Yana Davidov-Derevynko1,2,3,4,5,6,7,8, Gil Ben Yakov1,2, Anat Wieder2,3, Gad Segal2,4, Lior Naveh4, Natalia Orlova4, Irina Gringauz5, Sharon Amit2,6, Orna Mor2,7, Robert Klempfner2,8, Galia Rahav2,3, Ziv Ben Ari1,2. 1. Liver Diseases Center, Sheba Medical Center. 2. Sackler Faculty of Medicine, Tel-Aviv University. 3. Infectious Diseases Unit, Sheba Medical Center. 4. Department of Internal Medicine, Sheba Medical Center. 5. Geriatrics Division, Sheba Medical Center. 6. Clinical Microbiology Laboratory, Sheba Medical Center. 7. Central Virology Laboratory, Ministry of Health, Sheba Medical Center. 8. The Leviev Heart Center, Sheba Medical Center, Tel Aviv, Israel.
Abstract
BACKGROUND: The ongoing outbreak of COVID-19 is associated with higher levels of morbidity and mortality among patients with comorbidities, including the metabolic syndrome. Liver impairment has been reported in up to 54% of hospitalized patients with COVID-19. The impact of COVID-19 on a preexisting chronic liver disease is an actively studied area of research. The contribution of our study is towards determining the predictors of severity and the outcome of liver injury among hospitalized patients with COVID-19 infection, including patients with a preexisting liver disease and COVID-19. METHODS: This single center retrospective cohort study included all patients ≥18 years, admitted in Sheba Medical Center with confirmed COVID-19 infection. Demographic, clinical and laboratory data were obtained using the MDClone platform and rechecked after data decryption using electronic health records. RESULTS: Of 382 patients with COVID-19, 66.4% had increased liver biochemistry. Mild increase was observed in 76.7%. The higher level of fibrosis-4 (FIB-4) at admission was independently associated with higher mortality rate. Preexisting liver disease was detected in 15.4% patients. Most common etiology was nonalcoholic fatty liver disease (78.7%). The mortality of hospitalized patients with preexisting liver disease was 16.7% compared to 6.8% in patients without preexisting liver disease (RR = 2.792, P = 0.01). In multivariate analysis, liver disease adjusted to age and BMI was associated with mortality with high statistical significance. CONCLUSIONS: Patients with preexisting chronic liver disease were at a higher risk of mortality. The FIB-4 level at admission was associated with worse prognosis. These findings should be reevaluated in a larger cohort of patients.
BACKGROUND: The ongoing outbreak of COVID-19 is associated with higher levels of morbidity and mortality among patients with comorbidities, including the metabolic syndrome. Liver impairment has been reported in up to 54% of hospitalized patients with COVID-19. The impact of COVID-19 on a preexisting chronic liver disease is an actively studied area of research. The contribution of our study is towards determining the predictors of severity and the outcome of liver injury among hospitalized patients with COVID-19 infection, including patients with a preexisting liver disease and COVID-19. METHODS: This single center retrospective cohort study included all patients ≥18 years, admitted in Sheba Medical Center with confirmed COVID-19 infection. Demographic, clinical and laboratory data were obtained using the MDClone platform and rechecked after data decryption using electronic health records. RESULTS: Of 382 patients with COVID-19, 66.4% had increased liver biochemistry. Mild increase was observed in 76.7%. The higher level of fibrosis-4 (FIB-4) at admission was independently associated with higher mortality rate. Preexisting liver disease was detected in 15.4% patients. Most common etiology was nonalcoholic fatty liver disease (78.7%). The mortality of hospitalized patients with preexisting liver disease was 16.7% compared to 6.8% in patients without preexisting liver disease (RR = 2.792, P = 0.01). In multivariate analysis, liver disease adjusted to age and BMI was associated with mortality with high statistical significance. CONCLUSIONS: Patients with preexisting chronic liver disease were at a higher risk of mortality. The FIB-4 level at admission was associated with worse prognosis. These findings should be reevaluated in a larger cohort of patients.
Authors: Aleksandra Radivojevic; Anas A Abu Jad; Anvesh Ravanavena; Chetna Ravindra; Emmanuelar O Igweonu-Nwakile; Safina Ali; Salomi Paul; Shreyas Yakkali; Sneha Teresa Selvin; Sonu Thomas; Viktoriya Bikeyeva; Ahmed Abdullah; Prachi Balani Journal: Cureus Date: 2022-07-14