Crimean-Congo hemorrhagic fever-induced liver injury: a systematic
review and meta-analysis
Background: Crimean-Congo hemorrhagic fever (CCHF) is a fatal acute
tick-borne viral infection and a substantial emerging global public
health threat. This illness has a high case fatality rate of up to 40%.
The liver is one of the important target organs of the CCHF virus.
Objective: The aim of this meta-analysis to evaluate the correlation
between CCHF and liver injury and draw more generalized inferences
about the abnormal serum markers of liver injury such as alanine
aminotransferase (ALT), aspartate aminotransferase (AST) in CCHF
patients. Methods: A literature search was accomplished for published
eligible articles with MEDLINE/PubMed and Embase databases. All eligible
observational studies and case series were included from around the
world. The inclusion criteria were articles describing liver injury
biomarkers AST and ALT amongst patients diagnosed with CCHF. Results:
Data from 18 studies, consisting of 1238 patients with CCHF were
included in this meta-analysis. The overall pooled prevalence of at
least one raised liver injury biomarker was 77.95% (95% CI, I2
= 88.50%, p < 0.0001). Similarly, pooled prevalence of
elevated AST and ALT was 85.92% (95% CI, I2 = 85.27%, p <
0.0001) and 64.30% (95% CI, I2 = 88.32%, p < 0.0001)
respectively. Both Egger and Begg-Mazumdar’s tests detected no apparent
publication bias in all three meta-analyses(p > 0.05).
Conclusion: These elevated liver injury biomarkers have been identified
as significant prognostic factors. Hence, Physicians must recognize and
continuously monitor these biomarkers, since these aid early
stratification of prognosis and the prevention of severe outcomes in
infection with such a high case fatality rate.