Table 1.
Summary of selected studies deciphering abnormal liver biochemistries and their association with severe COVID-19 outcomes and death.
| Laboratory test | COVID-19 studies | Study design | Study region and patient demographics and clinical characteristics | Abnormal liver biochemistry findings (% of patients) | Association with severe disease progression |
Association with mortality |
|---|---|---|---|---|---|---|
| AST | Richardson et al. (May 2020) [2] | Case series | USA; n = 5700; COVID-19 plus hypertension (n = 3026); SARS-CoV-2 plus obesity ((n = 1737); SARS-CoV-2 plus diabetes ((n = 1808) |
16 %-58 % Richardson et al. (May 2020), Guan et al. (Apr 2020), Cai et al. (Apr 2020), Huang et al. (Feb 2020), Chen et al. (May 2020), Chen et al. (Feb 2020), Xu et al. (Feb 2020) |
Yes | Yes |
| Cai et al. (Jul 2020), Bloom et al. (Mar 2021), Huang et al. (Feb 2020), Chen et al. (May 2020) |
Deng et al. (Jun 2020) |
|||||
| Guan et al. (Apr 2020) [59] | Retrospective analysis | China; n = 1099; COVID-19 plus coexisting illness (hypertension and COPD) in 23.7 % of participants | ||||
| Cai et al. (Apr 2020) [27] | Cross-sectional study | China; n = 417; COVID-19 plus diabetes ((n = 12) hypertension (n = 25) and liver disease (n = 4) | ||||
| Cai et al. (Jul 2020) [28] | Retrospective analysis | China; n = 298; COVID-19 plus diabetes (6.4 %), hypertension (12.8 %), cardiovascular disease (3.7 %), liver disease (2.7 %), or malignancies (1.3 %) | ||||
| Bloom et al. (Mar 2021) [29] | Retrospective cohort analysis | USA; n = 60; COVID-19 plus CLD (n = 4), cirrhosis (n = 1) obese (n = 48), diabetes (n = 14), coronary artery disease (n = 11) and abnormal liver biochemistry on admission (n = 41) | ||||
| Huang et al. (Feb 2020) [30] | Retrospective cohort analysis | China; n = 41; COVID-19 plus diabetes ((n = 8), hypertension (n = 6), and cardiovascular disease (n = 6) | ||||
| Chen et al. (May 2020) [31] | Retrospective, single-center study | China; n = 99; COVID-19 plus cardiovascular and cerebrovacular illness (n = 40), endocrine system disease (n = 13) and malignant tumor ((n = 1) | ||||
| Xu et al. (Feb 2020) [33] | Retrospective case series | China; n = 62; COVID-19 plus liver disease (n = 7), Hypertension (n = 5), and diabetes (n = 1) | ||||
| Deng et al. (Jun 2020) [35] | Retrospective cohort analysis | China; n = 225; COVID-19 plus hypertension (n = 40), diabetes (n = 17), and heart disease (n = 13) | ||||
| ALT | Richardson et al. (May 2020) [2] | Case series | USA; n = 5700; COVID-19 plus hypertension (n = 3026); SARS-CoV-2 plus obesity (n = 1737); SARS-CoV-2 plus diabetes (n = 1808) |
13 %-39 % Richardson et al. (May 2020), Guan et al. (Apr 2020), Cai et al. (Apr 2020), Chen et al. (May 2020), Zhou et al. (Mar 2020) |
Yes Cai et al. (Jul 2020), Huang et al. (Feb 2020), Chen et al. (May 2020) |
Yes Deng et al. (Jun 2020), Zhou et al. (Mar 2020) |
| No Liu et al. (Mar 2020) | ||||||
| Guan et al. (Apr 2020) [59] | Retrospective analysis | China; n = 1099; COVID-19 plus coexisting illness (hypertension and COPD) in 23.7 % of participants | ||||
| Cai et al. (Apr 2020) [27] | Cross-sectional study | China; n = 417; COVID-19 plus diabetes ((n = 12) hypertension (n = 25) and liver disease (n = 4)) | ||||
| Cai et al. (Jul 2020) [28] | Retrospective analysis | China; n = 298; COVID-19 plus diabetes (6.4 %), hypertension (12.8 %), cardiovascular disease (3.7 %), liver disease (2.7 %), or malignancies (1.3 %). | ||||
| Huang et al. (Feb 2020) [30] | Retrospective cohort analysis | China; n = 41; COVID-19 plus diabetes (n = 8), hypertension (n = 6), and cardiovascular disease (n = 6) | ||||
| Chen et al. (Feb 2020) [32] | Retrospective observational study | China; n = 21; COVID-19 plus hypertension (n = 2) | ||||
| Chen et al. (May 2020) [31] | Retrospective, single-center study | China; n = 99; COVID-19 plus cardiovascular and cerebrovacular illness (n = 40), endocrine system disease (n = 13) and malignant tumor ((n = 1) | ||||
| Deng et al. (Jun 2020) [35] | Retrospective cohort analysis | China; n = 225; COVID-19 plus hypertension (n = 40), diabetes (n = 17), and heart disease (n = 13) | ||||
| Zhou et al. (Mar 2020) [36] | Retrospective multicenter cohort study | China; n = 191; COVID-19 plus hypertension (n = 58), diabetes (n = 36), and coronary heart disease (n = 15) | ||||
| Alkaline phosphatase | Cai et al. (Apr 2020) [27] | Cross-sectional study | China; n = 417; COVID-19 plus diabetes ((n = 12) hypertension (n = 25) and liver disease (n = 4) |
5 % Cai et al. (Apr 2020) |
Yes Cai et al. (Jul 2020) |
– |
| Cai et al. (Jul 2020) [28] | Retrospective analysis | China; n = 298; COVID-19 plus diabetes (6.4 %), hypertension (12.8 %), cardiovascular disease (3.7 %), liver disease (2.7 %), or malignancies (1.3 %) | ||||
| Total Bilirubin (Tbili) | Guan et al. (Apr 2020) [59] | Retrospective analysis | China; n = 1099; COVID-19 plus coexisting illness (hypertension and COPD) in 23.7 % of participants | 11 %−23 % | Yes Huang et al. (Feb 2020) |
– |
| Guan et al.(Apr 2020), Cai et al.(Jul 2020), Chen et al. (Feb 2020) | No Cai et al. (Apr 2020), Chen et al. (May 2020) |
|||||
| Cai et al. (Apr 2020) [27] | Cross-sectional study | China; n = 417; COVID-19 plus diabetes ((n = 12) hypertension (n = 25) and liver disease (n = 4) | ||||
| Cai et al. (Jul 2020) [28] | Retrospective analysis | China; n = 298; COVID-19 plus diabetes (6.4 %), hypertension (12.8 %), cardiovascular disease (3.7 %), liver disease (2.7 %), or malignancies (1.3 %). | ||||
| Huang et al. (Feb 2020) [30] | Retrospective cohort analysis | China; n = 41; COVID-19 plus diabetes (n = 8), hypertension (n = 6), and cardiovascular disease (n = 6) | ||||
| Chen et al. (Feb 2020) [32] | Retrospective observational study | China; n = 21; COVID-19 plus hypertension (n = 2) | ||||
| Chen et al. (May 2020)[31] | Retrospective, single-center study | China; n = 99; COVID-19 plus cardiovascular and cerebrovacular illness (n = 40), endocrine system disease (n = 13) and malignant tumor ((n = 1) | ||||
| Albumin | Huang et al. (Feb 2020)[30] | Retrospective cohort analysis | China; n = 41; COVID-19 plus diabetes (n = 8), hypertension (n = 6), and cardiovascular disease (n = 6) |
38 %−98 % Chen et al. (Feb 2020), Chen et al. (May 2020) |
Yes Huang et al. (Feb 2020), Chen et al. (May 2020), Liu et al. (May 2020), Liu et al. (Mar 2020) |
Yes Zhou et al. (Mar 2020) |
| Chen et al. (Feb 2020)[32] | Retrospective observational study | China; n = 21; COVID-19 plus hypertension (n = 2) | ||||
| Chen et al. (May 2020)[31] | Retrospective, single-center study | China; n = 99; COVID-19 plus cardiovascular and cerebrovacular illness (n = 40), endocrine system disease (n = 13) and malignant tumor ((n = 1) | ||||
| Liu et al. (May 2020)[34] | Retrospective observational study | China; n = 78; COVID-19 plus hypertension (n = 8), diabetes (n = 5), COPD (n = 2) and cancer (n = 4) | ||||
| Zhou et al. (Mar 2020)[132] | Retrospective multicenter cohort study | China; n = 191; COVID-19 plus hypertension (n = 58), diabetes (n = 36), and coronary heart disease (n = 15) | ||||
| Liu et al. (Mar 2020)[134] | Case series | China; n = 12; COVID-19 plus hypertension (n = 3), chronic heart disease (n = 4) | ||||
| Gamma Glutamyl Transferase (GGT) | Cai et al. (Apr 2020)[27] | Cross-sectional study | China; n = 417; COVID-19 plus diabetes ((n = 12) hypertension (n = 25) and liver disease (n = 4) |
16 % Cai et al. (Apr 2020) |
Yes Cai et al. (Jul 2020) |
– |
| Cai et al. (Jul 2020)[28] | Retrospective analysis | China; n = 298; COVID-19 plus diabetes (6.4 %), hypertension (12.8 %), cardiovascular disease (3.7 %), liver disease (2.7 %), or malignancies (1.3 %) | ||||
| Prothrombin time (PT) | Huang et al. (Feb 2020)[30] | Retrospective cohort analysis | China; n = 41; COVID-19 plus diabetes (n = 8), hypertension (n = 6), and cardiovascular disease (n = 6) |
5 % − 6 % Chen et al. (Feb 2020), Zhou et al. (Mar 2020) |
Yes Huang et al. (Feb 2020) |
Yes Zhou et al. (Mar 2020) |
| Chen et al. (Feb 2020)[32] | Retrospective observational study | China; n = 21; COVID-19 plus hypertension (n = 2) | ||||
| No Chen et al. (May 2020) | ||||||
| Chen et al. (May 2020)[31] | Retrospective, single-center study | China; n = 99; COVID-19 plus cardiovascular and cerebrovacular illness (n = 40), endocrine system disease (n = 13) and malignant tumor (n = 1) | ||||
| Zhou et al. (Mar 2020)[132] | Retrospective multicenter cohort study | China; n = 191; COVID-19 plus hypertension (n = 58), diabetes (n = 36), and coronary heart disease (n = 15) | ||||
AST; aspartate aminotransferase, COVID-19; coronavirus infectious disease-19, SARS-COV-2, severe acute respiratory syndrome coronavirus-2, ALT; alanine aminotransferase, COPD; chronic obstructive pulmonary disease, CLD; chronic liver disease, GGT; gamma-glutamyl transferase, PT; prothrombin time.