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
ARTICLE HIGHLIGHTS
Research background

This article was conceived considering the high prevalence of metabolic associated fatty liver disease (MAFLD) in the general population amid the coronavirus disease 2019 (COVID-19) pandemic and the risk of these patients in clinical settings with limited resources.

Research motivation

The growing evidence showing worse clinical outcomes in patients with metabolic diseases and COVID-19, including those with fatty liver disease, and the lack of a specific index to specifically stratify patients with both conditions motivated the creation of an index capable of discriminating those patients with an unfavorable outcome.

Research objectives

To evaluate the diagnostic yield of the liver fibrosis and nutrition (LNF)-COVID-19 index (includes lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase values), to predict adverse clinical outcomes, including mortality, in patients with both COVID-19 and MAFLD.

Research methods

Data from a derivation cohort, including patients admitted with a diagnosis of severe COVID-19 and meeting the MAFLD criteria identified the best LFN-COVID-19 index cutoff value for risk stratification. The results were evaluated using a validation cohort.

Research results

The LFN-COVID-19 index with a cutoff point > 1.67 was associated with higher mortality (P < 0.001) with an area under the curve of 0.77 (95% confidence interval: 0.709-0.823), sensitivity of 78.7% and specificity of 63.8%. It was independently associated with worse outcomes such as higher mortality, intubation rate and acute kidney injury in both cohorts.

Research conclusions

The LFN-COVID-19 index with a cutoff point > 1.67 showed good discrimination capability in patients with severe COVID-19 and MAFLD, identifying patients with an unfavorable prognosis associated with the need for mechanical ventilation, acute kidney injury and higher mortality.

Research perspectives

The use of this prognostic index will allow timely identification of patients with MAFLD and COVID-19 at higher risk of adverse clinical outcomes, leading to better therapeutic decision-making and resource allocation.