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Liver stiffness is associated with disease severity and worse clinical scenarios in coronavirus disease 2019: A
Coskun Ozer Demirtas1, Caglayan Keklikkiran1, Ilkay Ergenc1
1Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.
Insights
Severe liver fibrosis, identified by liver stiffness measurement (LSM), is linked to worse COVID-19 outcomes. This non-invasive test can help predict disease severity and intensive care unit needs in coronavirus disease 2019 patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pre-existing chronic liver disease is a known poor prognostic factor for COVID-19.
- Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) is a non-invasive method to assess liver fibrosis.
Purpose of the Study:
- To investigate the association between LSM and COVID-19 disease severity.
- To determine if LSM can predict clinical outcomes in hospitalized COVID-19 patients.
Main Methods:
- Prospective recruitment of hospitalized adult COVID-19 patients over 3 months.
- Recording of demographic, laboratory, clinical, and VCTE data at admission.
- Definition of severe liver fibrosis as LSM > 9.6 kPa.
- Multivariate logistic regression to identify factors associated with severity and outcomes.
Main Results:
- 12.2% of 98 COVID-19 patients had severe liver fibrosis.
- Severe liver fibrosis was associated with higher baseline disease severity (P=.022) and increased need for oxygen (P=.010).
- Severe liver fibrosis independently predicted disease severity (OR: 7.685) and ICU requirement (OR: 46.656).
Conclusions:
- Initial VCTE can help identify COVID-19 patients at higher risk of severe illness.
- LSM may serve as an additional tool for predicting adverse clinical outcomes.
- Further multicenter studies are needed to validate these findings.
Background:
Pre-existing chronic liver disease is currently considered a poor prognostic factor for coronavirus disease 2019 (COVID-19). The present study aimed to investigate the association of liver stiffness measurement (LSM) with disease severity and clinical course of COVID-19.
Methods:
We prospectively recruited consecutive hospitalised adult patients with COVID-19 in a 3-month period. Demographic, laboratory, clinical and vibration-controlled transient elastography (VCTE) features were recorded at entry, and all patients were prospectively followed-up. Severe liver fibrosis was defined as an LSM value higher than 9.6 kPA. Multivariate logistic regression analysis was performed to reveal factors associated with disease severity and outcomes.
Results:
Out of 98 eligible patients with COVID-19, 12 (12.2%) had severe liver fibrosis. Patients with severe liver fibrosis had higher baseline disease severity (P = .022), more commonly required oxygen treatment at entry (P = .010), and had intensive-care unit (ICU) requirements during the 6 (1-39)-day median follow-up time (P = .017). The presence of severe liver fibrosis was independently associated with disease severity (odds ratio (OR): 7.685, 95% confidence interval (CI): 1.435-41.162, P = .017) and ICU requirement (OR: 46.656, 95% CI: 2.144-1015.090, P = .014). LSM was correlated with alanine aminotransferase levels (P = .005, r: 0.283), but not with other markers of acute hepatic injury or inflammation.
Conclusion:
Initial VCTE application might help physicians identify patients who are more likely to have severe illness or worse clinical outcomes, in addition to other well-established clinical and laboratory factors. Further multicentre prospective studies are warranted to validate our results.
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