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Review
. 2022 Mar 29:2022:7235860.
doi: 10.1155/2022/7235860. eCollection 2022.

Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis

Menglu Liu  1 , Kaibo Mei  2 , Ziqi Tan  3 , Shan Huang  4 , Fuwei Liu  5 , Chao Deng  6 , Jianyong Ma  7 , Peng Yu  3   8 , Xiao Liu  8
Affiliations
Review

Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis

Menglu Liu et al. Can J Gastroenterol Hepatol. .

Abstract

Methods: We identified relevant cohort studies that assessed the relationship between liver fibrosis scores (e.g., FIB-4, NAFLD fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI)) and associated prognosis outcomes by searching the PubMed, EMBASE, and medRxiv databases. The potential dose-response effect was performed using a stage robust error meta-regression.

Results: Sixteen studies with 8,736 hospitalized patients with COVID-19 were included. One-point score in FIB-4 increase was significantly associated with increased mechanical ventilation (RR: 2.23, 95% CI: 1.37-3.65, P=0.001), severe COVID-19 (RR: 1.82, 95% CI: 1.53-2.16, P < 0.001), and death (RR: 1.47, 95% CI: 1.31-1.65, P < 0.001), rather than hospitalization (RR: 1.35, 95% CI: 0.72-2.56, P=0.35). Furthermore, there is a significant positive linear relationship between FIB-4 and severe COVID-19 (P nonlinearity=0.12) and mortality (P nonlinearity=0.18). Regarding other liver scores, one unit elevation in APRI increased the risk of death by 178% (RR: 2.78, 95% CI: 1.10-6.99, P=0.03). Higher NFS (≥-1.5) and Forns index were associated with increased risk of severe COVID-19 and COVID-19-associated death.

Conclusion: Our dose-response meta-analysis suggests high liver fibrosis scores are associated with worse prognosis in patients with COVID-19. For patients with COVID-19 at admission, especially for those with coexisting chronic liver diseases, assessment of liver fibrosis scores might be useful for identifying high risk of developing severe COVID-19 cases and worse outcomes.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of this meta-analysis.
Figure 2
Figure 2
Association between FIB-4 and clinical outcomes in patients with COVID-19. FIB-4 was analyzed for continuous analysis (per one-point increase). (a) Hospitalization. (b) MV. (c) Severe COVID-19. (d) Death. Abbreviation: MV, mechanical ventilation.
Figure 3
Figure 3
Nonlinear exposure-effect analysis between liver fibrosis scores and clinical outcomes in patients with COVID-19. (a) Hospitalization. (b) MV. (c) Severe COVID-19. (d) Death. The solid and dashed lines represent the estimated odd risk and the 95% confidence interval, respectively. Abbreviation: MV, mechanical ventilation.
See this image and copyright information in PMC

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