Association of liver steatosis and fibrosis with clinical outcomes in patients with SARS-CoV-2 infection (COVID-19)

Abstract

Introduction and Objectives Liver function tests (LFT) abnormalities are reported in up to 50% of COVID-19 patients, metabolic comorbidities are associated with poorer outcomes. The aim of the study is to determine prevalence of liver steatosis and fibrosis in patients with COVID-19 and their association with clinical outcomes. Material and methods Retrospective study in hospitalized COVID-19 patients. Risk for liver steatosis was estimated by HSI > 36, and risk for advanced liver fibrosis with APRI > 1.0, NAFLD FS > 0.675 and/or FIB-4 > 3.25. Clinical outcomes were admission to Intensive Care Unit (ICU) and mortality. Results Of 155 patients, 71.6% were male (n = 111), and 28.4% (n = 44) were obese. Abnormal LFT were present in 96.8% (n = 150), prevalence of steatosis was 42.6% (n = 66) and of significative liver fibrosis was 44.5% (n = 69). Liver fibrosis by FIB-4 was associated with risk of ICU admission (OR 1.74 [95%CI 1.74-2.68; p = 0.023]) and mortality (OR 6.45 [95%CI 2.01-20.83, p = 0.002]), no independent associations were found. Conclusions The prevalence of steatosis and significant liver fibrosis was high in COVID-19 patients but was not associated with clinical outcomes.

Non-alcoholic fatty liver disease and clinical outcomes in patients with COVID-19: A comprehensive systematic review and meta-analysis

“…Eleven of the included articles reported cohort studies [ 11 , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] ], while three were case-control or cross-sectional analysis [ [32] , [33] , [34] ]. The majority of the studies were from Asia (seven, in China) [ 11 , 24 , 26 , 27 , [29] , [30] , [31] ], while four were from the USA [ 22 , 23 , 25 , 28 ], and one from the UK [ 33 ], Mexico [ 32 ], and Israel [ 34 ] each. The studies were conducted in the time frame between December 2019 to September 2020.…”

“…Five studies confirmed the NAFLD as per imaging based on ultrasound or computerized tomography (CT) [ 23 , 24 , 27 , 30 , 33 ], four studies as per the hepatic steatosis index (HIS) [ 11 , 22 , 26 , 32 ], three used consensus definition of MAFLD [ 29 , 31 , 34 ] and two as per International Classification of Diseases (ICD) [ 25 , 28 ] code. Obesity, hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia were the major co-morbidities reported across the included studies with a higher prevalence in the NAFLD cohort [ [22] , [23] , [24] , [25] , [26] , [28] , [29] , [30] , [31] , [32] , [33] ]. Other co-morbidities included cardiovascular diseases (CVD), lung disease, and metabolic dysregulation [ 23 , 26 , 28 , [31] , [32] , [33] ].…”

“…Obesity, hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia were the major co-morbidities reported across the included studies with a higher prevalence in the NAFLD cohort [ [22] , [23] , [24] , [25] , [26] , [28] , [29] , [30] , [31] , [32] , [33] ]. Other co-morbidities included cardiovascular diseases (CVD), lung disease, and metabolic dysregulation [ 23 , 26 , 28 , [31] , [32] , [33] ]. The diagnosis of COVID-19 infection was conformed based on reverse transcription-polymerase chain reaction (RT-PCR) in eight studies [ 11 , 22 , 23 , 29 , [31] , [32] , [33] , [34] ]; five studies used lab-confirmed status of COVID-19 infection [ [24] , [25] , [26] , [27] , [28] ], while one study did not provide clear information on the assessment of COVID-19 infection [ 30 ] ( Table 1 ).…”

“…Other co-morbidities included cardiovascular diseases (CVD), lung disease, and metabolic dysregulation [ 23 , 26 , 28 , [31] , [32] , [33] ]. The diagnosis of COVID-19 infection was conformed based on reverse transcription-polymerase chain reaction (RT-PCR) in eight studies [ 11 , 22 , 23 , 29 , [31] , [32] , [33] , [34] ]; five studies used lab-confirmed status of COVID-19 infection [ [24] , [25] , [26] , [27] , [28] ], while one study did not provide clear information on the assessment of COVID-19 infection [ 30 ] ( Table 1 ).…”

COVID-19 and liver disease: mechanistic and clinical perspectives

“…Similarly, MRI data from 287 patients tested for SARS-CoV-2 (79 positive, 208 negative) demonstrated that individuals with obesity and a concomitant liver fat fraction of ≥10% were at threefold increased risk of developing symptomatic laboratory-confirmed COVID-19 (available as a non-peer-reviewed Preprint only) 89 . However, in a series of 155 consecutive inpatients with COVID-19, the presence of steatosis (in 43%) was not independently associated with mortality 90 . These findings were confirmed in a larger international cohort of 745 patients with CLD and cirrhosis from 29 countries collected using the SECURE-Cirrhosis and COVID-Hep registries in which the odds ratio for death for patients with NAFLD was 1.01 (95% CI 0.57–1.79) 91 .…”