Comparison of liver fibrosis scores and fatty liver on computed tomography as risk factors for severity of COVID‐19

Abstract Background and Aim Increased liver fibrosis scores (LFS), such as fibrosis‐4 index (FIB‐4) or non‐alcoholic fatty liver disease fibrosis score (NFS), and fatty liver are known risk factors for severe coronavirus disease 2019 (COVID‐19). The purpose of this study was to identify the best scores, which predict the prognosis of COVID‐19. Methods Participants comprised consecutive Japanese COVID‐19 patients admitted to our hospital between February 14, 2020, and April 14, 2021. Multivariate logistic regression analysis was performed to evaluate the relationships between LFS (FIB‐4, NFS, aspartate aminotransferase‐to‐platelet ratio index [APRI], BARD score, and hepatic steatosis index [HSI]) or fatty liver on computed tomography (CT), and severity of COVID‐19. Results Of the 415 patients (mean age, 59 years), 177 patients (42.7%) needed oxygen therapy, 90 patients (21.7%) worsened to severe COVID‐19, and 45 patients (10.8%) died during admission. Multivariate logistic regression analysis showed that increased FIB‐4 and NFS were risk factors for death, severe COVID‐19, and oxygen demand; that increased BARD was a risk factor for severe COVID‐19 and oxygen demand; and that increased APRI and HSI were not risk factors for any status of COVID‐19. Furthermore, increased NFS or BARD and fatty liver were independent risk factors for severe COVID‐19 and oxygen demand. Conclusions This study showed that FIB‐4 and NFS were the best liver fibrosis scores that predicted worse prognosis for COVID‐19, and that increased NFS or BARD and fatty liver evident on CT represented independent risk factors for severe COVID‐19 and oxygen demand.