The prevalence, predictors and outcomes of acute liver injury among patients with COVID-19: A systematic review and meta-analysis

Harapan Harapan, Jonny Karunia Fajar, Supriono Supriono, Gatot Soegiarto, Laksmi Wulandari, Fiha Seratin, Nyoman Gede Prayudi, Dara Puspita Dewi, Maria Theresia Monica Elsina, Lasarus Atamou, Sinta Wiranata, Dhito Pemi Aprianto, Erlin Friska, D. Fitria Sari Firdaus, Makdum Alaidin, Firdha Aprillia Wardhani, Milda Husnah, Nurdina Wahyu Hidayati, Yeni Hendriyanti, Kristia WardaniArde Evatta, Reizal Audi Manugan, Wiryawan Pradipto, Ade Rahmawati, Fredo Tamara, Aditya Indra Mahendra, Firzan Nainu, Budi Santoso, Chandra Adi Irawan Primasatya, Nindy Tjionganata, Hendarto Arif Budiman

Research output: Contribution to journalReview articlepeer-review

22 Citations (Scopus)


The data on the predictors and prognosis of acute liver injury (ALI) among patients in coronavirus disease 2019 (COVID-19) patients are limited. The aim of this study was to determine the prevalence, predictors and outcomes of ALI among patients with COVID-19. A systematic review was conducted up to 10 June 2021. The relevant papers were searched from PubMed, Embase, Cochrane and Web of Science, and the data were analysed using a Z test. A total of 1331 papers were identified and 16 papers consisting of 1254 COVID-19 with ALI and 4999 COVID-19 without ALI were analysed. The cumulative prevalence of ALI among patients with COVID-19 was 22.8%. Male and having low lymphocyte levels were more likely to be associated with ALI compared with female and having higher lymphocyte level, odds ratio (OR): 2.70; 95% confidence interval (CI): 2.03, 3.60 and mean difference (MD) −125; 95% CI: −207, −43, respectively. COVID-19 patients with ALI had higher risk of developing severe COVID-19 compared with those without ALI (OR: 3.61; 95% CI: 2.60, 5.02). Our findings may serve as the additional evaluation for the management of ALI in COVID-19 patients.

Original languageEnglish
Article numbere2304
JournalReviews in Medical Virology
Issue number3
Publication statusPublished - May 2022


  • COVID-19
  • acute liver injury
  • outcome
  • predictor
  • prevalence


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