Independent Predictors of Mortality Among Patients With NAFLD Hospitalized With COVID‐19 Infection

Younossi, Zobair M.; Stepanova, Maria; Lam, Brian; Cable, Rebecca; Felix, Sean; Jeffers, Thomas L.; Younossi, Elena; Pham, Huong; Srishord, Manirath; Austin, Patrick; Estep, James M.; Terra, Kathy; Escheik, Carey; Avila, Leyla de; Golabi, Pegah; Kolacevski, Andrej; Racila, Andrei; Henry, Linda; Gerber, Lynn H.

doi:10.1002/hep4.1802

Cited by 47 publications

(49 citation statements)

References 32 publications

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“…When we analyzed clinical outcomes, we found a mortality rate of 13% within 60 days from the admission to the emergency department. This finding is slightly higher than the 10.9% reported in the study by Li Y. et al [ 18 ] and 10.8% in the study by Younossi et al [ 15 ]. Of note, we found a higher prevalence of increased FIB-4 in patients who died compared to survivors.…”

Section: Discussioncontrasting

confidence: 62%

“…This figure is similar to that reported in a smaller cohort of 202 COVID-19 patients in which the prevalence of FIB-4 > 2.67 was 31.2% [ 18 ]. In addition, in a study using a FIB-4 cut off > 2.91 the prevalence of high FIB-4 was 24.9% [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Scarce data on the COVID-19 population have been reported so far; one previous study showed that FIB-4 was associated with the need for mechanical ventilation but no data on mortality were reported [ 14 ]. Conversely, studies on mortality risk according to FIB-4 included a relatively small sample or specific subgroups of patients, such as those with liver steatosis [ 15 , 16 ] or haematological malignancies [ 17 ], and used different cut-off of FIB-4, making results of difficult comparison [ 18 ]. Given the still wide-spread diffusion of SARS-CoV-2 infection, more data allowing a better risk stratification strategy and eventually sources allocation, are warranted.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…These results were consistent with the recent findings, which reported worse outcomes in COVID-19 patients with preexisting chronic liver diseases [ 45 ]. For example, FIB-4 was found to be an independent factor of mortality among hospitalized COVID-19 patients with imaging- or liver biopsy-proven NAFLD [ 46 ]. Sachdeva et al found that the NFLAD was a strong predictor for mortality in patients infected with SARS-CoV-2 [ 13 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis

Liu

Mei²,

Tan

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background and Aim. The relationship between liver fibrosis scores and clinical outcomes in patients with COVID-19 is not compressively assessed. Methods. We identified relevant cohort studies that assessed the relationship between liver fibrosis scores (e.g., FIB-4, NAFLD fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI)) and associated prognosis outcomes by searching the PubMed, EMBASE, and medRxiv databases. The potential dose-response effect was performed using a stage robust error meta-regression. Results. Sixteen studies with 8,736 hospitalized patients with COVID-19 were included. One-point score in FIB-4 increase was significantly associated with increased mechanical ventilation (RR: 2.23, 95% CI: 1.37–3.65, P = 0.001 ), severe COVID-19 (RR: 1.82, 95% CI: 1.53–2.16, P < 0.001 ), and death (RR: 1.47, 95% CI: 1.31–1.65, P < 0.001 ), rather than hospitalization (RR: 1.35, 95% CI: 0.72–2.56, P = 0.35 ). Furthermore, there is a significant positive linear relationship between FIB-4 and severe COVID-19 ( P nonlinearity = 0.12 ) and mortality ( P nonlinearity = 0.18 ). Regarding other liver scores, one unit elevation in APRI increased the risk of death by 178% (RR: 2.78, 95% CI: 1.10–6.99, P = 0.03 ). Higher NFS (≥−1.5) and Forns index were associated with increased risk of severe COVID-19 and COVID-19-associated death. Conclusion. Our dose-response meta-analysis suggests high liver fibrosis scores are associated with worse prognosis in patients with COVID-19. For patients with COVID-19 at admission, especially for those with coexisting chronic liver diseases, assessment of liver fibrosis scores might be useful for identifying high risk of developing severe COVID-19 cases and worse outcomes.

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“… 126 Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) are features of lipodystrophy 120 , 126 and within this pathogenesis, 122 , 123 lipodystrophy may increase the risk of complications in COVID-19. 127 , 128 …”

Section: Underweightmentioning

confidence: 99%

COVID-19 infection and body weight: A deleterious liaison in a J-curve relationship

Manolis

et al. 2021

Obesity Research & Clinical Practice

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Independent Predictors of Mortality Among Patients With NAFLD Hospitalized With COVID‐19 Infection

Abstract: is the guarantor of this work and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final version of the manuscript.

Cited by 47 publications

References 32 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

Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis

COVID-19 infection and body weight: A deleterious liaison in a J-curve relationship

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