Résumé
Introduction and aims. Patients with coronavirus disease-2019 (COVID-19) and metabolic-dysfunction associated fatty liver disease (MAFLD) appear to be at higher risk for severe manifestations like acute respiratory distress syndrome, especially in the youngest decades. Our aim was to examine whether patients with imaging-defined MAFLD and/or with increased non-invasive liver fibrosis scores (FIB-4) are at higher risk for severe illness from COVID-19, using a machine learning model. Methods. In this retrospective cohort study, we included 672 patients admitted for SARS-CoV-2 pneumonia between February the 28th 2020 and May the 1st 2021. Hepatic steatosis was detected by ultrasound or computed tomography (CT), whereas FIB-4 score was used to define the risk of advanced liver fibrosis. We used a machine learning (ML) model to evaluate the risks of both in-hospital death and prolonged hospitalizations (>28 days), considering MAFLD, a set of blood tests (hepatic profile;HP), and the FIB-4 score, either separately and together. Results. Three hundred-thirty-three (49.6% of total) had imaging-defined MAFLD. The accuracy in predicting in-hospital death in the whole sample was 0.709 for the HP alone, and 0.721 for HP+FIB-4 combined together;in the 55-to-75 age subgroup, the accuracies were respectively 0.842 and 0.855 for HP alone and HP+FIB-4 together. In the MAFLD subgroup, the accuracy in predicting death was 0.739 considering HP alone, and 0.772 when considering HP+FIB-4 together;whereas in the MAFLD 55-to-75 years cohort, the accuracies were respectively 0.825 for HP and 0.833 for HP+FIB-4. Similar results were obtained both in the entire cohort and in MAFLD patients when considering the accuracy in predicting prolonged hospitalization (>28 days). Conclusions. In our cohort of COVID-19 patients, the presence of a worse HP and a higher FIB-4 correlated with a higher risk of death and prolonged hospitalization, regardless of the presence of MAFLD. These findings could improve the clinical risk stratification of patients diagnosed with SARS-CoV-2 pneumonia.
Résumé
PURPOSE: Objective of this study was to assess the association between testosterone (T) levels and biochemical markers in a cohort of female patients admitted for SARS-CoV-2 infection in a respiratory intensive care unit (RICU). METHODS: A consecutive series of 17 women affected by SARSCoV-2 pneumonia and recovered in the RICU of the Hospital of Mantua were analyzed. Biochemical inflammatory markers as well as total testosterone (TT), calculated free T (cFT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were determined. RESULTS: TT and cFT were significantly and positively associated with PCT, CRP, and fibrinogen as well as with a worse hospital course. We did not observe any significant association between TT and cFT with LH; conversely, both TT and cFT showed a positive correlation with cortisol. By LOWESS analysis, a linear relationship could be assumed for CRP and fibrinogen, while a threshold effect was apparent in the relationship between TT and procalcitonin, LDH and ferritin. When the TT threshold value of 1 nmol/L was used, significant associations between TT and PCT, LDH or ferritin were observed for values above this value. For LDH and ferritin, this was confirmed also in an age-adjusted model. Similar results were found for the association of cFT with the inflammatory markers with a threshold effect towards LDH and ferritin with increased LDH and ferritin levels for values above cFT 5 pmol/L. Cortisol is associated with serum inflammatory markers with similar trends observed for TT; conversely, the relationship between LH and inflammatory markers had different trends. CONCLUSION: Opposite to men, in women with SARS-CoV-2 pneumonia, higher TT and cFT are associated with a stronger inflammatory status, probably related to adrenal cortex hyperactivity.