Liver Injury and Elevated FIB-4 Define a High-Risk Group in Patients with COVID-19

Area of Science:

• Hepatology
• Infectious Diseases
• Internal Medicine

Background:

• Liver involvement is common in COVID-19, but prognostic data are limited.
• Understanding liver-related factors influencing COVID-19 outcomes is crucial.

Purpose of the Study:

• To assess the prognostic role of abnormal liver tests and fibrosis estimators in hospitalized COVID-19 patients.
• To investigate the impact of non-invasive fibrosis scores and steatosis on mortality.

Main Methods:

• Retrospective cohort study of 370 hospitalized COVID-19 patients without prior liver disease.
• Evaluation of liver biochemistry, Fibrosis-4 (FIB-4), Forns, APRI scores, AST/ALT ratio, and CT-documented steatosis.
• Multivariate analysis to identify independent predictors of mortality.

Main Results:

• 72.9% of patients had abnormal liver biochemistry on admission.
• Non-survivors exhibited significantly higher FIB-4, Forns, APRI scores, and AST/ALT ratios.
• Severe FIB-4 (≥3.25) and elevated AST were independent predictors of mortality (AUROC 0.73 for FIB-4).

Conclusions:

• Abnormal liver biochemistry on admission may indicate a worse prognosis in COVID-19.
• A severe FIB-4 score is a significant independent predictor of mortality in hospitalized COVID-19 patients.
• Liver steatosis did not impact COVID-19 outcomes in this cohort.