Liver Fibrosis Scores and Clinical Outcomes in Patients With COVID-19

Jing Zhang; Fuwei Liu; Tiangang Song; Zhangwang Li; Panpan Xia; Xiaoyi Tang; Minxuan Xu; Yunfeng Shen; Jianyong Ma; Xiao Liu; Peng Yu

doi:10.3389/fmed.2022.829423

Liver Fibrosis Scores and Clinical Outcomes in Patients With COVID-19

Front Med (Lausanne). 2022 Apr 8:9:829423. doi: 10.3389/fmed.2022.829423. eCollection 2022.

Authors

Jing Zhang¹, Fuwei Liu², Tiangang Song³, Zhangwang Li³, Panpan Xia^{4

5}, Xiaoyi Tang¹, Minxuan Xu^{4

5}, Yunfeng Shen^{4

5}, Jianyong Ma⁶, Xiao Liu⁵, Peng Yu^{4

5}

Affiliations

¹ Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
² Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China.
³ The Second Clinical Medical College of Nanchang University, Nanchang, China.
⁴ Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
⁵ Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China.
⁶ Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States.

Abstract

Background and aims: We investigated the association between liver fibrosis scores and clinical outcomes in patients with COVID-19.

Methods: We performed a post-hoc analysis among patients with COVID-19 from the trial study Outcomes Related to COVID-19 treated with Hydroxychloroquine among Inpatients with symptomatic Disease (ORCHID) trial. The relationship between aspartate aminotransferase (AST) to platelet ratio index (APRI), non-alcoholic fatty liver disease fibrosis score (NFS), Fibrosis-4 index (FIB-4), and discharge and death during the 28-days of hospitalization was investigated.

Results: During the 28 days after randomization, 237 (80.6%) patients were discharged while 31 (10.5%) died among the 294 patients with COVID-19. The prevalence for advanced fibrosis was estimated to be 34, 21.8, and 37.8% for FIB-4 (>2.67), APRI (>1), and NFS (>0.676), respectively. In multivariate analysis, FIB-4 >2.67 [28-days discharge: hazard ratio (HR): 0.62; 95% CI: 0.46-0.84; 28-days mortality: HR: 5.13; 95% CI: 2.18-12.07], APRI >1 (28-days discharge: HR: 0.62; 95% CI: 0.44-0.87; 28-days mortality: HR: 2.85, 95% CI: 1.35-6.03), and NFS >0.676 (28-days discharge: HR: 0.5; 95% CI: 0.35-0.69; 28-days mortality: HR: 4.17; 95% CI: 1.62-10.72) was found to significantly reduce the discharge rate and increase the risk of death. Additionally, FIB-4, APRI, and NFS were found to have good predictive ability and calibration performance for 28-day death (C-index: 0.74 for FIB-4, 0.657 for APRI, and 0.745 for NFS) and discharge (C-index: 0.649 for FIB-4, 0.605 for APRI, and 0.685 for NFS).

Conclusion: In hospitalized patients with COVID-19, FIB-4, APRI, and NFS may be good predictors for death and discharge within 28 days. The link between liver fibrosis and the natural history of COVID-19 should be further investigated.

Keywords: COVID-19; discharge; liver fibrosis scores; mortality; prognosis.