Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19

Abstract

BACKGROUND Metabolic associated fatty liver disease (MAFLD) is associated with complications and mortality in patients with coronavirus disease 2019 (COVID-19). However, there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with MAFLD, despite its high prevalence. Lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase have been used as markers of liver damage. Therefore, we propose an index based on lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with MAFLD and COVID-19. AIM To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases (aspartate aminotransferase/alanine aminotransferase) in patients with COVID-19 and MAFLD [liver fibrosis and nutrition (LNF)-COVID-19 index]. METHODS In this retrospective cohort study, two cohorts from two different tertiary centers were included. The first was the derivation cohort to obtain the score cutoffs, and the second was the validation cohort. We included hospitalized patients with severe COVID-19 and MAFLD. Liver steatosis was evaluated by computed tomography scan. Area under the receiver operating characteristic (ROC) curve analysis and survival analysis were used. RESULTS In the derivation cohort, 44.6% had MAFLD; ROC curve analysis yielded a LFN-COVID-19 index > 1.67 as the best cutoff, with a sensitivity of 78%, specificity of 63%, negative predictive value of 91% and an area under the ROC curve of 0.77. In the multivariate analysis, the LFN-COVID-19 index > 1.67 was independently associated with the development of acute kidney injury (odds ratio: 1.8, 95% confidence interval: 1.3-2.5, P < 0.001), orotracheal intubation (odds ratio: 1.9, 95% confidence interval: 1.4-2.4, P < 0.001), and death (odds ratio: 2.86, 95% confidence interval: 1.6-4.5, P < 0.001) in both cohorts. CONCLUSION LFN-COVID-19 index has a good performance to predict prognosis in patients with MAFLD and COVID-19, which could be useful for the MAFLD population.

COVID-19 and Fatty Liver Disorders

“…An interesting prognostic model in MAFLD patients with SARS-CoV-2 infection has been developed by Macías-Rodríguez et al; this model, called the liver fibrosis and nutrition (LFN)-COVID-19 index, is based on lactate dehydrogenase and transaminases (AST/ALT), and shows a good performance to predict poor outcomes (acute kidney injury, intubation, death) when the value is >1.67. Nevertheless, further validation for this score is needed to include it in routine clinical practice [ 50 ].…”

Association between lactate dehydrogenase and the risk of diabetic kidney disease in patients with type 2 diabetes

“…LDH was commonly used for diagnosing such as myocardial infarction, vascular injury, tissue injury, advanced sarcoma, and other mesenchymal tumors ( 7 ). It has now been found that LDH can be used as a biomarker for the prognosis of diseases such as tumors, metabolism-associated fatty liver disease, and malaria ( 8 – 10 ), and it can also be used as a biomarker for predicting the pathological status of the lungs ( 11 ) and for the possibility of DM ( 12 ).…”

Potential risk of liver injury in epileptic patients during COVID-19 pandemic

“…In another meta-analysis, approximately 25% of COVID-19 patients experienced elevation of liver enzymes which was directly correlated to the severity of COVID-19 disease[ 17 ]. Liver dysfunction could also increase the mortality rate in these patients[ 18 ].…”