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Reuters Health Information: Liver fibrosis tied to ventilator need in COVID-19

Liver fibrosis tied to ventilator need in COVID-19

Last Updated: 2020-07-02

By David Douglas

NEW YORK (Reuters Health) - Middle-aged COVID-19 patients showing signs of advanced liver fibrosis, as estimated by the Fibrosis Index Based on 4 Factors (FIB-4), are at greater likelihood of requiring mechanical ventilation, according to researchers in Spain.

Not much is known about the role of liver fibrosis in the natural history of COVID-19, Dr. Luis Ibanez-Samaniego of Hospital General Universitario Gregorio Maran, in Madrid, and colleagues note in The Journal of Infectious Diseases.

The team examined data on 160 patients aged 35 to 65 years with COVID-19. The median length of follow-up was 29 days and none were lost to follow-up.

As many as 28.1% of the patients had an FIB-4 over 2.67, suggesting they were at risk for advanced liver fibrosis. This group also had a higher prevalence of cardiovascular risk factors as well as features suggestive of systemic inflammatory response such as higher levels of C-reactive protein.

Their need for mechanical ventilation was significantly greater than in those with a lower score (37.8% vs. 18.3%). Their time from diagnosis of COVID-19 to ICU admission was also significantly shorter (five days vs. 10 days).

Among factors significantly increasing the need for ICU admission were an FIB-4 of 2.67 or more (odds ratio, 3.41) and previous respiratory diseases (OR, 4.54). Multivariate logistic regression and bootstrap analysis confirmed that FIB-4 was an independent risk factor.

"Our findings," Dr. Ibanez-Samaniego continued, "are clinically meaningful because advanced liver fibrosis secondary to metabolic-associated fatty liver disease is the main driver of end-stage liver disease and hepatocellular carcinoma in Western countries. FIB-4, a validated and widely available score to assess the presence of liver fibrosis, could help clinicians to individualize the risk of poor clinical outcomes in patients with COVID-19."

"Importantly," he concluded, "this work is the first study to suggest that unsuspected hepatic fibrosis may play a relevant role in the course of COVID-19. Data coming from international registries, such as the COVID-Hep registry, will help to clarify this association."

SOURCE: The Journal of Infectious Diseases, online June 21, 2020.

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