Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies

Middleton, Paul; Hsu, Catherine; Lythgoe, Mark P.

doi:10.1136/bmjgast-2021-000739

Cited by 29 publications

(28 citation statements)

References 64 publications

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“…In addition, several evidence suggested that liver injury is associated with a more severe SARS-CoV-2 infection [ 6 – 8 ], especially when liver damage was defined by raised AST [ 5 ]. The presence of liver damage was also shown to represent a negative prognostic factor for COVID-19 patients [ 9 , 10 ]. However, previous studies on COVID-19 patients mostly used liver transaminases to define liver damage and to describe its association with mortality risk [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Bucci

Galardo²,

Gandini³

et al. 2022

Intern Emerg Med

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Liver damage worsens the prognosis of coronavirus 19 disease (COVID-19). However, the best strategy to stratify mortality risk according to liver damage has not been established. The aim of this study is to test the predictive value of the validated Fibrosis-4 (FIB-4) Index and compared it to liver transaminases and to the AST-to-Platelet ratio index (APRI). Multicenter cohort study including 992 consecutive COVID-19 patients admitted to the Emergency Department. FIB-4 > 3.25 and APRI > 0.7 were used to define liver damage. Multivariable Cox regression and ROC curve analysis for mortality were performed. Secondary endpoints were (1) need for high-flow oxygen and (2) mechanical ventilation. 240 (24.2%) patients had a FIB-4 > 3.25. FIB-4 > 3.25 associated with an increased mortality (n = 119, log-rank test p < 0.001 and adjusted hazard ratio (HR) 1.72 (95% confidence interval [95%CI] 1.14–2.59, p = 0.010). ROC analysis for mortality showed that FIB-4 (AUC 0.734, 95% CI 0.705–0.761) had a higher predictive value than AST (p = 0.0018) and ALT (p < 0.0001). FIB-4 > 3.25 was also superior to APRI > 0.7 (AUC 0.58, 95% CI 0.553–0.615, p = 0.0008). Using an optimized cut-off > 2.76 (AUC 0.689, 95% CI 0.659–0.718, p < 0.0001), FIB-4 was superior to FIB-4 > 3.25 (p = 0.0302), APRI > 0.7 (p < 0.0001), AST > 51 (p = 0.0119) and ALT > 42 (p < 0.0001). FIB-4 was also associated with high-flow oxygen use (n = 255, HR 1.69, 95% CI 1.25–2.28, p = 0.001) and mechanical ventilation (n = 39, HR 2.07, 95% CI 1.03–4.19, p = 0.043). FIB-4 score predicts mortality better than liver transaminases and APRI score. FIB-4 score may be an easy tool to identify COVID-19 patients at worse prognosis in the emergency department.

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Section: Introductionmentioning

confidence: 99%

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Bucci

Galardo²,

Gandini³

et al. 2022

Intern Emerg Med

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“…This systematic review has several strengths. Unlike previous meta-analyses on related topics [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], this study: (i) involves a comprehensive analysis of a large number of studies that are based in different countries in the world; (ii) includes many articles that were published in 2021, after the introduction of the Delta strain; (iii) analyzes only peer-reviewed data; (iv) assesses the extensive analysis of the source of the heterogeneity and bias in the studies; and (v) compares the risk of admission to the ICU vs. no admission among hospitalized COVID-19 patients, and is stratified on the basis of comorbidities and demographic status.…”

Section: Discussionmentioning

confidence: 92%

“…However, the associations with other comorbidities have been less clear, such as with cancer, chronic liver disease, diabetes, and kidney disease. While several meta-analyses studies report an increased risk of death in COVID-19 patients with diabetes [ 5 , 11 , 19 ], cancer [ 20 , 21 , 22 ], liver disease [ 23 , 24 , 25 ], and kidney disease [ 26 , 27 , 28 , 29 ], some report the lack of correlation between these comorbidities and the disease progression or the clinical outcomes of COVID-19 patients [ 30 , 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis

et al. 2022

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This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.

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“…cirrhosis, independent of etiology, have an approximately 80% elevated risk of all-cause mortality compared to non-cirrhotic patients (22). The mortality among liver transplantation candidates is more than 30% and reaches 45% among those with decompensated cirrhosis and high MELD scores (23).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Liver, NAFLD and COVID-19

Hoffmann¹,

Gerber²,

Cavelti-Weder³

et al. 2022

Horm Metab Res

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Coronavirus disease 2019 (COVID-19) is characterized by a wide clinical spectrum that includes abnormalities in liver function indicative of liver damage. Conversely, people with liver diseases are at higher risk of severe COVID-19. In the current review, we summarize first the epidemiologic evidence describing the bidirectional relationship between COVID-19 and liver function/liver diseases. Additionally, we present the most frequent histologic findings as well as the most important direct and indirect mechanisms supporting a COVID-19 mediated liver injury. Furthermore, we focus on the most frequent liver disease in the general population, non-alcoholic or metabolic-associated fatty liver disease (NAFLD/MAFLD), and describe how COVID-19 may affect NAFLD/MAFLD development and progression and conversely how NAFLD/MAFLD may further aggravate a COVID-19 infection. Finally, we present the long-term consequences of the pandemic on the development and management of NAFLD.

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Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies

Cited by 29 publications

References 64 publications

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis

Liver, NAFLD and COVID-19

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