Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2022; 14(12): 2012-2024
Published online Dec 27, 2022. doi: 10.4254/wjh.v14.i12.2012
Liver chemistries in severe or non-severe cases of COVID-19: A systematic review and meta-analysis
Xuan Dong, Dan-Yi Zeng, Qing-Qing Xing, Mei-Zhu Hong, Jin-Shui Pan
Xuan Dong, Dan-Yi Zeng, Qing-Qing Xing, Jin-Shui Pan, Department of Hepatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Mei-Zhu Hong, Department of Traditional Chinese Medicine, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Pan JS and Hong MZ were involved with the study conceptualization and design; analysis and interpretation of data; drafting of the manuscript; and approval of the final version of the manuscript; Dong X, Zeng DY, and Xing QQ were involved in data retrieval; All authors read and approved the final manuscript; Dong X and Zeng DY contributed equally to this work.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The study only utilizes publically available published aggregated anonymous data, not a human subject research. Potential studies were retrieved in accordance with the PRISMA guideline.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jin-Shui Pan, MD, PhD, Chief Doctor, Professor, Department of Hepatology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou 350005, Fujian Province, China.
Received: July 3, 2022
Peer-review started: July 3, 2022
First decision: September 30, 2022
Revised: October 21, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: December 27, 2022

Coronavirus disease (COVID-19) patients exhibit different patterns of liver impairment, according to growing evidence.


In this study, we sought to provide a comprehensive analysis of liver test parameters in patients with severe and non-severe COVID-19.


We performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19. We searched PubMed, Google Scholar, Embase, Cochrane Library, medRxiv, bioRxiv, and three Chinese electronic databases through April 18, 2020, in accordance with the Preferred Reporting Items for Meta-Analyses. We analyzed pooled data on liver chemistries stratified by COVID-19 severity using a fixed or random-effects model.


A meta-analysis of 56 studies, including 11052 patients, found that the pooled mean alanine aminotransferase (ALT) in severe COVID-19 cases was 35.9 IU/L whereas in non-severe COVID-19 cases was 27.3 IU/L. Average aspartate aminotransferase (AST) levels were 44.3 IU/L in severe cases compared to 27.9 IU/L in non-severe cases. In addition, AST levels are often higher than ALT levels regardless of disease severity. The severe cases tended to have a higher gamma-glutamyltransferase level but a lower albumin level than the non-severe cases.


Severe COVID-19 was more likely to be associated with abnormal liver test results. Monitoring liver chemistry closely can help detect disease progression early.

Keywords: Systematic reviews and Meta-Analyses, COVID-19, SARS-CoV-2, Meta-analysis, Liver chemistries, Severe

Core Tip: Data on abnormal liver chemistries related to coronavirus disease (COVID-19) are cumulating but are potentially confusing. We performed a meta-analysis of 56 studies that included a total of 11052 patients with COVID-19. We noted that patients with abnormal liver test results are at higher risk of progression to severe disease and close monitoring of liver chemistries provides early warning against disease progression.