Laboratory hematologic features of COVID-19 associated liver injury:A systematic review

摘要

BACKGROUND Liver injury is a common complication of infection by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus.The utility of laboratory hematology data in the diagnosis and risk stratification of patients with coronavirus disease 2019(COVID-19)has not been comprehensively examined.AIM To address the following.(1)Are the abnormalities in hematologic parameters seen in the general population of patients with COVID-19 also seen in those patients with associated liver injury?(2)Is liver injury in COVID-19 a sign of severe disease and does liver injury correlate with hematologic markers of severe disease?And(3)What is the quality of this evidence?METHODS To address these questions,a comprehensive systematic review was performed.We searched the peer reviewed medical literature using MEDLINE(PubMed interface),Web of Science,and EMBASE for cohort studies that specifically addressed liver injury and COVID-19 without limitation of date of publication or language.A quality assessment of the studies was performed using the Newcastle-Ottawa Scale.RESULTS Thirty-two articles were suitable for inclusion in our systematic review.These included 22 articles with a cohort of COVID-19 patients with liver injury,5 comparing non-severe vs severe COVID-19 populations in which liver injury was addressed,and 5 other cohort studies with a focus on liver injury.White blood cell count,absolute neutrophil count,absolute lymphocyte count(ALC),and hemoglobin were the parameters most helpful in distinguishing COVID-19 with liver injury from COVID-19 without liver injury.ALC and d-dimer were identified as being potentially useful in distinguishing non-severe from severe COVID-19. Liver injury was more frequently seen in cohorts with severe disease.Most studies were of high quality (24/48, 86%) with 4/28 (14%) of moderatequality and 0 of low quality.CONCLUSIONOur study supports the use of select hematologic parameters in diagnosis and riskstratification of liver injury in COVID-19 patients. Although of overall highquality, the current medical literature is limited by the small number of studieswith high statistical power and the variable definition of COVID-19 liver injury inthe literature.