Metabolic and liver alterations impact on the severity of SARS-COV2 disease

ABSTRACT

Background: SARS-COV2 is a threatful viral disease which can evolve into respiratory failure but identification of risk factors for progression towards severe forms is still ongoing During infection impairment of liver function tests has been frequently reported and evidence of the negative impact of metabolic alterations on the clinical course are emerging, mainly evaluated in Asiatic populations Aim: to define the prognostic role of metabolic disease and liver damage on SARS-COV2 severity in a cohort of Italian patients Methods: All patients with confirmed COVID-19 infection admitted to low-intensity care COVID Units between March and April 2020 were enrolled Severe SARS-COV2 infection was defined according to International consensus requiring intensive respiratory support (CPAP/orotracheal intubation) All data were collected at admission Results: 382 patients were enrolled, mean age was 65±17 ys and 60% were male Mean BMI was 27±5 kg/m2 (61% overweight and 25% obese), prevalence of T2DM 17%, hypertension 44%, dyslipidemia 29% At admission 39% and 40% of patients had increased ALT and GGT levels, respectively Median hospitalization stay was 14 days (IQR 8-24), with 30% of patients experiencing severe SARS-COV2 infection and mortality in 14% of overall cases Subjects with severe infection presented higher prevalence of male sex (68% vs 56%, p=0 03), T2DM (25% vs 14%, p=0 01), dyslipidemia (36% vs 26%, p=0 05) and increased ALT (53% vs 32%, p<0 001) and GGT (53% vs 34%, p=0 01) levels at admission In multivariate analysis (adjusted for age, sex, T2DM, dyslipidemia, increased ALT and GGT at admission and SARS-COV2 therapy), T2DM (OR 3 1, 95%CI 1 6-6 0;p=0 001), dyslipidemia (OR 1 9, 95%CI 1 1-3 3;p=0 03), and increased ALT (OR 4 7, 95%CI 2 5- 9 0;p<0 001) and GGT (OR 2 0, 95%CI 1 2-3-3;p=0 009), resulted associated with high risk of more severe SARSCOV2 disease Interestingly, in patients with both T2DM and dyslipidemia, this risk was further increased (OR 5 2, 95%CI 2 1-12 6;p<0 001) Conclusion: We confirm that liver involvement is common during SARS-COV2 infection and it is a negative prognostic factor although it is not clear whether it precedes or follows, the severity of clinical course In addition, the risk of severe form of respiratory distress is increased by metabolic alterations, and the more numerous the alterations, the higher the risk.