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. 2021 Jun 14:14:17562848211023410.
doi: 10.1177/17562848211023410. eCollection 2021.

Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients

Affiliations

Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients

Mario Romero-Cristóbal et al. Therap Adv Gastroenterol. .

Abstract

Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients.

Methods: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan-Meier and Cox regression analysis.

Results: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis (p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11-1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99-1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin.

Conclusion: Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

Keywords: biomarkers; coronavirus; critical care; liver diseases; survival analysis.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
(a) Distribution of patients according to the different fibrosis categories established by baseline Forns and FIB-4 indices. (b) Stratification of the NAFLD fibrosis score values (n = 95) according to the fibrosis severity determined by the Forns and FIB-4 indices. p-value for mean comparison between categories <0.01 for both indices. NAFLD, nonalcoholic fatty liver disease.
Figure 2.
Figure 2.
(a–d) Kaplan–Meier survival curves according to pre-existing fibrosis. Survival curves according to the severity of fibrosis (a,c) or the presence or absence of fibrosis (b,d) estimated by the Forns index (a,b) or the FIB-4 index (c,d).
Figure 3.
Figure 3.
Distribution of the liver laboratory tests in survivors and non-survivors at different time points during hospitalisation. Kernel density estimates were used for graphical representation; p values were nonsignificant in all cases.

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