scholarly journals Should We Quantify Valvular Calcifications on Cardiac CT in Patients with Infective Endocarditis?

2021 ◽  
Vol 10 (19) ◽  
pp. 4458
Author(s):  
Virgile Chevance ◽  
Remi Valter ◽  
Mohamed Refaat Nouri ◽  
Islem Sifaoui ◽  
Amina Moussafeur ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Calcium Score ◽  
Blood Cultures ◽  
Risk Of Death ◽  
Surgical Data ◽  
Risk Rate ◽  
The Impact ◽  
Atypical Bacteria

Background: Evaluate the impact of valvular calcifications measured on cardiac computed tomography (CCT) in patients with infective endocarditis (IE). Methods: Seventy patients with native IE (36 aortic IE, 31 mitral IE, 3 bivalvular IE) were included and explored with CCT between January 2016 and April 2018. Mitral and aortic valvular calcium score (VCS) were measured on unenhanced calcium scoring images, and correlated with clinical, surgical data, and 1-year death rate. Results: VCS of patients with mitral IE and no peripheral embolism was higher than those with peripheral embolism (868 (25–1725) vs. 6 (0–95), p < 0.05). Patients with high calcified mitral IE (mitral VCS > 100; n = 15) had a lower rate of surgery (40.0% vs.78.9%; p = 0.03) and a higher 1-year-death risk (53.3% vs. 10.5%, p = 0.04; OR = 8.5 (2.75–16.40) than patients with low mitral VCS (n = 19). Patients with aortic IE and high aortic calcifications (aortic VCS > 100; n = 18) present more frequently atypical bacteria on blood cultures (33.3% vs. 4.8%; p = 0.03) than patients with low aortic VCS (n = 21). Conclusion: The amount of valvular calcifications on CT was associated with embolism risk, rate of surgery and 1-year risk of death in patients with mitral IE, and germ’s type in aortic IE raising the question of their systematic quantification in native IE.

scholarly journals Complementary Diagnostic and Prognostic Contributions of Cardiac Computed Tomography for Infective Endocarditis Surgery

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Mnahi Bin Saeedan ◽  
Nicholas Chan ◽  
Nancy A. Obuchowski ◽  
Nabin Shrestha ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Cleveland Clinic ◽  
Total Mortality ◽  
Adverse Outcomes ◽  
Imaging Biomarker ◽  
Imaging Biomarkers ◽  
Contrast Enhanced Ct

Background: Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery. Methods: Of 833 consecutive patients with surgically proven IE during May 1, 2014 to May 1, 2019, at Cleveland Clinic, 155 underwent both preoperative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II (European System for Cardiac operative Risk Evaluation II). Results: CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients, respectively. Thirty-day mortality occurred in 3 (1.9%) patients and composite mortality or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality or morbidities in-hospital, with odds ratio (95% CI) of 3.66 (1.76–7.59), P =0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95% CI) of 3.82 (1.25–11.7), P <0.001 and 9.84 (1.89–51.0), P =0.007, respectively. Conclusions: We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.

P4451Screening for Coronary Artery Disease USing Primary Evaluation with Cardiac CT (SUSPECT) in Aviation Medicine in the Royal Netherlands Air Force

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R B Grobben ◽  
E Frijters ◽  
B K Velthuis ◽  
R T A Beekmann ◽  
R Rienks ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Air Force ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
False Negative ◽  
Calcium Score ◽  
Negative Results ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Military aircrew are subjected to both stress and excessive G-forces, which may be associated with an increased risk of coronary artery disease (CAD) and sudden cardiac death. Annual cardiac screening has therefore been implicated using exercise testing, which suffers from both false-positive and false-negative results. In this study, we have evaluated the prevalence of CAD in military aircrew using cardiac computed tomography (CT), and assessed whether cardiac CT would be a useful screening tool within this population. Methods Prospective, single-center, cohort study in 250 asymptomatic aircrew >40 years old in the Royal Netherlands Air Force. Included subjects underwent cardiac CT, in addition to the routine annual check-up that included an electrocardiogram, exercise test and laboratory analysis. Primary endpoint was obstructive CAD, defined as a coronary stenosis ≥50%. Secondary endpoints were non-obstructive CAD (<50% stenosis) and coronary artery calcium score (CACS) >100. Results Of the first 108 inclusions, mean age was 49 years (range 40–57), 99% were male and mean body mass index was 25.8 (SD 2.6). The prevalence of hypertension was 8%, hypercholesterolemia 9% and familial heart disease was noted in 22%. 16% were active smokers and none had diabetes. Obstructive CAD was observed in 2% of patients, non-obstructive CAD in 40% and CACS >100 in 11%. All subjects with obstructive CAD on cardiac CT underwent coronary artery angiography, which confirmed a stenosis >70% that required revascularization. Conclusion In asymptomatic military aviation aircrew >40 years old currently active in the Royal Netherlands Air Force, the prevalence of obstructive and non-obstructive CAD was 2% and 40%, respectively Acknowledgement/Funding Royal Netherlands Air Force

Abstract 12719: Diagnostic and Prognostic Contributions of Cardiac Computed Tomography for Infective Endocarditis Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Mnahi Bin Saeedan ◽  
Nicholas Chan ◽  
Nancy Obuchowski ◽  
Nabin Shrestha ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Cleveland Clinic ◽  
Total Mortality ◽  
Adverse Outcomes ◽  
Imaging Biomarker ◽  
Imaging Biomarkers ◽  
Contrast Enhanced Ct

Background: Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery. Methods: Of 833 consecutive patients with surgically proven IE during 5/1/2014-5/1/2019 at Cleveland Clinic, 155 underwent both pre-operative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II. Results: CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients respectively. CT identified an additional 11% of vegetations, 13% of pseudoaneurysms or abscesses, 5% of dehiscences and 14% of fistulae when TEE was negative. Thirty-day mortality occurred in 3 (1.9%) patients, and composite mortality and/or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality and/or morbidities in-hospital, with odds ratio (95%CI) of 3.66 (1.76-7.59), P=0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95%CI) of 3.82 (1.25, 11.7), P<0.001 and 9.84 (1.89, 51.0), P=0.007 respectively (Figure). Conclusion: We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.

Abstract 273: The Evolving Use of Cardiac CT to Inform Defining Quality in Imaging

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ming Zhang ◽  
James Earls ◽  
Brian G Choi ◽  
Robert K Zeman ◽  
Andrew D Choi
Keyword(s):  
Chest Pain ◽  
Cardiac Catheterization ◽  
Stress Testing ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Academic Medical Center ◽  
Significant Rise ◽  
Calcium Scoring ◽  
Ct Utilization ◽  
The Impact

Introduction: Cardiac computed tomography (CT) has emerged as a diagnostic technique beyond the evaluation of outpatient stable chest pain; however, as quality in imaging has only recently been defined by the American Heart Association, understanding the changing utilization of CT use may inform application of these standards. This study aims to characterize changes in cardiac CT utilization and for chest pain, assess the impact on downstream invasive testing over a 3 year time period. Methods: 439 consecutive patients from July 2013 through June 2016 who had cardiac CT performed at an urban academic medical center were evaluated. Patient demographics and cardiac CT indications were reviewed from electronic medical records and archived cardiac CT reports. Cardiac CT indication categories included calcium scoring, outpatient chest pain, inpatient chest pain, electrophysiology applications, transcatheter aortic valve replacement (TAVR) and other. For patients who had cardiac CT for outpatient or inpatient chest pain, all records were reviewed to assess for further invasive cardiac catheterization. The studies were divided into three academic years. Results: The average age of patients undergoing cardiac CT was 60 ± 14 years, 64% were male and 55% were white. Overall, there was a 34% increase in the utilization of Cardiac CT across the study period. There was a significant rise in CT for inpatient chest pain from 2% (2/123) to 14% (26/187; p=0.0002) from year one to year three of the study period. In addition there was a significant rise in CT for TAVR planning from 7% (8/123) in year one to 14% (26/187; p=0.04) in year three. The proportion of patients undergoing evaluation for outpatient chest pain and calcium scoring was relatively unchanged from year one to year three. There was a decrease in cardiac CT for electrophysiology applications from 33% (41/123) to 15% (28/187) from year one to year three (p=0.0001). Among patients who had cardiac CT for either inpatient or outpatient chest pain, 23% (29/123) patients had previous equivocal stress testing. Only 3 of these pts required further cardiac catheterization potentially preventing 90% (26/29)of patients from undergoing invasive cardiac catheterization. Conclusion: Cardiac CT utilization is rising for inpatient chest pain and for TAVR planning. For 90% of the patients undergoing evaluation for chest pain, and 90% of patients with equivocal stress testing, cardiac CT potentially prevented need for further downstream invasive testing. This hypothesis-generating data has potential implications that may inform application of quality standards for TAVR and chest pain imaging. Further research is needed to disseminate the effect of cardiac CT on patient outcomes in this cohort.

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals Surgical treatment of infective endocarditis in intravenous drug abusers

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alina Zubarevich ◽  
Marcin Szczechowicz ◽  
Anja Osswald ◽  
Jerry Easo ◽  
Arian Arjomandi Rad ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Mortality Rates ◽  
Blood Cultures ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Enterococcus Species ◽  
Function Impairment

Abstract Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.

scholarly journals The Influence of COVID-19-Induced Daily Activities on Health Parameters—A Case Study in Malaysia

2021 ◽  
Vol 13 (13) ◽  
pp. 7465
Author(s):  
Mujahid Ali ◽  
Afonso R. G. de Azevedo ◽  
Markssuel T. Marvila ◽  
Muhammad Imran Khan ◽  
Abdul Muhaimin Memon ◽  
...  
Keyword(s):  
Structural Equation ◽  
Linear Regression Analysis ◽  
Daily Activities ◽  
Social Health ◽  
Coefficient Of Determination ◽  
Equation Modeling ◽  
Risk Of Death ◽  
Unit Increase ◽  
The Impact ◽  
Health Parameters

Since December 2019, the COVID-19 epidemic has been spreading all over the world. This epidemic has brought a risk of death in the daily activity (physical and social) participation that influences travellers’ physical, social, and mental health. To analyze the impact of the COVID-19-induced daily activities on health parameters of higher education institutes, 150 students of the Universiti Teknologi PETRONAS, Perak, Malaysia, were surveyed through an online web survey using random sampling techniques. The data were analyzed through RStudio and SPSS using multilevel linear regression analysis and Hierarchical Structural Equation Modeling. The estimated results indicate that restricting individuals from doing out-of-home activities negatively influences physical and social health. A unit increase in the in-home maintenance activities during the COVID-19 pandemic introduced a daily increase of 0.5% in physical health. Moreover, a unit increase in the in-home activities at leisure time represents a 1% positive improvement in social health. Thus, physical activity has proven to be beneficial in improving physical and social health with severe COVID-19. In contrast, the coefficient of determination (R2) for all endogenous variables ranges from 0.148 to 0.227, which is incredibly acceptable in psychological research. For a healthier society with a better quality of life, this study adopted multidisciplinary approaches that are needed to be designed.

Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality

2021 ◽  
pp. 088307382110001
Author(s):  
Jody L. Lin ◽  
Joseph Rigdon ◽  
Keith Van Haren ◽  
MyMy Buu ◽  
Olga Saynina ◽  
...  
Keyword(s):  
Severe Pneumonia ◽  
Sensitivity Analyses ◽  
Tube Placement ◽  
Composite Outcome ◽  
Eligibility Criteria ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Neurologic Impairment ◽  
Increased Risk ◽  
The Impact

Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.

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

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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