| کلیدواژههای انگلیسی مقاله |
COVID-19, SARS-CoV-2, Liver function tests, What&,rsquo s Known Elevated serum levels of aspartate aminotransferase, alanine aminotransferase, total bilirubin, and low albumin levels are observed in patients with severe COVID-19 infection. In addition to elevated liver enzymes, patients with liver damage have an increased level of biomarkers such as D-dimer, erythrocyte sedimentation rate, C-reactive protein, and lactate dehydrogenase. What&,rsquo s New Elevation in liver function tests was higher in patients with severe than non-severe COVID-19 infection. Given the widespread use of drugs that increases the risk of hepatotoxicity, healthcare providers should be aware of changes in liver enzymes in COVID-19 patients. IntroductionGlobally, in February 2021, the cumulative number of coronavirus disease-2019 (COVID-19) infections had reached over 102.1 million reported cases. 1, The incidence and mortality rates are still increasing, especially among older adults and patients with comorbidity. Clinical manifestation of COVID-19 varies from asymptomatic or mild symptomatic symptoms to cough, fever, fatigue, gastrointestinal symptoms shortness of breath and dyspnea, acute respiratory distress, shock, and even the risk of death. 2,- 6, Infected patients may suffer from liver dysfunction characterized by abnormal liver tests, particularly in severe cases. 7,- 11, Therefore, it is extremely important to assess the effect of COVID-19 infection on liver function. 11,- 13, A recent study on the alteration in liver enzyme levels due to COVID-19 infection has indicated that higher levels of aspartate aminotransferase (AST) and direct bilirubin increase the risk of requiring critical care or admission to an intensive care unit (ICU). Elevated AST, alanine aminotransferase (ALT), total bilirubin (TBIL) levels, and low albumin levels have been reported in severe cases. 14,, 15, It is reported that an AST level of 30.5 (U/L) has a sensitivity of 71.4% and specificity of 68.5% for ICU transfer. 16, Previous studies of patients with liver damage reported increased levels of other biomarkers such as D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) in addition to abnormal liver enzymes. 17,, 18, This necessitates an additional focus on the assessment of biomarkers related to liver function in COVID-19 patients with varying degrees of liver damage.Recent studies on liver damage due to the COVID-19 outbreak have not been comprehensive and lack a comparison between the extent of the damage and the severity of the disease. In the present study, we reviewed both research data and experts&,rsquo opinions on the correlation between COVID-19 and liver injury. A systematic review and meta-analysis were conducted to establish the characteristics of liver function tests in COVID 19 patients.Materials and MethodsSearch StrategyThe study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). 19, Our systematic search included publications in Web of Science, Scopus, and Medline (via PubMed) databases from December 2019 up to April 2020. Both cross-sectional and case series studies, even those in preprint state, were included. Important references and related reviews of these articles were examined using the Google Scholar web search engine. The search was performed independently by two researchers using medical keywords &,ldquo 2019 novel coronavirus infection&,rdquo OR &,ldquo COVID19 OR COVID-19&,rdquo OR &,ldquo Coronavirus disease 2019&,rdquo OR &,ldquo Coronavirus disease-19&,rdquo OR &,ldquo 2019-nCoV disease&,rdquo OR &,ldquo 2019 novel coronavirus disease&,rdquo OR &,ldquo 2019-nCoV infection&,rdquo OR &,ldquo SARS COV-2&,rdquo OR &,ldquo SARS-COV-2&,rdquo in combination with &,ldquo Liver function&,rdquo OR &,ldquo AST&,rdquo OR &,ldquo ALT&,rdquo OR &,ldquo Liver toxicity&,rdquo OR &,ldquo Bilirubin&,rdquo OR &,ldquo SGOT&,rdquo OR &,ldquo Aspartate transaminase&,rdquo OR &,ldquo Alanine transaminase&,rdquo OR &,ldquo SGPT&,rdquo OR &,ldquo liver&,rdquo OR &,ldquo hepat*&,rdquo . A combination of keywords and free text was used to broaden the search result.Inclusion CriteriaObservational studies in the English language, as well as articles in other languages with English abstracts, were assessed. Eligible studies were those that assessed the association between serum levels (ALT, AST, albumin, bilirubin, CRP, ESR, D-dimer, LDH) and severe outcomes of COVID-19 infection as the primary outcomes of main interest. Studies that reported medians and interquartile ranges (IQR) for AST, ALT, albumin, and bilirubin levels in both severe and non-severe COVID-19 infected patients were deemed eligible. Patient age was not considered as an exclusion criterion, however, studies on a particular group of individuals with specific conditions such as cirrhosis and tissue graft were excluded. Other publications such as case reports, articles on experts&,rsquo opinions, letters to editors, review articles, books, and animal studies were also excluded. Identification of COVID-19 cases was based on the primary definition of the case study. The severity of COVID-19 infection was defined according to treatment guidelines by the Chinese National Institutes of Health. 20, Increased serum levels from laboratory data were defined as stated by the primary study classification.Study SelectionDuplicated papers were excluded using the EndNote software X8 (Thomson Reuters, Philadelphia, USA). Two researchers (Malekan and Abounori) independently assessed all potential articles against the inclusion and exclusion &,lrm criteria of our study. Disagreement between the reviewers was resolved in consultation with a third researcher (Mortazavi). Initially, the titles and abstracts of the articles were screened based on our inclusion criteria. Then, the full text of the selected articles was reviewed based on both our inclusion and exclusion criteria to confirm study eligibility. Quality AssessmentTwo authors independently assessed the quality of the selected articles using the modified version of the Newcastle-Ottawa Scale (NOS). 21, The selection was based on comparability &,lrm and exposure/outcome criteria and articles with a score of seven or higher were considered high-quality articles. The National Institutes of Health (NIH) quality assessment tool was used for case series studies and the articles were scored as acceptable, fair, or poor quality. 22, Data ExtractionTwo researchers (Malekan and Abounori) independently extracted the following information from the &,lrm selected articles, author&,rsquo s name, publication year, country, type of publication, study design, sample size, patients&,rsquo characteristics, number of patients in severe and non-severe groups, number of discharged and admitted patients, number of deaths, and the mean (standard deviation( of laboratory data in severe and non-severe groups. Laboratory data included serum levels of CRP, D-dimer, ESR, LDH, AST, ALT, albumin, and bilirubin. The reported values for increased/decreased indices (CRP, ALT, AST, LDH, and D-dimer) were used as stated in the reference of the selected articles. Statistical AnalysisThe data were analyzed using the STATA software version 11.0 (Stata Corp LLC- United States). The heterogeneity between the articles was examined using I-square (I2) test. The random-effects model for I2&,gt 50% was used to pool the results. To identify the source of heterogeneity between the articles, subgroup analysis was performed based on the severity of the disease. Pooled prevalence and odds ratio (OR) were used to assess the outcomes.ResultsSelection ProceduresThe search of Web of Science, Scopus, and Medline (via PubMed) databases identified 351 articles. A manual search of their references, using the Google Scholar search engine, yielded 643 additional articles. After excluding 341 duplicate articles, 653 articles were screened, out of which 92 articles were selected for full-text eligibility assessment. After excluding a further 50 articles, 42 studies were finally included in the meta-analysis. The PRISMA flow diagram of the study selection procedure is presented in figure 1,.Figure 1. PRISMA flowchart depicts the study selection process.A total of 6,557 confirmed cases of COVID-19 were reported in the 42 selected articles, and all studies were conducted in China (table 1,). The overall quality of the included cross-sectional studies was acceptable and of the case series it was good. The quality assessment score of each study is presented in table 2,.AuthorCountryType of studySample size (male/female)Mean AgeNumber of patients with liver toxicityCRP (mg/l)Serum levels (ALT, U/L, AST, U/L, Bilirubin, mg/dL, Albumin, g/L)LDH (U/L)D-dimer (&,mu g/mL)ESR (mm/h)Diagnosis methodClinical stage of liver enzymes dataQ/A scoreHuang et al. 2, ChinaC/S41 (30/11)49.0 (41.0-58.0)--ALT, 32.0 (21.0-50.0)286.0 (242.0-408.0)0.5 (0.3-1.3)-RT-PCROn admission 8AST, - |
| نویسندگان مقاله |
Mohammad Zahedi |
Department of Laboratory Sciences, School of Allied Medical Science, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
Mohammad Yousefi |
Department of Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
Mahdi Abounoori |
Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Mohammad Malekan |
Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Fatemeh Tajik |
Department of Medicine, School of Medicine, Azad University of Tehran, Tehran, Iran
Keyvan Heydari |
Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
Parham Mortazavi |
Student Research Committee, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
Sulmaz Ghahramani |
Health Policy Research Center, Institute of Health, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Monireh Ghazaeian |
Department of Clinical Pharmacy, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
Fateme Sheydaee |
Department of Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
Amirreza Nasirzadeh |
Student of Basic Sciences in Nursing, Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
Reza Alizadeh-Navaei |
Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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