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. 2022 Aug 31;11(17):5149.
doi: 10.3390/jcm11175149.

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

Mirela Loredana Grigoras  1 , Ioana Mihaela Citu  2 , Cosmin Citu  3 , Veronica Daniela Chiriac  3 , Florin Gorun  3 , Mihaela Codrina Levai  4 , Diana Manolescu  5 , Ovidiu Rosca  6 , Felix Bratosin  6 , Srivathsava Gurumurthy  7 , Prima Hapsari Wulandari  8 , Octavian Marius Cretu  9
Affiliations

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

Mirela Loredana Grigoras et al. J Clin Med. .

Abstract

Several investigations have revealed that COVID-19 causes a significant death rate due to acute respiratory distress syndrome, alterations in the quantity of ACE2 receptor expression, or the intensity of cytokine storm. Similarly, patients with hepatic impairment that are co-infected with SARS-CoV-2 are more likely to display upregulations of ACE2 receptors and cytokine storm overload, which exacerbates hepatic impairment, potentially increasing the death rate. Moreover, it is expected that the aging population develops a higher degree of hepatic fibrosis in association with other comorbid conditions that are likely to influence the course of COVID-19. Therefore, this research was developed to describe the differences in liver test parameters in elderly individuals with COVID-19 in relation to other inflammatory markers and outcomes. This current observational single-center research followed a case-control design of elderly patients hospitalized for SARS-CoV-2 infection. The research was conducted at a tertiary emergency hospital in western Romania during a two-year period. There were 632 patients included in the analysis that were split into two equal groups matched 1:1 based on gender and body mass index. Three hundred sixteen patients made the group of cases with COVID-19 patients older than 65 years, while the other half were the 316 patient controls with COVID-19 that were younger than 65 years old. Disease outcomes showed a higher prevalence of ICU admissions (22.8% vs. 12.7%, p-value < 0.001) and in-hospital mortality (17.1% vs. 8.9%, p-value = 0.002) in the group of cases. Specific and non-specific liver biomarkers were identified as risk factors for mortality in the elderly, such as ALP (OR = 1.26), LDH (OR = 1.68), AST (OR = 1.98), and ALT (OR = 2.34). Similarly, patients with APRI and NFS scores higher than 1.5 were, respectively, 2.69 times and, 3.05 times more likely to die from COVID-19, and patients with FIB-4 scores higher than 3.25 were 3.13 times more likely to die during hospitalization for SARS-CoV-2 infection. Our research indicates that abnormally increased liver biomarkers and high liver fibrosis scores are related to a worse prognosis in SARS-CoV-2 infected individuals.

Keywords: APRI; COVID-19; FIB-4; NFS; SARS-CoV-2; inflammatory markers; liver function.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of liver fibrosis scores between cases and controls at admission.
Figure 2
Figure 2
Comparison of liver fibrosis scores between cases and controls at discharge.
Figure 3
Figure 3
Comparison of liver fibrosis scores between survivors and deceased cases at admission.
Figure 4
Figure 4
Multivariate risk factor analysis for mortality in the elderly (≥65 years old) admitted for SARS-CoV-2 infection.
See this image and copyright information in PMC

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References

    1. Timircan M., Bratosin F., Vidican I., Suciu O., Turaiche M., Bota A.V., Mitrescu S., Marincu I. Coping Strategies and Health-Related Quality of Life in Pregnant Women with SARS-CoV-2 Infection. Medicina. 2021;57:1113. doi: 10.3390/medicina57101113. - DOI - PMC - PubMed
    1. Popescu A., Craina M., Pantea S., Pirvu C., Radu D., Marincu I., Bratosin F., Bogdan I., Hosin S., Citu C., et al. COVID-19 Pandemic Impact on Surgical Treatment Methods for Early-Stage Cervical Cancer: A Population-Based Study in Romania. Healthcare. 2022;10:639. doi: 10.3390/healthcare10040639. - DOI - PMC - PubMed
    1. Timircan M., Bratosin F., Vidican I., Suciu O., Tirnea L., Avram V., Marincu I. Exploring Pregnancy Outcomes Associated with SARS-CoV-2 Infection. Medicina. 2021;57:796. doi: 10.3390/medicina57080796. - DOI - PMC - PubMed
    1. Popescu A., Craina M., Pantea S., Pirvu C., Chiriac V.D., Marincu I., Bratosin F., Bogdan I., Hosin S., Citu C., et al. COVID-19 Pandemic Effects on Cervical Cancer Diagnosis and Management: A Population-Based Study in Romania. Diagnostics. 2022;12:907. doi: 10.3390/diagnostics12040907. - DOI - PMC - PubMed
    1. Zhang Q., Xiang R., Huo S., Zhou Y., Jiang S., Wang Q., Yu F. Molecular mechanism of interaction between SARS-CoV-2 and host cells and in-terventional therapy. Signal Transduct. Target. Ther. 2021;6:233. doi: 10.1038/s41392-021-00653-w. - DOI - PMC - PubMed

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