Liver injury in post-acute COVID-19 syndrome: A systematic review and meta-analysis of early observational studies
Abstract
Background:
Post-acute COVID-19 syndrome (PACS; long COVID) is characterized by persistent or delayed symptoms at least 4 weeks from acute COVID-19 infection. Given the well-documented incidence of liver injury in acute COVID-19, this systematic review aims to assess the odds of liver injury in earlier experiencers of PACS.
Methods:
Observational studies published prior to March 2022 were screened for data describing liver injury (defined per primary study) in patients with PACS.
Results:
A total of 2,117 abstracts and 35 full texts were screened, of which 26 met the inclusion criteria. The mean time since acute COVID infection across all studies was 195.5 days. Seven studies included COVID-negative control groups. Twenty-three studies measured lab findings, and nine studies measured imaging or elastography. Five studies were eligible for meta-analysis of odds ratios, which did not demonstrate a statistically significant difference in odds for liver injury in patients with PACS compared with COVID-negative patients (OR 2.22 [95% CI 0.51–9.61; p = 0.28]). Newcastle-Ottawa Scale assessments for all studies found 24 of 26 studies with high to very high risk of bias. ROBINS-E assessments for studies included in the meta-analysis found five of five studies with high to very high risk of bias.
Conclusions:
Overall, our findings demonstrate no statistical difference in odds ratios of liver injury in patients with PACS compared with COVID-negative controls. As such, routine assessment and monitoring of liver injury in patients with PACS may not be required; however, higher quality data with lower risk of bias are required to make recommendations of higher certainty.
Supplemental Material
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Registry and the Registration No. of the Study/Trial:
The review protocol was registered on PROSPERO on March 30, 2022 (ID: CRD42022321890).
Funding:
N/A
Peer Review:
This manuscript was peer reviewed.
Animal Studies:
N/A
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Information & Authors
Information
Published In
Canadian Liver Journal
Volume 7 • Number 4 • December 2024
Pages: 470 - 489
Copyright
© Canadian Association for the Study of the Liver, 2024. This article is free to read to all interested readers, immediately upon publication. For their own personal use, users may read, download, print, search, or link to the full text. Manuscripts published in the Canadian Liver Journal are copyrighted to the Canadian Association for the Study of the Liver. Requests for permission to reproduce this article should be made to the University of Toronto Press using the Permission Request Form: https://canlivj.utpjournals.press/policies#_copyright or by email: [email protected].
History
Received: 11 March 2024
Accepted: 13 April 2024
Published online: 19 December 2024
Published in print: December 2024
Keywords:
Data Accessibility:
All data will be available free of charge upon request.
Authors
Contributions:
Conceptualization, PS Mundra, S Albashir; Methodology, PS Mundra, S Albashir; Validation, PS Mundra; Formal Analysis, PS Mundra, M Yaghoobi; Investigation, PS Mundra, Z Kailani; Resources, PS Mundra, S Albashir; Data Curation, PS Mundra; Writing – Original Draft, PS Mundra, Z Kailani, P Matthews, M Tobis, S Sadeghian; Writing - Review & Editing, PS Mundra, Z Kailani, M Yaghoobi, P Matthews, M Tobis, S Sadeghian, S Albashir; Visualization, PS Mundra; Supervision, PS Mundra; Project Administration, PS Mundra.
Disclosures:
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Canadian Liver Journal 2024 7:4, 470-489
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