In-hospital mortality is associated with inflammatory response in NAFLD patients admitted for COVID-19

Abstract

Background & aims Although metabolic risk factors are associated with more severe COVID-19, there is little evidence on outcomes in patients with non-alcoholic fatty liver disease (NAFLD). We here describe the clinical characteristics and outcomes of NAFLD patients in a cohort hospitalised for COVID-19. Methods This study included all consecutive patients admitted for COVID-19 between February and April 2020 at Imperial College Healthcare NHS Trust, with either imaging of the liver available dated within one year from the admission or a known diagnosis of NAFLD. Clinical data and early weaning score (EWS) were recorded. NAFLD diagnosis was based on imaging or past medical history and patients were stratified for Fibrosis-4 (FIB-4) index. Clinical endpoints were admission to intensive care unit (ICU)and in-hospital mortality. Results 561 patients were admitted. Overall, 193 patients were included in the study. Fifty nine patients (30%) died, 9 (5%) were still in hospital, and 125 (65%) were discharged. The NAFLD cohort (n = 61) was significantly younger (60 vs 70.5 years, p = 0.046) at presentation compared to the non-NAFLD (n = 132). NAFLD diagnosis was not associated with adverse outcomes. However, the NAFLD group had higher C reactive protein (CRP) (107 vs 91.2 mg/L, p = 0.05) compared to non-NAFLD(n = 132). Among NAFLD patients, male gender (p = 0.01), ferritin (p = 0.003) and EWS (p = 0.047) were associated with in-hospital mortality, while the presence of intermediate/high risk FIB-4 or liver cirrhosis was not.

Comparing Decision Tree-Based Ensemble Machine Learning Models for COVID-19 Death Probability Profiling

“…The fact that males with no underlying comorbidity or disease also tend to have higher death risk than females as age progresses also reinforces the findings of an asymmetric impact of COVID-19 in regards to sex and is consistent with previous studies' results [1][2][3][4][5]. A possible explanation provided in [5], regarding male infectiousness, relates to smoking and higher circulating angiotensin converting enzyme 2 (ACE2) levels in men, SARS-CoV-2 utilizes ACE2 receptors found at the surface of the host cells to get inside the cell, this is also an important factor in specific underlying comorbidities or diseases.…”

“…When dealing with an epidemiological scenario, the profiling of death probabilities, conditional on subjects' features, can help identify risk groups and guide response strategies. In this context, when dealing with the assessment of death probability profiles, the target is binary, with 0 labeling a person who survived and 1 a person who died 3 .…”

“…Different studies have identified age group, sex and underlying comorbidity or disease as critical factors for disease severity and mortality risk [1][2][3][4][5]. In the current work, we use these three factors as feature variables in machine learning models for extracting a profile for COVID-19 death probability, conditional on these three risk factors, using the US Centers for Disease Control and Prevention (CDC)'s COVID-19 case surveillance data sample 1 which contains a large sample of COVID-19 confirmed cases with records for these three factors.…”

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] ].…”