Impact of Fibrosis-4 Index Prior to COVID-19 on Outcomes in Patients at Risk of Non-alcoholic Fatty Liver Disease.
Liver fibrosis
Metabolic syndrome
Metabolic-associated fatty liver disease
Non-alcoholic steatohepatitis
SARS-CoV-2
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
08
02
2021
accepted:
16
06
2021
pubmed:
27
6
2021
medline:
30
6
2022
entrez:
26
6
2021
Statut:
ppublish
Résumé
Severity of disease and outcomes in patient with COVID-19 has been associated with several risk factors tied to the metabolic syndrome. We conducted a study with the objective of describing the association between the baseline Fibrosis-4 (FIB-4) index prior to SARS-CoV-2 infection and the severity of COVID-19 among patients at risk of non-alcoholic fatty liver disease (NAFLD). This was a retrospective cohort study of patients with at least two risk factors for metabolic syndrome diagnosed with COVID-19. The main exposure of interest was FIB-4 index prior to infection, categorized into three previously validated age-specific levels. The main outcomes of interest were disease requiring hospitalization and in-hospital mortality. We included 373 patients [median age, 62 years; 194 male (52%); median number of metabolic syndrome risk factors, 3]. The median FIB-4 index was 1.10 (interquartile range 0.78-1.61). In models adjusting for diabetes mellitus and chronic kidney disease, patients with intermediate FIB-4 index had 67% higher odds of hospitalization compared to those in the low category {odds ratio (OR) 1.67 [(95% CI 1.06-2.64); p = 0.03]} and patients with high FIB-4 index had higher odds of mortality compared to intermediate and low category with an OR 2.22 (95% CI 1.20-4.12; p = 0.01). However, when we evaluated components of FIB-4 (age and AST/ALT ratio), we found that age alone was the best predictor of hospitalization and mortality. Among patients at risk of NAFLD with COVID-19 infection, elevated pre-infection FIB-4 index was associated with worsened clinical outcomes, but age was the strongest predictor.
Sections du résumé
BACKGROUND
Severity of disease and outcomes in patient with COVID-19 has been associated with several risk factors tied to the metabolic syndrome.
AIMS
We conducted a study with the objective of describing the association between the baseline Fibrosis-4 (FIB-4) index prior to SARS-CoV-2 infection and the severity of COVID-19 among patients at risk of non-alcoholic fatty liver disease (NAFLD).
METHODS
This was a retrospective cohort study of patients with at least two risk factors for metabolic syndrome diagnosed with COVID-19. The main exposure of interest was FIB-4 index prior to infection, categorized into three previously validated age-specific levels. The main outcomes of interest were disease requiring hospitalization and in-hospital mortality.
RESULTS
We included 373 patients [median age, 62 years; 194 male (52%); median number of metabolic syndrome risk factors, 3]. The median FIB-4 index was 1.10 (interquartile range 0.78-1.61). In models adjusting for diabetes mellitus and chronic kidney disease, patients with intermediate FIB-4 index had 67% higher odds of hospitalization compared to those in the low category {odds ratio (OR) 1.67 [(95% CI 1.06-2.64); p = 0.03]} and patients with high FIB-4 index had higher odds of mortality compared to intermediate and low category with an OR 2.22 (95% CI 1.20-4.12; p = 0.01). However, when we evaluated components of FIB-4 (age and AST/ALT ratio), we found that age alone was the best predictor of hospitalization and mortality.
CONCLUSIONS
Among patients at risk of NAFLD with COVID-19 infection, elevated pre-infection FIB-4 index was associated with worsened clinical outcomes, but age was the strongest predictor.
Identifiants
pubmed: 34173917
doi: 10.1007/s10620-021-07120-0
pii: 10.1007/s10620-021-07120-0
pmc: PMC8233600
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3333-3339Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Guan WJ, Ni ZY, Hu Y et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720.
doi: 10.1056/NEJMoa2002032
World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19—11 March 2020 Geneva 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 . Accessed September 28, 2020.
Johns Hopkins Coronavirus Resources Center. COVID-19 Unites States Cases 2020. COVID-19 Unites States Cases. 2020. Available at: https://coronavirus.jhu.edu/us-map . Accessed January 31, 2021.
Koff WC, Williams MA. Covid-19 and immunity in aging populations—a new research agenda. N Engl J Med. 2020;383:804–805.
doi: 10.1056/NEJMp2006761
Ji D, Qin E, Xu J et al. Non-alcoholic fatty liver diseases in patients with COVID-19: a retrospective study. J Hepatol. 2020;73:451–453.
doi: 10.1016/j.jhep.2020.03.044
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323:2052–2059.
doi: 10.1001/jama.2020.6775
Gao F, Zheng KI, Wang XB et al. Metabolic associated fatty liver disease increases coronavirus disease 2019 disease severity in nondiabetic patients. J Gastroenterol Hepatol. 2021;36:204–207.
doi: 10.1111/jgh.15112
Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis. 2017;14:E24.
doi: 10.5888/pcd14.160287
Eslam M, Sanyal AJ, George J. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020;158:1999-2014.e1.
doi: 10.1053/j.gastro.2019.11.312
Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol. 2020;73:202–209.
doi: 10.1016/j.jhep.2020.03.039
Taylor RS, Taylor RJ, Bayliss S et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Gastroenterology. 2020;158:1611–25.e12.
doi: 10.1053/j.gastro.2020.01.043
Huang R, Zhu L, Wang J, Xue L, Liu L, Yan X et al. Clinical features of COVID-19 patients with non-alcoholic fatty liver disease. Hepatol Commun. 2020;4:1758–1768.
doi: 10.1002/hep4.1592
Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–1325.
doi: 10.1002/hep.21178
McPherson S, Hardy T, Dufour JF et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol. 2017;112:740–751.
doi: 10.1038/ajg.2016.453
Bozeman SR, Hoaglin DC, Burton TM, Pashos CL, Ben-Joseph RH, Hollenbeak CS. Predicting waist circumference from body mass index. BMC Med Res Methodol. 2012;12:115.
doi: 10.1186/1471-2288-12-115
Hernán MA, Hernández-Díaz S, Werler MM, Mitchell AA. Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. Am J Epidemiol. 2002;155:176–184.
doi: 10.1093/aje/155.2.176
Portincasa P, Krawczyk M, Smyk W, Lammert F, Di Ciaula A. COVID-19 and non-alcoholic fatty liver disease: two intersecting pandemics. Eur J Clin Invest. 2020;50:e13338.
doi: 10.1111/eci.13338
Targher G, Mantovani A, Byrne CD et al. Risk of severe illness from COVID-19 in patients with metabolic dysfunction-associated fatty liver disease and increased fibrosis scores. Gut. 2020;69:1545–1547.
doi: 10.1136/gutjnl-2020-321611
Centers for Disease Control and Prevention. COVID-19 Hospitalization and Death by Age 2020. Available at https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html.Accessed November 1, 2020.
Ibáñez-Samaniego L, Bighelli F, Usón C et al. Elevation of liver fibrosis index FIB-4 Is associated with poor clinical outcomes in patients with COVID-19. J Infect Dis. 2020;222:726–733.
doi: 10.1093/infdis/jiaa355
Sterling RK, Oakes T, Gal TS, Stevens MP, deWit M, Sanyal AJ. The FIB-4 index is associated with need for mechanical ventilation and 30-day mortality in patients admitted with COVID-19. J Infect Dis. 2020;222:1794–1797.
doi: 10.1093/infdis/jiaa550
Rentsch CT, Kidwai-Khan F, Tate JP, et al. Covid-19 testing, hospital admission, and intensive care among 2,026,227 United States veterans aged 54–75 years. medRxiv. 2020:2020.04.09.20059964.
Sterling RK, Shin D, Shin Y, et al. FIB-4 Predicts Need for Mechanical Ventilation in a Multi-ethnic National cohort of COVID-19. Hepatology Communications. Published online 29 April 2021.