key: cord-0873489-h6imcb1b
authors: Paliogiannis, Panagiotis; Zinellu, Angelo
title: Bilirubin levels in patients with mild and severe Covid‐19: A pooled analysis
date: 2020-05-22
journal: Liver Int
DOI: 10.1111/liv.14477
sha: 9c6c18cf1134be419db946ee68fc7db5e8cd73d2
doc_id: 873489
cord_uid: h6imcb1b

The letter comments on a recent commentary published in Liver International entitled "COVID-19 and liver disease" by Sun et al., and describes a pooled analysis of data on bilirubin levels in patients with and without severe Covid-19. This is the first pooled analysis of data on bilirubin in Covid-19 patients. The results evidence that bilirubin levels are significantly associated with the severity of the disease.

vere Covid-19. The keywords used were 'bilirubin' and 'coronavirus' or 'bilirubin' and 'Covid-19'. In all, 19 articles were initially detected, but 12 were excluded as duplicates and three because of lacking data; two further articles were retrieved from reviewing the reference lists, and therefore, six articles were enrolled for analysis. [2] [3] [4] [5] [6] [7] Standardized mean differences (SMD) were used to build forest plots of continuous data and to evaluate differences in bilirubin levels. P < .05 was considered statistically significant, and 95% confidence intervals (CIs) were reported. In five studies, 2,3,5-7 the mean and standard deviation values were extrapolated from median and interquartile range (IQR). Heterogeneity of SMD was tested with Q statistic (significance level at P < .10), and the I 2 was calculated. In analyses with high heterogeneity, a random-effects model was applied. Sensitivity was tested by sequentially excluding one study in each turn. Statistical analyses were performed using Stata 14 (STATA Corp.).

The mean difference in serum bilirubin between Covid-19 patients with or without severe disease is shown in Figure 1 

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