S1145 Comparison of Non-Invasive Liver Fibrosis Scores in Predicting Outcomes Among Non-Alcoholic Fatty Liver Disease (NAFLD) Patients with COVID-19

Abstract

Introduction: Throughout the COVID-19 pandemic, multiple studies have shown worse outcomes among patients with NAFLD. As the most common etiology for chronic liver disease in the US, more research is needed to develop tools to predict outcomes in NAFLD patients. Non-invasive fibrosis scores, derived from basic labs, can be valuable. Although traditionally shown to predict liver-disease related mortality, early data has suggested an association between fibrosis scores during COVID-19 and severity of illness. However, as acute COVID-19 infection can cause lab fluctuations leading to elevated fibrosis scores, baseline fibrosis scores utilizing labs prior to COVID-19 may be more accurate. We aimed to determine if there was a correlation between elevated baseline fibrosis scores and adverse outcomes related to COVID-19. Methods: We retrospectively studied patients over 18 years of age with a diagnosis of NAFLD and confirmed COVID-19 at Community Medical Centers in Fresno, CA between March 1, 2020 and September 30, 2020. Baseline labs prior to COVID-19 were used to calculate NAFLD Fibrosis Score (NFS), Fibrosis 4 (FIB-4) index, AST to Platelet Ratio Index (APRI) score, and Model for End-Stage Liver Disease (MELD/Na) score. Correlations of scores with adverse outcomes were calculated using Pearson correlation testing. Correlation coefficient (r) and p values were generated using SPSS version 27. Results: A total of 203 patients had prior labs available to calculate NFS, FIB-4, and APRI and 124 patients for MELD/Na. Mean age was 55 years, with 52% male and 71% Hispanic. 4.4% had underlying cirrhosis. NFS, FIB-4, and APRI all had positive correlations of worse outcomes with higher baseline scores (Figure 1). For NFS, outcomes of NIPPV, ICU admission, intubation and death reached statistical significance. For FIB-4, outcomes of NIPPV, ICU admission, intubation and death reached statistical significance. For APRI, outcomes of intubation and death reached statistical significance. MELD/Na failed to demonstrate statistically a significant difference in outcome correlations for all variables except death. Conclusion: Our data suggests that baseline NFS, FIB-4, and APRI correlate to adverse outcomes of COVID-19 in patients with NAFLD. In our study, these scores were all superior to MELD/Na. To the best of our knowledge, this is the first study to show these findings, and we encourage the continued use of these scores to help predict outcomes in this otherwise heterogeneous population.Figure 1.: Prescription of medications for AUD among patients with ALD at University of Nebraska Medical Center from 2018-2020.