Report

The clinical extremes of autoimmune cholangitis

DOI: 10.17235/reed.2017.4167/2015

Review

Serrated lesions and serrated polyposis syndrome

DOI: 10.17235/reed.2017.4065/2015

Letter to the Editor

Lupus as a paraneoplastic manifestation of cholangiocarcinoma

DOI: 10.17235/reed.2016.4064/2015

Letter to the Editor

Endobronchial metastases of colorectal cancer

DOI: 10.17235/reed.2016.4080/2015

Letter to the Editor

Acute transverse colon volvulus with secondary gastric isquemia. Case report

DOI: 10.17235/reed.2016.4024/2015

Letter to the Editor

Hiatal herniation following total gastrectomy

DOI: 10.17235/reed.2016.4009/2015

Letter to the Editor

Gastric neuroendocrine tumor presenting with gastrointestinal bleeding

DOI: 10.17235/reed.2015.3998/2015

Letter to the Editor

Endoscopic submucosal dissection for a gastric fibrolipoma

DOI: 10.17235/reed.2015.3982/2015

Case Report

Metastatic Crohn’s disease in pediatrics

DOI: 10.17235/reed.2016.3948/2015

Letter to the Editor

Authors' reply: Spanish or English in scientific reporting

DOI: 10.17235/reed.2015.3945/2015

Case Report

Glycogenic hepatopathy in young adults: a case series

DOI: 10.17235/reed.2016.3934/2015

Case Report

Primary esophageal melanoma: report of a case

DOI: 10.17235/reed.2016.3908/2015

Case Report

Gastric varicella: two cases in cancer patients

DOI: 10.17235/reed.2016.3925/2015

Letter to the Editor

Case report: Amyand’s hernia, diagnosis to consider in a routine procedure

DOI: 10.17235/reed.2015.3816/2015

Review

Impaired esophageal motor function in eosinophilic esophagitis

DOI: 10.17235/reed.2015.3801/2015

Case Report

Appendicular bleeding: an excepcional cause of lower hemorrhage

DOI: 10.17235/reed.2015.3828/2015

Digestive Diseases Image

Granular cell tumor of cecum

Review

Anal Intraepithelial neoplasia: A narrative review

DOI: 10.17235/reed.2015.3788/2015

Case Report

Pelvic inflammatory myofibroblastic tumor mimicking a rectal cancer

DOI: 10.17235/reed.2015.3777/2015

Case Report

Downhill varices: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2015.3697/2015

Letter to the Editor

Acute gastric dilatation in the context of bulimia nervosa

DOI: 10.17235/reed.2015.3673/2015

Letter to the Editor

Duodenal involvement by seminomatous tumors

DOI: 10.17235/reed.2015.3646/2014

Letter to the Editor

Synchronic gastric and pancreatic ductal adenocarcinoma. A case report

DOI: 10.17235/reed.2015.3720/2014

Letter to the Editor

Severe acute liver failure and thyrotoxicosis: an unusual association

DOI: 10.17235/reed.2015.3607/2014

Letter to the Editor

Leiomyosarcoma of the ascending colon: a rare tumor with poor prognosis

DOI: 10.17235/reed.2015.3606/2014

Letter to the Editor

PITAVASTATIN: OTHER STATIN TO BE USED AND MONITORED

DOI: 10.17235/reed.2015.3565/2014

Letter to the Editor

Liver abscess by Eikenella Corrodens

DOI: 10.17235/reed.2015.3613/2014

Letter to the Editor

Leiomyoma of the round ligament of the liver: Report of one case

DOI: 10.17235/reed.2015.3725/2014

Citation tools
Ampuero J, Sánchez Y, García-Lozano M, Maya-Miles D, Romero Gómez M. Impact of liver injury on the severity of COVID-19: a systematic review with meta-analysis. 7397/2020


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Publication history

Received: 08/07/2020

Accepted: 24/09/2020

Online First: 03/12/2020

Published: 08/02/2021

Article revision time: 72 days

Article Online First time: 148 days

Article editing time: 215 days


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