Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2022; 28(37): 5444-5456
Published online Oct 7, 2022. doi: 10.3748/wjg.v28.i37.5444
Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19
Ricardo Ulises Macías-Rodríguez, Alberto Adrián Solís-Ortega, Victoria J Ornelas-Arroyo, Astrid Ruiz-Margáin, Maria Sarai González-Huezo, Nestor A Urdiales-Morán, Berenice M Román-Calleja, Juan M Mayorquín-Aguilar, José A González-Regueiro, Alejandro Campos-Murguía, Israel Vicente Toledo-Coronado, Mónica Chapa-Ibargüengoitia, Bernardo Valencia-Peña, Carlos Fernando Martínez-Cabrera, Nayelli C Flores-García
Ricardo Ulises Macías-Rodríguez, Alberto Adrián Solís-Ortega, Victoria J Ornelas-Arroyo, Astrid Ruiz-Margáin, Berenice M Román-Calleja, Juan M Mayorquín-Aguilar, José A González-Regueiro, Alejandro Campos-Murguía, Bernardo Valencia-Peña, Carlos Fernando Martínez-Cabrera, Nayelli C Flores-García, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Maria Sarai González-Huezo, Nestor A Urdiales-Morán, Department of Gastroenterology, Centro Médico ISSEMYM, Toluca 52140, Mexico
Israel Vicente Toledo-Coronado, Mónica Chapa-Ibargüengoitia, Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Author contributions: Macías-Rodríguez RU contributed to conception and design of the study; Macías-Rodríguez RU, Solís-Ortega AA and Ornelas-Arroyo VJ contributed with data extraction, literature review and writing; Macías-Rodríguez RU, Ruiz-Margáin A and Román-Calleja BM contributed with writing and analysis of data; Macías-Rodríguez RU, Solís-Ortega AA, Ornelas-Arroyo VJ, Ruiz-Margáin A, Román-Calleja BM, González-Huezo MS, Urdiales-Morán NA, Mayorquín-Aguilar JM, González-Regueiro JA, Campos-Murguía A, Toledo-Coronado IV, Chapa-Ibargüengoitia M, Valencia-Peña B, Martínez-Cabrera CF and Flores-García NC contributed to drafting, critical revision, supervision and editing of the content of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Institutional Review Board (approval No. 3777).
Informed consent statement: Due to the retrospective nature of the study, no informed consent was needed.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ricardo Ulises Macías-Rodríguez, MD, MSc, PhD, Assistant Professor, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Belisario Domínguez Sección XVI, Liver Fibrosis and Nutrition Lab, MICTLÁN Network: Mechanisms of Liver Injury, Cell Death and Translational Nutrition in Liver Diseases-Research Network, Mexico City 14080, Mexico. ricardomacro@yahoo.com.mx
Received: June 22, 2022
Peer-review started: June 22, 2022
First decision: August 1, 2022
Revised: August 16, 2022
Accepted: September 13, 2022
Article in press: September 13, 2022
Published online: October 7, 2022
Abstract
BACKGROUND

Metabolic associated fatty liver disease (MAFLD) is associated with complications and mortality in patients with coronavirus disease 2019 (COVID-19). However, there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with MAFLD, despite its high prevalence. Lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase have been used as markers of liver damage. Therefore, we propose an index based on lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with MAFLD and COVID-19.

AIM

To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases (aspartate aminotransferase/alanine aminotransferase) in patients with COVID-19 and MAFLD [liver fibrosis and nutrition (LNF)-COVID-19 index].

METHODS

In this retrospective cohort study, two cohorts from two different tertiary centers were included. The first was the derivation cohort to obtain the score cutoffs, and the second was the validation cohort. We included hospitalized patients with severe COVID-19 and MAFLD. Liver steatosis was evaluated by computed tomography scan. Area under the receiver operating characteristic (ROC) curve analysis and survival analysis were used.

RESULTS

In the derivation cohort, 44.6% had MAFLD; ROC curve analysis yielded a LFN-COVID-19 index > 1.67 as the best cutoff, with a sensitivity of 78%, specificity of 63%, negative predictive value of 91% and an area under the ROC curve of 0.77. In the multivariate analysis, the LFN-COVID-19 index > 1.67 was independently associated with the development of acute kidney injury (odds ratio: 1.8, 95% confidence interval: 1.3-2.5, P < 0.001), orotracheal intubation (odds ratio: 1.9, 95% confidence interval: 1.4-2.4, P < 0.001), and death (odds ratio: 2.86, 95% confidence interval: 1.6-4.5, P < 0.001) in both cohorts.

CONCLUSION

LFN-COVID-19 index has a good performance to predict prognosis in patients with MAFLD and COVID-19, which could be useful for the MAFLD population.

Keywords: COVID-19, Metabolic associated fatty liver disease, Lactate dehydrogenase, Transaminases, Prognosis, Nonalcoholic fatty liver disease

Core Tip: The liver fibrosis and nutrition-coronavirus disease 2019 (LFN-COVID-19) index that includes lactate dehydrogenase and transaminases is a new prognostic index for patients with metabolic associated fatty liver disease and COVID-19; it was developed to specifically predict adverse clinical outcomes, including mortality, in this population with both conditions. The variables included in this index allow an easy, quick and reliable risk assessment in this population with simple markers, allowing for broad implementation.