APRI has Utility as a Biomarker of COVID-19 Severity in Patients with Nonalcoholic Fatty Liver Disease.

Abstract

Patients with NAFLD are reported to have greater coronavirus disease 19 (COVID-19) severity compared to patients without NAFLD. Previous studies have reported that noninvasive liver fibrosis scores, including the FIB-4 index, NAFLD fibrosis score (NFS), and AST to platelet ratio index (APRI), have utility in predicting COVID-19 mortality and disease severity in patients without NAFLD. However, the utility of liver fibrosis scores in predicting COVID-19 mortality and disease severity among patients with NAFLD infected with SARS-CoV-2 has yet to be evaluated. This retrospective observational study comprised 126 patients with NAFLD and active SARS-CoV-2 infection. Patients were classified into low COVID-19 severity (mild or moderate I disease) and high COVID-19 severity (moderate II or severe disease) groups based on the therapeutic guideline implemented by the Ministry of Health, Labour and Welfare of Japan. Of the 126 patients, only one had been diagnosed with NAFLD before admission. Age; levels of serum aspartate aminotransferase, γ-glutamyl transpeptidase, lactate dehydrogenase, blood urea nitrogen, serum CRP, FIB-4 index; NFS; and APRI levels on admission were higher in the high COVID-19 severity group compared to the low COVID-19 severity group. Serum albumin levels, platelet counts, and lymphocyte counts on admission were lower in the high COVID-19 severity group compared to the low COVID-19 severity group. Univariate and multivariate analysis revealed that APRI values were significantly associated with COVID-19 severity and hospitalization duration for COVID-19. APRI was independently associated with COVID-19 severity and hospitalization duration for COVID-19 in patients with NAFLD.