Predictors of adverse outcomes among patients with NAFLD, COVID-19

Researchers found certain diagnostics linked to adverse outcomes among patients with non-alcoholic fatty liver disease during COVID-19, according to a presentation at Digestive Disease Week.

“COVID-19 has consistently shown in multiple studies to disproportionately affect those with metabolic syndrome-associated conditions. Although some smaller studies done during the pandemic reported an increased frequency of severe COVID-19 infection in patients with NAFLD, there is not much that is known in addition to this,” Sunny Sandhu, MD, internal medicine resident at the University of California San Francisco Center for Medical Education and Research, said. “Specifically, we don't have very much information regarding which specific factors portend adverse outcomes in this very vulnerable population; all these reasons make it extremely important to identify any predictors.”

In a retrospective study, researchers analyzed 298 patients with NAFLD and confirmed COVID-19 (mean age, 55 years; 51.7% men) to assess how certain predictors correlated with virus severity. Evaluated factors included baseline demographics, medication use, liver fibrosis score, NAFLD Fibrosis Score (NFS), aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 and Model for End-Stage Liver Disease-sodium (MELD-Na) score.

According to study data, peak AST, alanine aminotransferase (ALT) and total bilirubin levels correlated positively with ICU admission, intubation and death while albumin and platelet levels correlated negatively. Further, PPI use correlated with incidence of intubation and ICU admission and chronic angiotensin-converting enzyme inhibitor use with death. The COVID-19 related mortality rate in this cohort was 14%.

“Patients with NAFLD with elevated baseline liver fibrosis scores, elevated ALT, AST, total bilirubin and decreased albumin and platelets during COVID-19 are at a significantly elevated risk for adverse outcomes,” Sandhu concluded. “NFS, APRI and FIB-4 scores appeared superior to MELD-Na in predicting outcomes. We also found that chronic PPI and ACE-inhibitor use are associated with adverse outcomes and we suggest that they be used with caution.”