SARS-CoV-2 induced liver injury: Incidence, risk factors, impact on COVID-19 severity and prognosis in different population groups

Table 2 Incidence of abnormal liver function tests (liver injury)

Author/citation LFTs performed	Type of study (n = participants)	Incidence (%)	Country/year of publication
Cai et al[20]	Study (n = 417)		China/2020
Abnormal LFTs
SLI (AST/ALT > 3 × ULN		76.3
or ALP/γGT > 2 × ULN)		21.8
ALT (> 3 × ULN)		37
GGT (> 3 × ULN)		41
AST (> 3 × ULN)		20
TBIL (> 3 × ULN)		10
MOF		23.3
Phipps et al[23]	Study (n = 2273)		United States/2020
Mild (peak ALT < 2 × ULN)		45
Moderate (peak ALT 2-5 × ULN)		21
SLI (peak ALT > 5 × ULN)		6.4
Huang et al[191]	Study (n = 675)		China/2020
Abnormal LFTs		37.5
SLI		7.7
Guan et al[284]	Study (n = 1099)		China/2020
AST/ALT
mild disease		18.2–19.8
severe disease		28.1–39.4
Hundt et al[185]	Study (n = 1827)		United States/2020
LFTs (on admission)
AST		66.9
ALT		41.6
TBIL		4.3
ALP		13.5
Wang et al[65]	Study (n = 657)		China/2020
Liver injury		46.1
ALT		42.2
GGT		24.4
TBIL		4.9
Chu et al[320]	Study (n = 838)		China/2020
Liver Injury		51.2
Yip et al[287]	Study (n = 1040)		China/2021
Aminotransferases		22.5
ALP		58.5
TBIL		52.1
Ding et al[22]	Study (n = 2073)		China/2021
Survivors		90.3
Any abnormal LFT		61.8
Mild abnormal LFT		47.5
SLI		14.3
LI type
Hepatocellular		25.8
Cholestatic		6.7
Mixed		25.7
Specific liver indices
ALT		43.3
AST		38.9
GGT		31.8
Shao et al[38]	Study (n = 1520)		China/2021
SLI		17.9
Mishra et al[200]	Study (n = 348)		United States/2021
New-onset LI		52.8
Sikkema et al[204]	Study (n = 382)		Netherlands/2021
LI		41.6
Moderate LI (ALT > 100 or ALP > 200)		6.5
Cholestatic LI		9.2
Chew et al[190]	Study (n = 834)		United States/2021
AST		62.5
ALT		33.7
ALP		11.9
TBIL		3.1
Richardson et al[25]	Study (n = 5700)		United States/2020
AST		58.4
ALT		39
Bernal-Monterde et al[187]	Study (n = 540)		Spain/2020
Abnormal LFTs		64.3
ALT		28.6
AST		40.9
GGT		47.3
Krishnan et al[321]	Study (n = 3830)		United States/2022
ALT		70.4
AST		44.4
ALP		16.1
TBIL		5.9
Kodavoor et al[180]	Study (n = 708)		India/2022
AST		69.91
< 1–2 times ULN		42.51
2–3 times ULN		14.26
3–5 times ULN		8.19
> 5		4.94
ALT		80.22
< 1–2 times ULN		42.93
2–3 times ULN		17.93
3–5 times ULN		12.14
> 5		7.2
Russo et al[234]	Study (n = 1641)		Italy/2022
AST		27.7
ALT		23
TBIL		12.6
Marjot et al[44]	Review		United Kingdom/2021
AST		29–39
ALT		38–63
Cai et al[82]	Review		China/2021
ALT		11–56.3
AST		15–86.8
TBIL		2.7–30.6
CLD		2–11
Ekpanyapong et al[322]	Review		Multinational/2022
Aminotransferases		10–58
ALP		1–10
TBIL		3–23
GGT		13–54
Esteban et al[209]	Review		United States/2022
Aminoransferases (admission)		20–67
Aminoransferases (hospitalization)		61–83
ALP		23–30
TBIL		4–16
Garrido et al[59]	Review		Portugal/2020
ALT		2.5–50
AST		2.5–61.1
TBIL		0–35.3
Kullar et al[2]	Meta-analysis (n = 3046)		United States/2020
ALT		21
AST		24
TBIL		9
Wijarnpreecha et al[198]	Meta-analysis (n = 64 studies) (n = 11245 pts)		United States/2021
AST		23.2
ALT		21.2
TBil		9.7
GGT		15
ALP		4
AST
Severe cases		45.5
Non-severe		15
Wu et al[253]	Meta-analysis (n = 45 studies)		Multinational/2018
Admission
Any abnormal LFT		27.2
ALT		20.4
AST		21.8
ALP		4.7
GGT		35.8
TBIL		8.8
Hospitalization
Any abnormal LFT		36
ALT		38.4
AST		28.1
TBIL		23.2
Del Zompo et al[323]	Meta-analysis (n = 36 studies) (n = 20724 patients)		Italy/2020
At admission (pooled prevalence)
Abnormal LFT		46.9
ALT		22.8
AST		26.5
GGT		22.5
ALP		5.7
TBIL		8
Zhu et al[262]	Meta-analysis (n = 38 studies) (n = 3063 pts)		China/2020
Abnormal LFTs		29
Mao et al[18]	Meta-analysis (n = 1267)		China/2020
Abnormal LFTs		19
Alqahtani et al[324]	Meta-analysis (n = 30 studies)		Multinational/2020
Abnormal LFTs		61.1
Sultan et al[325]	Meta-Analysis (n = 47 studies) (n = 10,890 pts)		United States/2020
Pooled prevalence
ALT		15
AST		15
TBIL		16.7
Kumar et al[210]	Meta-analysis (n = 128 studies)		India/2020
Pooled prevalence
TBIL		13.71
ALT		31.1
AST		33.95
ALP		6.99
GGT		30.62
ALB		61.57
Severe vs non-severe pts
TBIL		18.80 vs 9.24
ALT		39.58 vs 24.15
AST		49.68 vs 19.40
ALP		11.33 vs 4.0
GGT		46.90 vs 18.66
ALB		75.91 vs 31.04

The table encompasses several studies and meta-analyses which included more than 200 individuals.

ALB: Albumin; ALI: Acute liver injury; ALT: Alanine transaminase; ALP: Alkaline phosphatase; AST: Aspartate transaminase; GGT: Gamma-glutamyl transferase; LI: Liver injury; LFTs: Liver function tests; SLI: Severe liver injury; MOF: Multiple organ failure; TBIL: Total bilirubin; ULN: Upper limit of normal; γGT: Gamma-glutamyltransferase; LFT: Liver function tests; pts: Patients.