Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

Abstract

Liver damage worsens the prognosis of coronavirus 19 disease (COVID-19). However, the best strategy to stratify mortality risk according to liver damage has not been established. The aim of this study is to test the predictive value of the validated Fibrosis-4 (FIB-4) Index and compared it to liver transaminases and to the AST-to-Platelet ratio index (APRI). Multicenter cohort study including 992 consecutive COVID-19 patients admitted to the Emergency Department. FIB-4 > 3.25 and APRI > 0.7 were used to define liver damage. Multivariable Cox regression and ROC curve analysis for mortality were performed. Secondary endpoints were (1) need for high-flow oxygen and (2) mechanical ventilation. 240 (24.2%) patients had a FIB-4 > 3.25. FIB-4 > 3.25 associated with an increased mortality (n = 119, log-rank test p < 0.001 and adjusted hazard ratio (HR) 1.72 (95% confidence interval [95%CI] 1.14–2.59, p = 0.010). ROC analysis for mortality showed that FIB-4 (AUC 0.734, 95% CI 0.705–0.761) had a higher predictive value than AST (p = 0.0018) and ALT (p < 0.0001). FIB-4 > 3.25 was also superior to APRI > 0.7 (AUC 0.58, 95% CI 0.553–0.615, p = 0.0008). Using an optimized cut-off > 2.76 (AUC 0.689, 95% CI 0.659–0.718, p < 0.0001), FIB-4 was superior to FIB-4 > 3.25 (p = 0.0302), APRI > 0.7 (p < 0.0001), AST > 51 (p = 0.0119) and ALT > 42 (p < 0.0001). FIB-4 was also associated with high-flow oxygen use (n = 255, HR 1.69, 95% CI 1.25–2.28, p = 0.001) and mechanical ventilation (n = 39, HR 2.07, 95% CI 1.03–4.19, p = 0.043). FIB-4 score predicts mortality better than liver transaminases and APRI score. FIB-4 score may be an easy tool to identify COVID-19 patients at worse prognosis in the emergency department.

Obesity-Associated Hepatic Steatosis, Somatotropic Axis Impairment, and Ferritin Levels Are Strong Predictors of COVID-19 Severity

“…Furthermore, our work confirms that ferritin levels and liver damage (in the form of hepatic steatosis) worsens the prognosis of COVID-19, as already shown by Bucci and colleagues [ 55 ] and by our group [ 3 , 4 ]. A further step was to develop a model that could predict the risk of lung impairment and the need for oxygen therapy in COVID-19 patients by integrating clinical characteristics and laboratory parameters for each patient.…”

Obesity-Associated Hepatic Steatosis, Somatotropic Axis Impairment and Ferritin Levels are Strong Predictors of COVID-19 Severity

“…Furthermore, our confirms that ferritin levels and liver damage (in the form of hepatic steatosis) worsens the prognosis of COVID-19, as already shown by Bucci and colleagues [54] and by our group [3,4]. A further step was to develop a model that could predict the risk of lung impairment and the need for oxygen therapy in COVID-19 patients by integrating clinical characteristics and laboratory parameters for each patient.…”

Fibrosis‑4 (FIB‑4) index and mortality in COVID‑19 patients admitted to the emergency department: a new interesting predictive index for patients with COVID-19 disease?

“…Second, age is a very important factor, because it is in the numerator of the FIB-4 formula and the authors reported a statistically significant difference (p < 0.001) in the age in the group of patients with a FIB-4 > 3.25 for the group with a FIB-4 < 3.25 with a mean age of 76 (70-81) and 57 (51-64), respectively [1].…”

“…We read with great interest the article by Bucci et al, which investigated the Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department [1].…”