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Letters to the editor
Association of liver steatosis and fibrosis with clinical outcomes in patients with SARS-CoV-2 infection (COVID-19)
Xiaofei Li
Corresponding author
icqwc46@163.com

Corresponding author.
Department of Infectious Diseases, YiWu Central Hospital, Zhejiang 322000, China
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with great interest the research by Mendez et al&#46; &#91;<a class="elsevierStyleCrossRef" href="#bib0005">1</a>&#93; mainly evaluated the association of liver steatosis and fibrosis with clinical outcomes in patients with SARS-CoV-2 infection &#40;COVID-19&#41;&#46; The authors&#39; great efforts provide evidence for assessing the prognosis of COVID-19 patients&#44; but the following questions need to be considered&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">First&#44; it should be emphasized that advanced liver fibrosis was defined as APRI&#8239;&#62;&#8239;1&#46;0&#44; NAFLD FS&#8239;&#62;&#8239;0&#46;675 and&#47;or FIB-4&#8239;&#62;&#8239;3&#46;25 in Mendez&#8217;s study&#44; and the final result exhibited that steatosis and significant liver fibrosis was not associated with adverse outcomes&#46; In contrast&#44; a study based on COVID-19 patients defined advanced liver fibrosis as FIB-4&#8239;&#8805;&#8239;2&#46;67&#44; and the results presented that liver fibrosis was associated with poor prognosis in COVID-19 patients &#91;<a class="elsevierStyleCrossRef" href="#bib0010">2</a>&#93;&#46; The above description indicates that different definitions of liver fibrosis based on FIB-4 will lead to different outcomes&#44; and might be misunderstood by clinicians&#44; which will ultimately be detrimental to improving the prognosis of COVID-19 patients&#46; In my opinion&#44; it is extremely important to describe the theoretical basis of liver fibrosis grouping and provide evidence from previous studies&#44; which might help to reduce confounding bias&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Second&#44; the results of this study indicated that elevated glucose levels were associated with higher risk of ICU admission &#40;OR&#8239;&#61;&#8239;3&#46;58&#44; 1&#46;05 to 12&#46;2&#44; P&#8239;&#61;&#8239;0&#46;041&#41; &#40;Table 3&#41;&#46; However&#44; we are curious that this conclusion is for diabetes patients&#63; Or for non-diabetes patients&#63; Obviously&#44; 15&#46;5&#37; of the participants included in this study had type 2 diabetes&#46; Therefore&#44; it is necessary to conduct subgroup analysis &#91;<a class="elsevierStyleCrossRef" href="#bib0015">3</a>&#93; according to diabetes in order to explore the association between elevated glucose levels and ICU admission risk&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Third&#44; obesity is prevalent worldwide nowadays&#44; with an incidence rate of 40&#37; &#91;<a class="elsevierStyleCrossRef" href="#bib0020">4</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0025">5</a>&#44;<a class="elsevierStyleCrossRef" href="#bib0030">6</a>&#93;&#46; In addition&#44; obesity has been shown to be an independent risk factor for a range of diseases&#44; including COVID-19 patients &#91;<a class="elsevierStyleCrossRef" href="#bib0035">7</a>&#93;&#46; A meta-analysis of nine studies revealed that obesity was associated with the severity of COVID-19 and was associated with poor prognosis &#91;<a class="elsevierStyleCrossRef" href="#bib0040">8</a>&#93;&#46; However&#44; the results of Mendez&#8217;s study indicated that obesity is not associated with poor prognosis in COVID-19 patients&#44; which is contrary to previous results&#46; Additionally&#44; this conclusion is even easy to cause clinicians to pay less attention to obese patients&#46; In my opinion&#44; insufficient statistical power may explain why obesity is not associated with poor prognosis in COVID-19 patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Declaration of funding interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos