Liver involvement in Coronavirus Disease 2019 (COVID-19) has been widely documented. However, data regarding liver-related prognosis are scarce and heterogeneous. The current study aims to evaluate the role of abnormal liver tests and incidental elevations of non-invasive fibrosis estimators on the prognosis of hospitalized COVID-19 patients. We conducted a retrospective cohort study to investigate the impact of elevated liver tests, non-invasive fibrosis estimators (the Fibrosis-4 (FIB-4), Forns, APRI scores, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio), and the presence of computed tomography (CT)-documented liver steatosis on mortality in patients with moderate and severe COVID-19, with no prior liver disease history. A total of 370 consecutive patients were included, of which 289 patients (72.9%) had abnormal liver biochemistry on admission. Non-survivors had significantly higher FIB-4, Forns, APRI scores, and a higher AST/ALT ratio. On multivariate analysis, severe FIB-4 (exceeding 3.25) and elevated AST were independently associated with mortality. Severe FIB-4 had an area under the receiver operating characteristic (AUROC) of 0.73 for predicting survival. The presence of steatosis was not associated with a worse outcome. Patients with abnormal liver biochemistry on arrival might be susceptible to a worse disease outcome. An FIB-4 score above the threshold of 3.25, suggestive of the presence of fibrosis, is associated with higher mortality in hospitalized COVID-19 patients.
【저자키워드】 COVID-19, Mortality, liver, FIB-4, 【초록키워드】 Biochemistry, severe COVID-19, Prognosis, fibrosis, outcome, Computed tomography, survival, Patient, AST, threshold, characteristic, disease, Admission, liver steatosis, Analysis, Liver disease, Liver tests, retrospective cohort study, Non-invasive, hospitalized COVID-19 patients, Fibrosis-4, aspartate, Elevation, heterogeneous, AUROC, steatosis, AST/ALT, susceptible, evaluate, elevated, conducted, significantly higher, consecutive patient, liver test, patients with moderate, 【제목키워드】 group, with COVID-19,