Liver stiffness is associated with disease severity and worse clinical scenarios in coronavirus disease 2019: A prospective transient elastography study

Abstract

Background Pre‐existing chronic liver disease is currently considered a poor prognostic factor for coronavirus disease 2019 (COVID‐19). The present study aimed to investigate the association of liver stiffness measurement (LSM) with disease severity and clinical course of COVID‐19. Methods We prospectively recruited consecutive hospitalised adult patients with COVID‐19 in a 3‐month period. Demographic, laboratory, clinical and vibration‐controlled transient elastography (VCTE) features were recorded at entry, and all patients were prospectively followed‐up. Severe liver fibrosis was defined as an LSM value higher than 9.6 kPA. Multivariate logistic regression analysis was performed to reveal factors associated with disease severity and outcomes. Results Out of 98 eligible patients with COVID‐19, 12 (12.2%) had severe liver fibrosis. Patients with severe liver fibrosis had higher baseline disease severity ( P = .022), more commonly required oxygen treatment at entry ( P = .010), and had intensive‐care unit (ICU) requirements during the 6 (1‐39)‐day median follow‐up time ( P = .017). The presence of severe liver fibrosis was independently associated with disease severity (odds ratio (OR): 7.685, 95% confidence interval (CI): 1.435‐41.162, P = .017) and ICU requirement (OR: 46.656, 95% CI: 2.144‐1015.090, P = .014). LSM was correlated with alanine aminotransferase levels ( P = .005, r: 0.283), but not with other markers of acute hepatic injury or inflammation. Conclusion Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well‐established clinical and laboratory factors. Further multicentre prospective studies are warranted to validate our results.

Prevalence and Prognostic Impact of Deranged Liver Blood Tests in COVID-19: Experience from the Regional COVID-19 Center over the Cohort of 3812 Hospitalized Patients

“…This view is supported by the lack of larger series of liver biopsies, and the microinjury of muscles in COVID-19 leading to the elevation of aminotransferases [17]. Additionally, studies that were using liver dedicated non-invasive diagnostic devices such of Fibroscan came to conflicting conclusions in terms of liver involvement and prognostic impact of the indicators of liver health among patients with COVID-19 [18,19].…”

The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and validation study

“…Two other rules also identified liver disease as a risk factor for death, perhaps owing to the potential for virus-induced liver inflammation. 14 , 33 , 37 Other prognostic decision rules have used similar analytic approaches 27 , 28 , 33 but had lower predictive performance, with C-statistics ranging from 0.80 to 0.82, and were based on patients from early in the pandemic. Other rules incorporate measures of hypoxemia or respiratory support, which is indicative of their strong predictive power.…”

FibroScan-AST Score Predicts 30-Day Mortality or Need for Mechanical Ventilation among Patients Hospitalized with COVID-19

“…Two studies (one European with 32 patients, and one Asian with 98 patients) reported a more severe clinical picture and higher mortality of COVID-19 patients with higher LSM. CAP was not associated with clinical outcomes, and both studies found correlation between LSM and liver transaminases [ 15 , 16 ]. The authors excluded patients with a history of chronic liver disease (CLD) and liver biopsy was not performed to support the findings obtained by TE.…”

“…On the other hand, patients with non-cirrhotic chronic liver disease (CLD) seem to have comparable survival to patients without CLD. However, more specific data on the prevalence, severity and prognostic impact of liver steatosis, fibrosis and non-alcoholic steatohepatitis (NASH), on the course of COVID-19 are scarce with conflicting results published [ 15 , 16 , 17 , 18 ]. In fact, there are no specific data considering the impact of NASH, as the inflammatory phenotype of NAFLD, because liver biopsy as the gold standard method to diagnose NASH is rarely performed in the setting of COVID-19.…”