Open AccessPossible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients
Author(s) -
Mario RomeroCristóbal,
Ana ClementeSánchez,
Patricia Piñeiro,
Jamil Cedeño,
Laura Rayón,
Julia Del Río,
Carlos Ramos,
Diego-Andrés Hernández,
Miguel Cova,
Aránzazu Caballero,
Ignacio Garutti,
Pablo García-Olivares,
Javier Hortal,
J. M. Martin Guerrero,
Rita García,
Rafael Bañares,
Diego Rincón
Publication year - 2021
Publication title -
therapeutic advances in gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.278
H-Index - 51
eISSN - 1756-2848
pISSN - 1756-283X
DOI - 10.1177/17562848211023410
Subject(s) - medicine , intensive care unit , liver disease , severity of illness , fibrosis , liver injury , ards , comorbidity , gastroenterology , lung
Background: 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.Methods: 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.Results: 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) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 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 ( p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11–1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99–1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin.Conclusion: 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.