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Crimean-Congo hemorrhagic fever-induced liver injury: a systematic review and meta-analysis
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  • Sawai Singh Rathore,
  • Ade Harrison Manju,
  • Qingqing Wen,
  • Manush Sondhi,
  • Reshma Pydi,
  • Iskander Haddad,
  • Jamal Hasan,
  • Muhammad Adnan Ali,
  • Sohaib Tousif,
  • Romil Singh,
  • Abdul-Azeez Muhammed,
  • Noman Khurshid Ahmed,
  • Deep Manojkumar Patel
Sawai Singh Rathore
Dr Sampurnanand Medical College

Corresponding Author:[email protected]

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Ade Harrison Manju
Faculty of Biochemical Science, University of Yaounde I
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Qingqing Wen
University of California Los Angeles, Fielding School of Public Health,
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Manush Sondhi
Kasturba Medical College Manipal
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Reshma Pydi
Andhra Medical College
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Iskander Haddad
Lebanese American University
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Jamal Hasan
Al Rafidian private hospital
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Muhammad Adnan Ali
Jinnah Sindh Medical University
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Sohaib Tousif
Ziauddin Medical University
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Romil Singh
Mayo Clinic Rochester
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Abdul-Azeez Muhammed
Federal medical center
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Noman Khurshid Ahmed
Dow Medical College
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Deep Manojkumar Patel
Our Lady of Fatima University College of Medicine
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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.
11 Apr 2021Submitted to International Journal of Clinical Practice
12 Apr 2021Submission Checks Completed
12 Apr 2021Assigned to Editor
28 Apr 2021Reviewer(s) Assigned
23 Jul 2021Review(s) Completed, Editorial Evaluation Pending
23 Jul 2021Editorial Decision: Revise Major
24 Jul 20211st Revision Received
24 Jul 2021Submission Checks Completed
24 Jul 2021Assigned to Editor
24 Jul 2021Review(s) Completed, Editorial Evaluation Pending
29 Aug 2021Reviewer(s) Assigned
31 Aug 2021Editorial Decision: Accept