tetano
Editor, Senior Moderator
J Clin Med
. 2021 Dec 28;11(1):153.
doi: 10.3390/jcm11010153.
Liver Injury and Elevated FIB-4 Define a High-Risk Group in Patients with COVID-19
Dana Crisan[SUP] 1 2 [/SUP], Lucretia Avram[SUP] 1 2 [/SUP], Cristiana Grapa[SUP] 1 [/SUP], Alexandra Dragan[SUP] 1 [/SUP], Dan Radulescu[SUP] 1 2 [/SUP], Sorin Crisan[SUP] 1 2 [/SUP], Alin Grosu[SUP] 1 2 [/SUP], Valentin Militaru[SUP] 1 2 [/SUP], Elena Buzdugan[SUP] 1 2 [/SUP], Laurentiu Stoicescu[SUP] 1 2 [/SUP], Liliana Radulescu[SUP] 1 2 [/SUP], Felix Ciovicescu[SUP] 1 2 [/SUP], Delia Bunea Jivanescu[SUP] 1 2 [/SUP], Oana Mocan[SUP] 1 2 [/SUP], Bogdan Micu[SUP] 1 3 [/SUP], Valer Donca[SUP] 1 2 [/SUP], Luminita Marinescu[SUP] 1 2 [/SUP], Antonia Macarie[SUP] 1 2 [/SUP], Marina Rosu[SUP] 1 2 [/SUP], Andrada Nemes[SUP] 4 [/SUP], Rares Craciun[SUP] 1 [/SUP]
Affiliations
Abstract
Liver involvement in Coronavirus Disease 2019 (COVID-19) has been widely documented. However, data regarding liver-related prognosis are scarce and heterogeneous. The current study aims to evaluate the role of abnormal liver tests and incidental elevations of non-invasive fibrosis estimators on the prognosis of hospitalized COVID-19 patients. We conducted a retrospective cohort study to investigate the impact of elevated liver tests, non-invasive fibrosis estimators (the Fibrosis-4 (FIB-4), Forns, APRI scores, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio), and the presence of computed tomography (CT)-documented liver steatosis on mortality in patients with moderate and severe COVID-19, with no prior liver disease history. A total of 370 consecutive patients were included, of which 289 patients (72.9%) had abnormal liver biochemistry on admission. Non-survivors had significantly higher FIB-4, Forns, APRI scores, and a higher AST/ALT ratio. On multivariate analysis, severe FIB-4 (exceeding 3.25) and elevated AST were independently associated with mortality. Severe FIB-4 had an area under the receiver operating characteristic (AUROC) of 0.73 for predicting survival. The presence of steatosis was not associated with a worse outcome. Patients with abnormal liver biochemistry on arrival might be susceptible to a worse disease outcome. An FIB-4 score above the threshold of 3.25, suggestive of the presence of fibrosis, is associated with higher mortality in hospitalized COVID-19 patients.
Keywords: COVID-19; FIB-4; liver; mortality.
. 2021 Dec 28;11(1):153.
doi: 10.3390/jcm11010153.
Liver Injury and Elevated FIB-4 Define a High-Risk Group in Patients with COVID-19
Dana Crisan[SUP] 1 2 [/SUP], Lucretia Avram[SUP] 1 2 [/SUP], Cristiana Grapa[SUP] 1 [/SUP], Alexandra Dragan[SUP] 1 [/SUP], Dan Radulescu[SUP] 1 2 [/SUP], Sorin Crisan[SUP] 1 2 [/SUP], Alin Grosu[SUP] 1 2 [/SUP], Valentin Militaru[SUP] 1 2 [/SUP], Elena Buzdugan[SUP] 1 2 [/SUP], Laurentiu Stoicescu[SUP] 1 2 [/SUP], Liliana Radulescu[SUP] 1 2 [/SUP], Felix Ciovicescu[SUP] 1 2 [/SUP], Delia Bunea Jivanescu[SUP] 1 2 [/SUP], Oana Mocan[SUP] 1 2 [/SUP], Bogdan Micu[SUP] 1 3 [/SUP], Valer Donca[SUP] 1 2 [/SUP], Luminita Marinescu[SUP] 1 2 [/SUP], Antonia Macarie[SUP] 1 2 [/SUP], Marina Rosu[SUP] 1 2 [/SUP], Andrada Nemes[SUP] 4 [/SUP], Rares Craciun[SUP] 1 [/SUP]
Affiliations
- PMID: 35011894
- DOI: 10.3390/jcm11010153
Abstract
Liver involvement in Coronavirus Disease 2019 (COVID-19) has been widely documented. However, data regarding liver-related prognosis are scarce and heterogeneous. The current study aims to evaluate the role of abnormal liver tests and incidental elevations of non-invasive fibrosis estimators on the prognosis of hospitalized COVID-19 patients. We conducted a retrospective cohort study to investigate the impact of elevated liver tests, non-invasive fibrosis estimators (the Fibrosis-4 (FIB-4), Forns, APRI scores, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio), and the presence of computed tomography (CT)-documented liver steatosis on mortality in patients with moderate and severe COVID-19, with no prior liver disease history. A total of 370 consecutive patients were included, of which 289 patients (72.9%) had abnormal liver biochemistry on admission. Non-survivors had significantly higher FIB-4, Forns, APRI scores, and a higher AST/ALT ratio. On multivariate analysis, severe FIB-4 (exceeding 3.25) and elevated AST were independently associated with mortality. Severe FIB-4 had an area under the receiver operating characteristic (AUROC) of 0.73 for predicting survival. The presence of steatosis was not associated with a worse outcome. Patients with abnormal liver biochemistry on arrival might be susceptible to a worse disease outcome. An FIB-4 score above the threshold of 3.25, suggestive of the presence of fibrosis, is associated with higher mortality in hospitalized COVID-19 patients.
Keywords: COVID-19; FIB-4; liver; mortality.