Methods
A systematic search of PubMed, EMBASE and Cochrane library was done with no restriction on publication date. The following search strategy was used: [infectious mononucleosis OR glandular fever] AND [liver function* OR liver enzyme* OR ultrasound]. Two authors (ETT, DW) independently screened title and abstract according to prespecified criteria and full texts of relevant articles were retrieved for further eligibility assessment. References of included full text articles were further screened for relevant studies. Any discrepancies on study eligibility were discussed with a third author (OE) and resolved accordingly.
We included all original studies evaluating any form of LFTs and/or abdominal ultrasound (USS) in both adult and/or paediatric patients with suspected or confirmed diagnosis of IM. Standard LFTs included any of the following: Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALP), Bilirubin, Albumin, Total protein and Gamma-Glutamyltransferase (GGT). Abdominal ultrasound included liver and/or spleen and/or gallbladder ultrasound. We excluded studies evaluating patients with solely viral hepatitis (i.e. not related to clinical presentation of infectious mononucleosis), reviews, non-human studies, conference abstracts, letters/commentaries, expert opinions or recommendations, case reports and studies not published in English.
A standardized data collection proforma was used. This was initially piloted on five studies by all authors and revised accordingly. Subsequent data collection was by one author (DW) and checked for accuracy by a second author (ETT). In case of duplicate publications, we included the manuscript with the most complete data. The following data items were extracted: study characteristics, participants’ demographics, method of ascertainment of IM, evaluation of LFTs, clinical findings on abdominal ultrasound and complications relating to liver disease. Our main outcomes are the proportion of patients with abnormal LFTs at presentation and time to resolution of LFTs. Secondary outcomes include presence of clinical hepatosplenomegaly, findings of abdominal ultrasound and any evidence of decompensated liver disease.
Quality assessment of included studies were performed using Murad’s tool.3Although the tool was originally developed for case series and case reports, this was discussed among the authors and deemed suitable for our review irrespective of study type as we were only extracting data relating to a single arm of interest. Data was expressed as count and percentages. Proportion of abnormal LFTs in individual studies were aggregated and an average calculated for all studies.
PRISMA reporting guideline was used in preparation of the manuscript.