Journal Article

In-hospital mortality is associated with inflammatory response in NAFLD patients admitted for COVID-19

Crook, Peter, Nathwani, Rooshi, Dhar, Ameet, Lemoine, Maud, Mukherjee, Sujit K., Judge, Rebekah, Soubieres, Anet, Mullish, Benjamin H., Selvapatt, Nowlan, Forlano, Roberta, Harlow, Cristopher, Perez-Guzman, Pablo, Middleton, Paul, Daunt, Anna, Thursz, Mark R., Nayagam, Shevanthi, Manousou, Pinelopi

2020

Overview

Although metabolic risk factors are associated with more severe COVID-19, there is little evidence on outcomes in patients with non-alcoholic fatty liver disease (NAFLD). We here describe the clinical characteristics and outcomes of NAFLD patients in a cohort hospitalised for COVID-19. This study included all consecutive patients admitted for COVID-19 between February and April 2020 at Imperial College Healthcare NHS Trust, with either imaging of the liver available dated within one year from the admission or a known diagnosis of NAFLD. Clinical data and early weaning score (EWS) were recorded. NAFLD diagnosis was based on imaging or past medical history and patients were stratified for Fibrosis-4 (FIB-4) index. Clinical endpoints were admission to intensive care unit (ICU)and in-hospital mortality. 561 patients were admitted. Overall, 193 patients were included in the study. Fifty nine patients (30%) died, 9 (5%) were still in hospital, and 125 (65%) were discharged. The NAFLD cohort (n = 61) was significantly younger (60 vs 70.5 years, p = 0.046) at presentation compared to the non-NAFLD (n = 132). NAFLD diagnosis was not associated with adverse outcomes. However, the NAFLD group had higher C reactive protein (CRP) (107 vs 91.2 mg/L, p = 0.05) compared to non-NAFLD(n = 132). Among NAFLD patients, male gender (p = 0.01), ferritin (p = 0.003) and EWS (p = 0.047) were associated with in-hospital mortality, while the presence of intermediate/high risk FIB-4 or liver cirrhosis was not. The presence of NAFLD per se was not associated with worse outcomes in patients hospitalised for COVID-19. Though NAFLD patients were younger on admission, disease stage was not associated with clinical outcomes. Yet, mortality was associated with gender and a pronounced inflammatory response in the NAFLD group.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age Factors / Aged / Betacoronavirus / Biology and Life Sciences / C-reactive protein / Cirrhosis / Cohort Studies / Coronavirus Infections - complications / Coronavirus Infections - epidemiology / Coronavirus Infections - immunology / Coronavirus Infections - mortality / Coronaviruses / COVID-19 / Diabetes / Diagnosis / Fatty liver / Female / Ferritin / Fibrosis / Health risks / Hospital Mortality / Humans / Inflammation / Inflammatory response / Liver / Liver - pathology / Liver cirrhosis / Liver diseases / London - epidemiology / Male / Medical imaging / Medicine and Health Sciences / Middle Aged / Middle East respiratory syndrome / Mortality / Non-alcoholic Fatty Liver Disease - complications / Non-alcoholic Fatty Liver Disease - immunology / Non-alcoholic Fatty Liver Disease - mortality / Non-alcoholic Fatty Liver Disease - pathology / Pandemics / Patient outcomes / Patients / Pneumonia, Viral - complications / Pneumonia, Viral - epidemiology / Pneumonia, Viral - immunology / Pneumonia, Viral - mortality / Respiratory diseases / Retrospective Studies / Risk analysis / Risk factors / SARS-CoV-2 / Sex Factors / Weaning