Kamiya Yuji, Shinoda Masahiro, Ishii Naoki, Yamamoto Saki, Sekine Tetsuo, Morikawa Miwa, Ota Shinichiro, Toyama-Kousaka Mio, Takahashi Hidenori, Takei Hiroaki, Shinkai Masaharu
Department of Endocrinology and Metabolism Tokyo Shinagawa Hospital Tokyo Japan.
Department of Respiratory Medicine Tokyo Shinagawa Hospital Tokyo Japan.
JGH Open. 2024 Aug 8;8(8):e70004. doi: 10.1002/jgh3.70004. eCollection 2024 Aug.
Increased liver fibrosis scores (LFS), such as fibrosis-4 index (FIB-4) or non-alcoholic fatty liver disease fibrosis score (NFS), and fatty liver are known risk factors for severe coronavirus disease 2019 (COVID-19). The purpose of this study was to identify the best scores, which predict the prognosis of COVID-19.
Participants comprised consecutive Japanese COVID-19 patients admitted to our hospital between February 14, 2020, and April 14, 2021. Multivariate logistic regression analysis was performed to evaluate the relationships between LFS (FIB-4, NFS, aspartate aminotransferase-to-platelet ratio index [APRI], BARD score, and hepatic steatosis index [HSI]) or fatty liver on computed tomography (CT), and severity of COVID-19.
Of the 415 patients (mean age, 59 years), 177 patients (42.7%) needed oxygen therapy, 90 patients (21.7%) worsened to severe COVID-19, and 45 patients (10.8%) died during admission. Multivariate logistic regression analysis showed that increased FIB-4 and NFS were risk factors for death, severe COVID-19, and oxygen demand; that increased BARD was a risk factor for severe COVID-19 and oxygen demand; and that increased APRI and HSI were not risk factors for any status of COVID-19. Furthermore, increased NFS or BARD and fatty liver were independent risk factors for severe COVID-19 and oxygen demand.
This study showed that FIB-4 and NFS were the best liver fibrosis scores that predicted worse prognosis for COVID-19, and that increased NFS or BARD and fatty liver evident on CT represented independent risk factors for severe COVID-19 and oxygen demand.
肝纤维化评分（LFS）升高，如纤维化-4指数（FIB-4）或非酒精性脂肪性肝病纤维化评分（NFS），以及脂肪肝是已知的2019冠状病毒病（COVID-19）重症风险因素。本研究的目的是确定能预测COVID-19预后的最佳评分。
研究对象为2020年2月14日至2021年4月14日期间我院收治的连续性日本COVID-19患者。采用多因素logistic回归分析来评估LFS（FIB-4、NFS、天冬氨酸转氨酶与血小板比值指数[APRI]、BARD评分和肝脂肪变性指数[HSI]）或CT显示的脂肪肝与COVID-19严重程度之间的关系。
415例患者（平均年龄59岁）中，177例（42.7%）需要吸氧治疗，90例（21.7%）病情恶化为重症COVID-19，45例（10.8%）在住院期间死亡。多因素logistic回归分析显示，FIB-4和NFS升高是死亡、重症COVID-19和吸氧需求的危险因素；BARD升高是重症COVID-19和吸氧需求的危险因素；APRI和HSI升高不是COVID-19任何状态的危险因素。此外，NFS或BARD升高以及脂肪肝是重症COVID-19和吸氧需求的独立危险因素。
本研究表明，FIB-4和NFS是预测COVID-19预后较差的最佳肝纤维化评分，CT显示的NFS或BARD升高以及脂肪肝是重症COVID-19和吸氧需求的独立危险因素。
