tetano
Editor, Senior Moderator
Therap Adv Gastroenterol
. 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
Mario Romero-Cristóbal[SUP] 1 [/SUP], Ana Clemente-Sánchez[SUP] 1 [/SUP], Patricia Piñeiro[SUP] 2 [/SUP], Jamil Cedeño[SUP] 3 [/SUP], Laura Rayón[SUP] 1 [/SUP], Julia Del Río[SUP] 1 [/SUP], Clara Ramos[SUP] 1 [/SUP], Diego-Andrés Hernández[SUP] 1 [/SUP], Miguel Cova[SUP] 1 [/SUP], Aranzazu Caballero[SUP] 1 [/SUP], Ignacio Garutti[SUP] 2 [/SUP], Pablo García-Olivares[SUP] 3 [/SUP], Javier Hortal[SUP] 2 [/SUP], Jose-Eugenio Guerrero[SUP] 3 [/SUP], Rita García[SUP] 4 [/SUP], Rafael Bañares[SUP] 5 [/SUP], Diego Rincón[SUP] 1 [/SUP]
Affiliations
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.
. 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
Mario Romero-Cristóbal[SUP] 1 [/SUP], Ana Clemente-Sánchez[SUP] 1 [/SUP], Patricia Piñeiro[SUP] 2 [/SUP], Jamil Cedeño[SUP] 3 [/SUP], Laura Rayón[SUP] 1 [/SUP], Julia Del Río[SUP] 1 [/SUP], Clara Ramos[SUP] 1 [/SUP], Diego-Andrés Hernández[SUP] 1 [/SUP], Miguel Cova[SUP] 1 [/SUP], Aranzazu Caballero[SUP] 1 [/SUP], Ignacio Garutti[SUP] 2 [/SUP], Pablo García-Olivares[SUP] 3 [/SUP], Javier Hortal[SUP] 2 [/SUP], Jose-Eugenio Guerrero[SUP] 3 [/SUP], Rita García[SUP] 4 [/SUP], Rafael Bañares[SUP] 5 [/SUP], Diego Rincón[SUP] 1 [/SUP]
Affiliations
- PMID: 34178116
- PMCID: PMC8207265
- DOI: 10.1177/17562848211023410
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.