Furthermore, experimental studies, studies describing the mechanism, review articles, virology studies, studies describing only the radiological features or studies describing the usage of artificial intelligence in COVID‐19, epidemiology, transmission, and surveillance‐related articles, editorials, investigations (testing)‐related articles, guidelines, recommendations, unpublished data and management‐related articles were excluded. Studies that did not report any data on liver chemistries or underlying CLD were excluded. Case reports (of >2 patients), case series, cross‐sectional studies, case‐control studies, cohort studies (retrospective and prospective), quasi‐randomised and randomised controlled trials that mentioned elevated liver chemistries in patients with COVID‐19 were included irrespective of age and gestational status. The data were abstracted by two investigators independently (AVK and PK) based on the protocol priori, which was registered on Prospero (CRD42020181962).
We aimed to answer these questions: (a) What is the prevalence of CLD in the global COVID‐19 burden? (b) What is the incidence of elevated liver chemistries at initial presentation and during the illness in COVID‐19? and (c) What is the association of elevated liver chemistries and pre‐existing CLD on clinical outcomes of COVID‐19?Ģ.1. In this systematic review, we compiled all the data published and analysed the liver involvement in COVID‐19, describing each variable of liver chemistries in COVID‐19 and the effect of COVID‐19 in patients with pre‐existing CLD. However, the incidence of elevated liver chemistries at initial presentation or during illness or the presence of pre‐existing CLD on outcomes of COVID‐19 has not been extensively reviewed so far. Previous reviews have analysed a limited number of studies.
The incidence of elevation in aminotransferases and/or bilirubin have been variably reported in COVID‐19. Moreover patients with cirrhosis, being immunocompromised, are expected to be more susceptible and have worse outcomes in viral illness. Chronic liver disease (CLD) is one such population with increasing burden worldwide. However, pandemics may not affect all populations equally, and certain populations are particularly vulnerable. Age, severity of the infection and comorbidity are important predictors of poor outcomes in COVID‐19. Severe COVID‐19 can lead to multi‐organ failure and may be associated with high mortality. Coronavirus disease‐2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is a global health problem.
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