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Abstract Details
Impact of Fibrosis-4 Index Prior to COVID-19 on Outcomes in Patients at Risk of Non-alcoholic Fatty Liver Disease
Dig Dis Sci. 2021 Jun 26;1-7. doi: 10.1007/s10620-021-07120-0. Online ahead of print.
Mohamed A Elfeki123, Julian Robles12, Zaheer Akhtar12, Fauzia Ullah12, Ice Ganapathiraju12, Calvin Tran45, Casey Inman45, Simon M Collin6, Rossana Rosa7
Author information
1Internal Medicine Department, University of Iowa, Des Moines, IA, USA.
2Iowa Methodist Medical Center, UnityPoint Health-Des Moines, 1415 Woodland Avenue, Des Moines, IA, 50309, USA.
3Avera Medical Group Liver Disease, 1315 South Cliff Avenue, Suite 200-Plaza 3, Sioux Falls, SD, USA.
4Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
5Infectious Diseases Service, UnityPoint Health-Des Moines, 1221 Pleasant Street, Suite 300, Des Moines, IA, 50309, USA.
6National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
7Infectious Diseases Service, UnityPoint Health-Des Moines, 1221 Pleasant Street, Suite 300, Des Moines, IA, 50309, USA. rossana.rosaespinoza@unitypoint.org.
Abstract
Background: Severity of disease and outcomes in patient with COVID-19 has been associated with several risk factors tied to the metabolic syndrome.
Aims: We conducted a study with the objective of describing the association between the baseline Fibrosis-4 (FIB-4) index prior to SARS-CoV-2 infection and the severity of COVID-19 among patients at risk of non-alcoholic fatty liver disease (NAFLD).
Methods: This was a retrospective cohort study of patients with at least two risk factors for metabolic syndrome diagnosed with COVID-19. The main exposure of interest was FIB-4 index prior to infection, categorized into three previously validated age-specific levels. The main outcomes of interest were disease requiring hospitalization and in-hospital mortality.
Results: We included 373 patients [median age, 62 years; 194 male (52%); median number of metabolic syndrome risk factors, 3]. The median FIB-4 index was 1.10 (interquartile range 0.78-1.61). In models adjusting for diabetes mellitus and chronic kidney disease, patients with intermediate FIB-4 index had 67% higher odds of hospitalization compared to those in the low category {odds ratio (OR) 1.67 [(95% CI 1.06-2.64); p = 0.03]} and patients with high FIB-4 index had higher odds of mortality compared to intermediate and low category with an OR 2.22 (95% CI 1.20-4.12; p = 0.01). However, when we evaluated components of FIB-4 (age and AST/ALT ratio), we found that age alone was the best predictor of hospitalization and mortality.
Conclusions: Among patients at risk of NAFLD with COVID-19 infection, elevated pre-infection FIB-4 index was associated with worsened clinical outcomes, but age was the strongest predictor.