Cholongitas Evangelos, Bali Triada, Georgakopoulou Vasiliki E, Kamiliou Aikaterini, Vergos Ioannis, Makrodimitri Sotiria, Samara Stamatia, Triantafylou Maria, Basoulis Dimitrios, Eliadi Irene, Karamanakos Georgios, Sipsas Nikolaos V, Samarkos Michael
First Department of Internal Medicine.
Pulmonology Department.
Eur J Gastroenterol Hepatol. 2022 Nov 1;34(11):1165-1171. doi: 10.1097/MEG.0000000000002446. Epub 2022 Sep 10.
Although several liver- and inflammation-based scores to predict the clinical course of patients with coronavirus disease 2019 (COVID-19) have been evaluated, no direct comparison regarding their predictive ability has been performed.
1038 patients (608 males, age 63.5 ± 17 years) hospitalized with documented COVID-19 infection to the non-ICU ward, were included retrospectively. Clinical and laboratory characteristics on admission including evaluation of Fibrosis-4 (FIB-4) score and C-Reactive Protein (CRP) to albumin ratio (CAR) were recorded.
One hundred and twenty-four patients (11.9%) died during hospitalization after 8 (3-72) days. In multivariate analysis, FIB-4 (hazard ratio, 1.11; 95% confidence interval (CI), 1.034-1.19; P = 0.004), was independently associated with mortality, with very good discriminative ability (area under the receiver operating characteristic curve curve, 0.76). The patients with FIB-4 >2.67 (n = 377), compared to those with ≤2.67 (n = 661), had worse survival (log-rank 32.6; P < 0.001). Twenty-four (6.8%) of 352 patients with possible nonalcoholic fatty liver disease (NAFLD) (defined as Hepatic Steatosis Index >36) died during hospitalization. In multivariate analysis, CAR was an independent risk factor (1) for mortality (hazard ratio, 1.014; 95% CI, 1.002-1.025; P = 0.021), (2) the need for high-flow nasal cannula with or without intubation (hazard ratio, 1.016; 95% CI, 1.004-1.027; P = 0.007) and (3) development of acute kidney injury (hazard ratio, 1.017; 95% CI, 1.006-1.028; P = 0.002). In addition, the patients with possible NAFLD and CAR >12 (n = 154), compared to those with CAR ≤12 (n = 198), had worse survival (log-rank 5.1; P = 0.024).
FIB-4 was an independent factor for mortality with better performance compared to other liver function test- and inflammation-based scores in patients with COVID-19, while CAR was the only score independently associated with the clinical course in COVID-19 patients with possible NAFLD.
尽管已经评估了几种基于肝脏和炎症的评分来预测2019冠状病毒病（COVID-19）患者的临床病程，但尚未对它们的预测能力进行直接比较。
回顾性纳入1038例确诊为COVID-19感染并入住非重症监护病房的患者（608例男性，年龄63.5±17岁）。记录入院时的临床和实验室特征，包括Fibrosis-4（FIB-4）评分和C反应蛋白（CRP）与白蛋白比值（CAR）的评估。
124例患者（11.9%）在住院8（3 - 72）天后死亡。在多变量分析中，FIB-4（风险比，1.11；95%置信区间（CI），1.034 - 1.19；P = 0.004）与死亡率独立相关，具有很好的判别能力（受试者操作特征曲线下面积，0.76）。FIB-4＞2.67的患者（n = 377）与FIB-4≤2.67的患者（n = 661）相比，生存率更差（对数秩检验32.6；P＜0.001）。352例可能患有非酒精性脂肪性肝病（NAFLD）（定义为肝脏脂肪变性指数＞36）的患者中有24例（6.8%）在住院期间死亡。在多变量分析中，CAR是（1）死亡率的独立危险因素（风险比，1.014；95% CI，1.002 - 1.025；P = 0.021），（2）需要使用高流量鼻导管（无论是否插管）的独立危险因素（风险比，1.016；95% CI，1.004 - 1.027；P = 0.007）以及（3）发生急性肾损伤的独立危险因素（风险比，1.017；95% CI，1.006 - 1.028；P = 0.002）。此外，可能患有NAFLD且CAR＞12的患者（n = 154）与CAR≤12的患者（n = 198）相比，生存率更差（对数秩检验5.1；P = 0.024）。
在COVID-19患者中，FIB-4是死亡率的独立因素，与其他基于肝功能检查和炎症的评分相比表现更好，而CAR是唯一与可能患有NAFLD的COVID-19患者临床病程独立相关的评分。
