Romero-Cristóbal Mario, Clemente-Sánchez Ana, Piñeiro Patricia, Cedeño Jamil, Rayón Laura, Del Río Julia, Ramos Clara, Hernández Diego-Andrés, Cova Miguel, Caballero Aranzazu, Garutti Ignacio, García-Olivares Pablo, Hortal Javier, Guerrero Jose-Eugenio, García Rita, Bañares Rafael, Rincón Diego
Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain.
Department of Anesthesiology, H.G.U. Gregorio Marañón, Madrid, Spain.
Therap Adv Gastroenterol. 2021 Jun 14;14:17562848211023410. doi: 10.1177/17562848211023410. eCollection 2021.
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.
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.
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) 4.99 (1.58), < 0.001; FIB-4: 1.77 (1.17) 1.41 (0.91), = 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 ( < 0.05 for both indexes). Both Forns [HR 1.41 (1.11-1.81); = 0.006] and FIB-4 [HR 1.31 (0.99-1.72); = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin.
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.
患有急性呼吸窘迫综合征的冠状病毒病（COVID-19）是一种危及生命的疾病。先前诊断为慢性肝病与较差的预后相关。然而，隐匿性肝损伤的影响尚未得到研究。我们旨在探讨入院前肝纤维化指标与危重症COVID-19患者预后的关联。
本研究为一项对214例连续入住重症监护病房（ICU）的COVID-19患者进行的观察性研究。计算入院前肝纤维化指标。采用Kaplan-Meier法和Cox回归分析探讨院内死亡率及预测因素。
平均年龄为59.58（13.79）岁；16例患者（7.48%）先前被诊断为慢性肝病。根据Forns指数，高达78.84%的患者存在超过轻度的纤维化，根据FIB-4指数，45.76%的患者存在超过轻度的纤维化。非幸存者的纤维化指标更高[Forns指数：6.04（1.42）对4.99（1.58），P<0.001；FIB-4指数：1.77（1.17）对1.41（0.91），P=0.020]，但肝生化参数无差异。Forns或FIB-4显示有任何程度纤维化的患者死亡率更高，且死亡率随纤维化严重程度增加（两个指数P均<0.05）。校正Charlson合并症指数、急性生理与慢性健康状况评分系统II（APACHE II）和铁蛋白后，Forns指数[风险比（HR）1.41（1.11-1.81）；P=0.006]和FIB-4指数[HR 1.31（0.99-1.72）；P=0.051]均与生存独立相关。
入院前通过血清学检测评估的未被识别的肝纤维化与入住ICU的重症COVID-19患者较高的死亡风险独立相关。
