Takaya Hiroaki, Ueyama Shunichi, Osaki Yui, Kaji Kosuke, Kawaratani Hideto, Saito Ko, Aizawa Shigeyuki, Namisaki Tadashi, Morioka Chie, Yoshida Motoyuki, Akahane Takemi, Yoshiji Hitoshi
Department of Gastroenterology, Nara Prefecture Seiwa Medical Center, Sango, Nara, Japan.
Department of Gastroenterology, Nara Medical University, Kashihara, Nara, Japan.
Hepatol Res. 2023 Nov;53(11):1047-1058. doi: 10.1111/hepr.13943. Epub 2023 Jul 31.
Patients with nonalcoholic fatty liver disease (NAFLD) are reported to have greater coronavirus disease 2019 (COVID-19) severity compared with patients without NAFLD. Previous studies have reported that noninvasive liver fibrosis scores, including the Fibrosis-4 index, NAFLD fibrosis score, and aspartate aminotransferase to platelet ratio index (APRI), have utility in predicting COVID-19 mortality and disease severity in patients without NAFLD. However, the utility of liver fibrosis scores in predicting COVID-19 mortality and disease severity among patients with NAFLD infected with SARS-CoV-2 has yet to be evaluated.
This retrospective observational study comprised 126 patients with NAFLD and active SARS-CoV-2 infection. Patients were classified into low COVID-19 severity (mild or moderate I disease) and high COVID-19 severity (moderate II or severe disease) groups based on the therapeutic guideline implemented by the Ministry of Health, Labor, and Welfare of Japan.
Of the 126 patients, only one had been diagnosed with NAFLD before admission. Age; levels of serum aspartate aminotransferase, γ-glutamyl transpeptidase, lactate dehydrogenase, blood urea nitrogen, and serum C-reactive protein; Fibrosis-4 index; NAFLD fibrosis score; and APRI levels on admission were higher in the high COVID-19 severity group compared with the low COVID-19 severity group. Serum albumin levels, platelet counts, and lymphocyte counts on admission were lower in the high COVID-19 severity group compared with the low COVID-19 severity group. Univariate and multivariate analysis revealed that APRI values were significantly associated with COVID-19 severity and hospitalization duration for COVID-19.
APRI was independently associated with COVID-19 severity and hospitalization duration for COVID-19 in patients with NAFLD.
据报道，与非非酒精性脂肪性肝病（NAFLD）患者相比，非酒精性脂肪性肝病患者感染2019冠状病毒病（COVID-19）的病情更严重。既往研究报道，包括Fibrosis-4指数、NAFLD纤维化评分和天冬氨酸转氨酶与血小板比值指数（APRI）在内的非侵入性肝纤维化评分，在预测非NAFLD患者的COVID-19死亡率和疾病严重程度方面具有一定作用。然而，肝纤维化评分在预测感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的NAFLD患者的COVID-19死亡率和疾病严重程度方面的作用尚未得到评估。
这项回顾性观察性研究纳入了126例患有NAFLD且SARS-CoV-2感染活跃的患者。根据日本厚生劳动省实施的治疗指南，将患者分为COVID-19低严重程度（轻度或中度I型疾病）和COVID-19高严重程度（中度II型或重度疾病）组。
在这126例患者中，只有1例在入院前被诊断为NAFLD。与COVID-19低严重程度组相比，COVID-19高严重程度组患者的年龄、血清天冬氨酸转氨酶、γ-谷氨酰转肽酶、乳酸脱氢酶、血尿素氮和血清C反应蛋白水平、Fibrosis-4指数、NAFLD纤维化评分和入院时的APRI水平更高。与COVID-19低严重程度组相比，COVID-19高严重程度组患者入院时的血清白蛋白水平、血小板计数和淋巴细胞计数更低。单因素和多因素分析显示，APRI值与COVID-19严重程度和COVID-19住院时间显著相关。
在NAFLD患者中，APRI与COVID-19严重程度和COVID-19住院时间独立相关。
