Background: Emerging evidence suggests that patients with metabolic (dysfunction) associated fatty liver disease (MAFLD) are prone to severe forms of coronavirus disease (COVID-19), especially those with underlying liver fibrosis. The aim of our study is to assess the association of an increased FIB-4 score with COVID-19 disease prognosis. Methods: We performed a prospective study on hospitalized patients with known type II diabetes mellitus (T2DM) and confirmed COVID-19, with imaging evidence of liver steatosis within the last year or known diagnosis of MAFLD. All individuals were screened for liver fibrosis with a FIB-4 index. We evaluated the link between FIB-4 and disease prognosis. Results: Of 138 participants, 91.3% had MAFLD and 21.5% patients had a high risk of fibrosis. In the latter group of patients, the number of severe forms of disease, the hospital stay length, the rate of ICU admissions and the number of deaths reported registered a statistically significant increase. The independent predictors for developing severe forms of COVID-19 were obesity (odds ratio (OR), 3.24; 95% confidence interval (CI), p = 0.003), higher values of ferritin (OR-1.9; 95% CI, 1.17–8.29, p = 0.031) and of FIB-4 ≥ 3.25 (OR-4.89; 95% CI, 1.34–12.3, p = 0.02). Conclusions: Patients with high scores of FIB-4 have poor clinical outcomes and liver fibrosis may have a relevant prognostic role. Although the link between liver fibrosis and the prognosis of COVD-19 needs to be evaluated in further studies, screening for liver fibrosis with FIB-4 index, particularly in patients at risk, such as those with T2DM, will make a huge contribution to patient risk stratification.

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In the global context of COVID-19 outbreak, scientific efforts have been directed to investigate the risk factors associated with the development of severe illness. Emerging evidence linked the metabolic syndrome to more severe forms of the disease. The majority of the patients with these risk factors develop hepatic injury, particularly those previously diagnosed with nonalcoholic fatty liver disease (NAFLD). NAFLD is the most common cause of chronic liver disease, affecting a quarter of the population worldwide. While type II diabetes mellitus is linked to a higher severity of COVID-19, it has not been established whether patients with metabolic-associated fatty liver disease are prone to worse outcomes. To have a closer look at the consequences of this association, we have systematically searched the latest updates and studies to assess the connection between NAFLD and the severity of COVID-19, as well as the treatment considerations. Rezumat În contextul pandemiei COVID-19, eforturile cercetătorilor au fost îndreptate spre a identifica factorii de risc asociați cu progresia severă a bolii. Studii recente scot în evidență legătura sindromului metabolic cu formele grave de COVID-19. O proporție mare din pacienții cu tulburări metabolice au dezvoltat afectare hepatică, în special cei diagnosticați anterior cu boala ficatului gras non-alcoolic (FGNA), patologie ce afectează peste un sfert din populația lumii. În timp ce diabetul zaharat tip II este cunoscut ca fiind factor de risc pentru evoluția severă a COVID-19, nu este încă stabilit dacă pacienții cu FGNA asociat cu sindromul metabolic au un prognostic nefast. Scopul acestei lucrări este de a analiza asocierea dintre FGNA și evoluția COVID-19, precum și posibilele implicații terapeutice, axându-se pe cele mai recente actualizări și cercetări din domeniu.

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD)-related severe liver fibrosis is associated with a higher risk of progressing to decompensated cirrhosis and hepatic failure and developing NAFLD-related hepatocellular carcinoma (HCC), particularly in populations with diabetes. Our pilot study aims to evaluate the performances of various noninvasive methods in predicting liver fibrosis in a population of patients with diabetes and to establish a new scoring system for the prediction of severe fibrosis (>F3). Materials and Methods: A total of 175 patients with diabetes were enrolled for liver fibrosis evaluation. Using the degree of agreement (concordance) between a noninvasive score based on serum biomarkers (NAFLD fibrosis score) and point shear-wave elastography (pSWE) as the reference method, we generated receiver operating characteristic (ROC) curves and performed a multivariate analysis to predict severe liver fibrosis. Results: In our population of patients with diabetes, gamma-glutamyltransferase (GGT), age, body mass index (BMI), the homeostatic model assessment of insulin resistance (HOMA-IR), and glycosylated hemoglobin (HbA1C) were significant predictors for the diagnosis of the F3/F4 group (area under the ROC: 0.767, 0.743, 0.757, 0.772, and 0.7, respectively; p < 0.005 for all). Moreover, the combined composite score (the sum of GGT, age, BMI, HOMA index, and HbA1C) had the highest diagnostic performance at a cut-off value of 3 (AUROC—0.899; p < 0001). The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 91.20%, 79%, 79%, and 89%, respectively, and 89% of patients were correctly classified as having severe liver fibrosis. In contrast with the Fibrosis 4 (FIB-4) score and the AST-to-platelet ratio index (APRI), the composite score had the best accuracy in discriminating advanced fibrosis. Conclusions: The proposed composite score had a reliable and acceptable diagnostic accuracy in identifying patients with diabetes at risk of having severe fibrosis using readily available laboratory and clinical data.