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Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity
Despite vaccination programs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains a public health problem. Identifying key prognostic determinants of severity of the disease may help better focus health resources. The negative prognostic role for metabolic and hepatic alte...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9244481/ https://www.ncbi.nlm.nih.gov/pubmed/35754075 http://dx.doi.org/10.1007/s11739-022-03000-1 |
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author | Lombardi, Rosa Mura, Vincenzo La Cespiati, Annalisa Iuculano, Federica Sigon, Giordano Pallini, Giada Proietti, Marco Motta, Irene Montinaro, Beatrice Fiorelli, Elisa Cesari, Matteo Bandera, Alessandra Valenti, Luca Peyvandi, Flora Montano, Nicola Baldini, Marina Fracanzani, Anna Ludovica |
author_facet | Lombardi, Rosa Mura, Vincenzo La Cespiati, Annalisa Iuculano, Federica Sigon, Giordano Pallini, Giada Proietti, Marco Motta, Irene Montinaro, Beatrice Fiorelli, Elisa Cesari, Matteo Bandera, Alessandra Valenti, Luca Peyvandi, Flora Montano, Nicola Baldini, Marina Fracanzani, Anna Ludovica |
author_sort | Lombardi, Rosa |
collection | PubMed |
description | Despite vaccination programs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains a public health problem. Identifying key prognostic determinants of severity of the disease may help better focus health resources. The negative prognostic role for metabolic and hepatic alterations is established; however, the interplay among different metabolic comorbidities and their interconnections with the liver have never been explored. The objective of this study is to evaluate the impact of liver alterations in addition to metabolic comorbidities as a predictor of SARS-CoV-2 severity. 382 SARS-CoV-2 patients were enrolled. Severe SARS-CoV-2 was diagnosed according to international consensus. Transaminases > 2 times the upper limit of normality (2ULN), hepatic steatosis (by ultrasound and/or computed tomography in 133 patients), and FIB-4 defined liver alterations. All data were collected on admission. The results are severe SARS-CoV-2 infection in 156 (41%) patients (mean age 65 ± 17; 60%males). Prevalence of obesity was 25%; diabetes, 17%; hypertension, 44%; dyslipidaemia, 29%; with 13% of the cohort with ≥ 3 metabolic alterations. Seventy patients (18%) had transaminases > 2ULN, 82 (62%) steatosis; 199 (54%) had FIB-4 < 1.45 and 45 (12%) > 3.25. At multivariable analysis, ≥ 3 metabolic comorbidities (OR 4.1, CI 95% 1.8–9.1) and transaminases > 2ULN (OR 2.6, CI 95% 1.3–6.7) were independently associated with severe SARS-CoV-2. FIB-4 < 1.45 was a protective factor (OR 0.42, CI 95% 0.23–0.76). Hepatic steatosis had no impact on disease course. The presence of metabolic alterations is associated with severe SARS-CoV-2 infection, and the higher the number of coexisting comorbidities, the higher the risk of severe disease. Normal FIB-4 values are inversely associated with advanced SARS-CoV-2 regardless of metabolic comorbidities, speculating on use of these values to stratify the risk of severe infection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-022-03000-1. |
format | Online Article Text |
id | pubmed-9244481 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-92444812022-06-30 Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity Lombardi, Rosa Mura, Vincenzo La Cespiati, Annalisa Iuculano, Federica Sigon, Giordano Pallini, Giada Proietti, Marco Motta, Irene Montinaro, Beatrice Fiorelli, Elisa Cesari, Matteo Bandera, Alessandra Valenti, Luca Peyvandi, Flora Montano, Nicola Baldini, Marina Fracanzani, Anna Ludovica Intern Emerg Med Im - Original Despite vaccination programs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains a public health problem. Identifying key prognostic determinants of severity of the disease may help better focus health resources. The negative prognostic role for metabolic and hepatic alterations is established; however, the interplay among different metabolic comorbidities and their interconnections with the liver have never been explored. The objective of this study is to evaluate the impact of liver alterations in addition to metabolic comorbidities as a predictor of SARS-CoV-2 severity. 382 SARS-CoV-2 patients were enrolled. Severe SARS-CoV-2 was diagnosed according to international consensus. Transaminases > 2 times the upper limit of normality (2ULN), hepatic steatosis (by ultrasound and/or computed tomography in 133 patients), and FIB-4 defined liver alterations. All data were collected on admission. The results are severe SARS-CoV-2 infection in 156 (41%) patients (mean age 65 ± 17; 60%males). Prevalence of obesity was 25%; diabetes, 17%; hypertension, 44%; dyslipidaemia, 29%; with 13% of the cohort with ≥ 3 metabolic alterations. Seventy patients (18%) had transaminases > 2ULN, 82 (62%) steatosis; 199 (54%) had FIB-4 < 1.45 and 45 (12%) > 3.25. At multivariable analysis, ≥ 3 metabolic comorbidities (OR 4.1, CI 95% 1.8–9.1) and transaminases > 2ULN (OR 2.6, CI 95% 1.3–6.7) were independently associated with severe SARS-CoV-2. FIB-4 < 1.45 was a protective factor (OR 0.42, CI 95% 0.23–0.76). Hepatic steatosis had no impact on disease course. The presence of metabolic alterations is associated with severe SARS-CoV-2 infection, and the higher the number of coexisting comorbidities, the higher the risk of severe disease. Normal FIB-4 values are inversely associated with advanced SARS-CoV-2 regardless of metabolic comorbidities, speculating on use of these values to stratify the risk of severe infection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-022-03000-1. Springer International Publishing 2022-06-26 2022 /pmc/articles/PMC9244481/ /pubmed/35754075 http://dx.doi.org/10.1007/s11739-022-03000-1 Text en © The Author(s) 2022, corrected publication 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Im - Original Lombardi, Rosa Mura, Vincenzo La Cespiati, Annalisa Iuculano, Federica Sigon, Giordano Pallini, Giada Proietti, Marco Motta, Irene Montinaro, Beatrice Fiorelli, Elisa Cesari, Matteo Bandera, Alessandra Valenti, Luca Peyvandi, Flora Montano, Nicola Baldini, Marina Fracanzani, Anna Ludovica Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity |
title | Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity |
title_full | Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity |
title_fullStr | Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity |
title_full_unstemmed | Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity |
title_short | Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity |
title_sort | usefulness of fibrosis-4 (fib-4) score and metabolic alterations in the prediction of sars-cov-2 severity |
topic | Im - Original |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9244481/ https://www.ncbi.nlm.nih.gov/pubmed/35754075 http://dx.doi.org/10.1007/s11739-022-03000-1 |
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