Journal of Clinical Medicine (Sep 2022)

Liver Fibrosis Indices Predict the Severity of SARS-CoV-2 Infection

  • Lucilla Crudele,
  • Fabio Novielli,
  • Stefano Petruzzelli,
  • Stefano Battaglia,
  • Antonio Francesco Maria Giuliano,
  • Rosa Melodia,
  • Chiara Maria Morano,
  • Paola Dell’Aquila,
  • Renata Moretti,
  • Luigi Castorani,
  • Roberto Salvia,
  • Gianfranco Inglese,
  • Nicola Susca,
  • Lucrezia dell’Olio,
  • Francesca Falcone,
  • Mariapaola Castaldo,
  • Carlo De Matteis,
  • Carlo Sabbà,
  • Antonio Moschetta

DOI
https://doi.org/10.3390/jcm11185369
Journal volume & issue
Vol. 11, no. 18
p. 5369

Abstract

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Discovering novel risk and prognostic factors for COVID-19 may help not only in reducing severity and mortality but also in creating targeted therapies considering patients’ individual features. Liver fibrosis is considered a complication in Non-alcoholic Fatty Liver Disease (NAFLD), it is a feature of steatohepatitis (NASH), and it has already been related to an increased risk for a wide range of diseases. Here, we aimed to define if any parameter assessing metabolic status has predictive power in identifying inpatients at risk for poorer prognosis and an increased mortality from COVID-19. This retrospective study was conducted at the Sub-Intensive Medicine Care Unit of the Presidio Maxi-Emergenze Fiera del Levante, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy. We evaluated 271 inpatients with moderate-to-severe SARS-CoV-2-related respiratory failure by comparing biochemical features and non-invasive liver fibrosis scores among discharged, transferred to Intensive Care Units (ICU) and non-survivor patients. Moreover, by performing ROC curves, we defined cut-off values to predict mortality and disease severity for each score. We found that non-invasive scores of liver fibrosis, obtained at day of admission, such as AAR (p p < 0.05) strongly predict not only in-hospital mortality but also the length of hospitalization and eventual admission to ICU. FIB-4 was the best score to identify non-survivor patients (sensitivity of 80% and specificity of 63%) and predict the need for ICU or mortality (71% of sensitivity and 65% of specificity), with a cut-off value of 1.94. Therefore, we present the predictive power and the cut-off values of several liver fibrosis scores here for disease severity and mortality in SARS-CoV-2 in-patients and we proposed the use of the present scores to identify ab initio the clinical therapeutic and diagnostic protocols for high-risk patients.

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