Unrecognized liver injury assessed by fibrosis indexes is associated with mortality in critically ill COVID-19 patients

Abstract Background Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indexes with the prognosis of critically ill COVID-19 patients.Methods Observational study in 214 patients with COVID-19 consecutively admitted to the ICU. Pre-admission liver fibrosis indexes were calculated. In-hospital mortality and predictive factors were explored with Kaplan-Meier and Cox regression analysis.Results The mean age was 59.58 (13.79) years. Sixteen patients (7.48%) had previously recognized chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indexes were higher in non-survivors [Forns: 6.04 (1.42) vs 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) vs 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis (p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11-1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99-1.72); p = 0.051] were independently related to survival after adjusting for the Charlson Comorbidity Index, APACHE II and ferritin.Conclusion Unrecognized liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

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Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211023410 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110234

Author(s):

Mario Romero-Cristóbal ◽

Ana Clemente-Sánchez ◽

Patricia Piñeiro ◽

Jamil Cedeño ◽

Laura Rayón ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Injury ◽

Chronic Liver Disease ◽

Critically Ill ◽

Cox Regression ◽

Chronic Liver ◽

Cox Regression Analysis ◽

Risk Of Death ◽

The Impact

Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. Methods: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan–Meier and Cox regression analysis. Results: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis ( p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11–1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99–1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin. Conclusion: Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

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Liver Fibrosis is Associated with a Decrease in Gait Speed in Older Men with Chronic Liver Disease: A Retrospective Cross-Sectional Study

10.21203/rs.3.rs-819599/v1 ◽

2021 ◽

Author(s):

Kenichi Fudeyasu ◽

Takuo Nomura ◽

Toshihiro Kawae ◽

Daisuke Iwaki ◽

Yuki Nakashima ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Motor Function ◽

Gait Speed ◽

Older Patients ◽

Knee Extension ◽

Chronic Liver ◽

Cross Sectional ◽

The Impact

Abstract Background: Although it has already been reported that chronic liver disease (CLD) can induce sarcopenia, the impact of sarcopenia, especially on motor function, in older patients with CLD is still unclear. Therefore, we investigated the effects of liver fibrosis on motor function in these patients.Methods: In all, 117 older patients with CLD aged above 60 years (men, n=70; women, n=47) were included in this study. We examined the presence or absence of sarcopenia and checked motor functions such as muscle strength and walking speed. The results were compared between patients with FIB-4 index of >3.25, indicative of severe-degree liver fibrosis (SLF), and those with an index of <3.25, indicative of low-degree liver fibrosis (LLF). We also analyzed the factors related to the decrease in gait speed.Results: The decrease in gait speed (<1.0 m/s) was significantly higher (P = 0.027) and the knee extension force (KEF) was significantly lower (P = 0.010) in men with SLF than in those with LLF. In this study, liver fibrosis (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.56–0.90) and KEF (OR = 1.09, 95% CI = 1.02–1.16) were identified as factors associated with the decrease in gait speed.Conclusions: Older male patients with CLD have decreased motor function as the disease progresses. We found that the decrease in gait speed is related to liver fibrosis and KEF. It is necessary to focus on the motor function of older patients with CLD, especially the gait speed.

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Growth differentiation factor (GDF) -15– a novel biomarker to assess the extent of liver fibrosis in patients with chronic liver disease?

Zeitschrift für Gastroenterologie ◽

10.1055/s-0029-1191796 ◽

2009 ◽

Vol 47 (01) ◽

Cited By ~ 1

Author(s):

T Rädle-Hurst ◽

E Herrmann ◽

G Hess ◽

S Zeuzem ◽

F Lammert ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Differentiation Factor

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Mac‐2 Binding Protein Glycan Isomer as non‐invasive tool to assess liver fibrosis in children with chronic liver disease

Hepatology Research ◽

10.1111/hepr.13608 ◽

2021 ◽

Author(s):

Ola G Behairy ◽

Soha A El‐Gendy ◽

Dalia Y Ibrahim ◽

Amira I Mansour ◽

Ola S El‐Shimi

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Binding Protein ◽

Chronic Liver ◽

Non Invasive

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Chronic liver disease not a significant comorbid condition for COVID-19

Scientific Reports ◽

10.1038/s41598-021-91238-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jiahao Lin ◽

Bingting Bao ◽

Nigar Anjuman Khurram ◽

Kasey Halsey ◽

Ji Whae Choi ◽

...

Keyword(s):

Liver Disease ◽

Liver Injury ◽

Chronic Liver Disease ◽

The United States ◽

Postmortem Examination ◽

Chronic Liver ◽

Critical Groups ◽

Comorbid Condition ◽

Central Vein ◽

Significant Difference

AbstractTo explore the role of chronic liver disease (CLD) in COVID-19. A total of 1439 consecutively hospitalized patients with COVID-19 from one large medical center in the United States from March 16, 2020 to April 23, 2020 were retrospectively identified. Clinical characteristics and outcomes were compared between patients with and without CLD. Postmortem examination of liver in 8 critically ill COVID-19 patients was performed. There was no significant difference in the incidence of CLD between critical and non-critical groups (4.1% vs 2.9%, p = 0.259), or COVID-19 related liver injury between patients with and without CLD (65.7% vs 49.7%, p = 0.065). Postmortem examination of liver demonstrated mild liver injury associated central vein outflow obstruction and minimal to moderate portal lymphocytic infiltrate without evidence of CLD. Patients with CLD were not associated with a higher risk of liver injury or critical/fatal outcomes. CLD was not a significant comorbid condition for COVID-19.

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