Abstract
Background: Liver involvement in Coronavirus disease 2019 (COVID-19) has been recognised. We aimed to investigate the correlation of non-invasive surrogates of liver steatosis, fibrosis and inflammation using transient elastography (TE) and FibroScan-AST (FAST) score with (a) clinical severity and (b) 30-day composite outcome of mechanical ventilation (MV) or death among patients hospitalized due to COVID-19. Method: Patients with non-critical COVID-19 at admission were included. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed by TE. Clinical severity of COVID-19 was assessed by 4C Mortality Score (4CMS) and need for high-flow nasal cannula (HFNC) oxygen supplementation. Results: 217 patients were included (66.5% males, median age 65 years, 4.6% with history of chronic liver disease). Twenty-four (11.1%) patients met the 30-day composite outcome. Median LSM, CAP and FAST score were 5.2 kPa, 274 dB/m and 0.31, respectively, and neither was associated with clinical severity of COVID-19 at admission. In multivariate analysis FAST > 0.36 (OR 3.19, p = 0.036), 4CMS (OR 1.68, p = 0.002) and HFNC (OR 7.03, p = 0.001) were independent predictors of adverse composite outcome. Conclusion: Whereas LSM and CAP failed to show correlation with COVID-19 severity and outcomes, FAST score was an independent risk factor for 30-day mortality or need for MV.
Highlights
Coronavirus disease 2019 (COVID-19) is respiratory disease with multisystem involvement and is responsible for a worldwide pandemic [1]
In the present study we aimed to investigate the correlation of non-invasive surrogates of liver steatosis, fibrosis and inflammation using transient elastography (TE) and FAST score with (a) severity of clinical presentation and (b) 30-day composite outcome of mechanical ventilation (MV) or death among patients hospitalized with non-critical form of COVID-19 at admission
Our study demonstrates a lack of association between Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) as non-invasive surrogates for liver fibrosis and steatosis with the outcomes of COVID-19 defined as (a) severity of clinical presentation of COVID-19 and (b) 30-day mortality or need for MV
Summary
Coronavirus disease 2019 (COVID-19) is respiratory disease with multisystem involvement and is responsible for a worldwide pandemic [1]. Risk factors for severe clinical course include older age, male sex, comorbidity, arterial hypertension, diabetes mellitus and obesity [2,3,4,5,6,7]. NAFLD affects around 25% of adults worldwide, with even greater prevalence among obese individuals (>50%) and those having additional metabolic conditions [8,9]. In line with these facts, the presence of fatty liver might be assumed as the risk factor for more severe forms of COVID-19 and adverse outcomes [10]
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