Infectious Disease

Predictors of Adverse Outcomes in Patients with NAFLD, COVID-19

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Sandhu S. et al. Abstract 8. Presented at: Digestive Disease Week; 21.-23. May 2021 (virtual meeting).

Disclosure:
Sandhu does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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According to a presentation at Digestive Disease Week, researchers found certain diagnoses associated with adverse outcomes in patients with non-alcoholic fatty liver disease during COVID-19.

“COVID-19 has consistently shown in several studies that it disproportionately affects people with diseases that are associated with the metabolic syndrome. Although some smaller studies conducted during the pandemic reported an increased incidence of severe COVID-19 infections in patients with NAFLD, not much is known beyond that. ” Sunny Sandhu, MD, Internal Medicine at the University of California’s San Francisco Center for Medical Education and Research, said. “In particular, we don’t have a lot of information on what specific factors are having a negative impact on this very vulnerable population. All of these reasons make it extremely important to identify predictors. “

In a retrospective study, researchers analyzed 298 patients with NAFLD and confirmed COVID-19 (mean age 55 years; 51.7% men) to see how certain predictors correlated with virus severity. Factors assessed included baseline demographic, drug use, liver fibrosis score, NAFLD fibrosis score (NFS), aspartate aminotransferase platelet ratio index (APRI), fibrosis-4, and the sodium disease model in the final stage (MELD-Na).

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

“Patients with NAFLD with elevated baseline liver fibrosis, elevated ALT, AST, total bilirubin, and decreased albumin and platelets during COVID-19 are at a significantly increased risk of adverse outcomes,” concluded Sandhu. “NFS, APRI, and FIB-4 scores appeared to be superior to MELD-Na in predicting outcomes. We have also found that the use of chronic PPIs and ACE inhibitors is associated with undesirable results and we recommend using them with caution. “

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