Fibrosis-4 index as a predictor for mortality in hospitalised patients with COVID-19: a retrospective multicentre cohort study

Park, Jung Gil; Kang, Min Kyu; Lee, Yu Rim; Song, JooSeok; Kim, Na Young; Kweon, Young Oh; Tak, Won Young; Jang, Se Young; Lee, Changhyeong; Kim, Byung Seok; Jang, Byoung Kuk; Bae, Jinmok; Lee, Ji Yeon; Suh, Jeong Ill; Park, Soo Young; Chung, Woo Jin

doi:10.1136/bmjopen-2020-041989

Cited by 29 publications

(46 citation statements)

References 33 publications

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“…As we commented above, worse outcomes have been reported in patients with underlying liver disease and cirrhosis, it is easily speculated the subjects having higher FIB-4 are vulnerable to SARS-CoV-2 infection. Consistently to our results, Park et al [ 16 ] demonstrated that the survival rate was significantly lower in high FIB-4 group compare to the low FIB-4 group. These findings supported the predictive role of FIB-4 as we shown in our study, and would be useful to effective delivery of healthcare resources in COVID-19 pandemic era.…”

Section: Discussionsupporting

confidence: 93%

“…Several pieces of evidence suggest the prognostic value of the FIB-4 index in COVID-19 cases [ 12 , 16 , 24 , 25 ]. Liver injury in COVID-19 cases has been observed more frequently in severe cases [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, FIB-4 was independently associated with risks of all-cause mortality in atrial fibrillation patients [ 13 , 14 ], and even in the general population [ 15 ]. Recently, there have been reports that FIB-4 may be a predictor of prognosis in COVID-19 patients [ 16 ] regardless of the presence of NAFLD/non-alcoholic steatohepatitis (NASH), but the results were not conclusive [ 17 , 18 ]. This prompted us to determine whether the FIB-4 index affects the severity of or mortality from COVID-19 in patients with and without DM.…”

Section: Introductionmentioning

confidence: 99%

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High Fibrosis-4 Index Is Related with Worse Clinical Outcome in Patients with Coronavirus Disease 2019 and Diabetes Mellitus: A Multicenter Observational Study

et al. 2021

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Background: Based on recent evidence on the importance of the presence of diabetes mellitus (DM) and fibrosis-4 (FIB-4) index in coronavirus disease 2019 (COVID-19) mortality, we analyzed whether these factors could additively predict such mortality.Methods: This multicenter observational study included 1,019 adult inpatients admitted to university hospitals in Daegu. The demographic and laboratory findings, mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM and/or a high FIB-4 index. The mortality risk and corresponding hazard ratio (HR) were analyzed using the Kaplan-Meier method and Cox proportional hazard models.Results: The patients with DM (n=217) exhibited significantly higher FIB-4 index and mortality compared to those without DM. Although DM (HR, 2.66; 95% confidence interval [CI], 1.63 to 4.33) and a high FIB-4 index (HR, 4.20; 95% CI, 2.21 to 7.99) were separately identified as risk factors for COVID-19 mortality, the patients with both DM and high FIB-4 index had a significantly higher mortality (HR, 9.54; 95% CI, 4.11 to 22.15). Higher FIB-4 indices were associated with higher mortality regardless of DM. A high FIB-4 index with DM was more significantly associated with a severe clinical course with mortality (odds ratio, 11.24; 95% CI, 5.90 to 21.41) than a low FIB-4 index without DM, followed by a high FIB-4 index alone and DM alone. The duration of quarantine and hospital stay also tended to be longer in those with both DM and high FIB-4 index.Conclusion: Both DM and high FIB-4 index are independent and additive risk factors for COVID-19 mortality.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High Fibrosis-4 Index Is Related with Worse Clinical Outcome in Patients with Coronavirus Disease 2019 and Diabetes Mellitus: A Multicenter Observational Study

et al. 2021

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“…Furthermore, elevation of this FIB-4 (equal or higher than 2.67) was associated with poor clinical outcomes in middle-aged patients with COVID-19, including required mechanical ventilation and ICU admission [ 22 ]. Moreover, FIB-4 was also related with increased risk of mortality in hospitalized patients with COVID-19 as well as with lower survival [ 23 , 24 ]. In addition, FIB-4 positively correlated to SARS-CoV-2 viral load and the levels of inflammatory cytokines [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients

Ramos-López

San-Cristóbal

Martínez-Urbistondo

et al. 2021

JCM

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Objective: to screen putative associations between liver markers and proinflammatory-related features concerning infectious morbidity and fatal outcomes in COVID-19 patients. Methods: a total of 2094 COVID-19 positive patients from the COVID-DATA-SAFE-LIFES cohort (HM hospitals consortium) were classified according to median values of hepatic, inflammatory, and clinical indicators. Logistic regression models were fitted and ROC cures were generated to explain disease severity and mortality. Results: intensive care unit (ICU) assistance plus death outcomes were associated with liver dysfunction, hyperinflammation, respiratory insufficiency, and higher associated comorbidities. Four models including age, sex, neutrophils, D-dimer, oxygen saturation lower than 92%, C-reactive protein (CRP), Charlson Comorbidity Index (CCI), FIB-4 and interactions with CRP, neutrophils, and CCI explained ICU plus death variance in more than 28%. The predictive values of ROC curves were: FIB-4 (0.7339), AST/ALT ratio (0.7107), CRP (0.7003), CCI index (0.6778), neutrophils (0.6772), and platelets (0.5618) concerning ICU plus death outcomes. Conclusions: the results of this research revealed that liver and proinflammatory features are important determinants of COVID-19 morbidity and fatal outcomes, which could improve the current understanding of the COVID-19 physiopathology as well as to facilitate the clinical management and therapy decision-making of this disease under a personalized medicine scope.

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“…Although initially used as a marker of liver fibrosis, FIB-4 index has been repurposed for prognostication in patients with COVID-19, with or without liver disease [ 7 , 9 – 11 ]. Age, liver injury, and thrombocytopenia have been shown to increase mortality in COVID-19 [ 1 , 5 , 6 , 12 ].…”

Section: Resultsmentioning

confidence: 99%

Repurposing FIB-4 index as a predictor of mortality in patients with hematological malignancies and COVID-19

et al. 2021

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Background In this study, we aimed to investigate whether FIB-4 index is useful in predicting mortality in patients with concurrent hematological malignancies and COVID-19. We also aimed to determine the optimal cut-off point for the prediction. Methods This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia. Consecutive sampling of adults with hematological malignancies and COVID-19 was performed between May 2020 and January 2021. COVID-19 screening test using the reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal samples were performed prior to hospitalization for chemotherapy. FIB-4 index is derived from [age (years) × AST (IU/L)]/[platelet count (109/L) × √ALT (U/L)]. The primary outcome of this study is mortality, defined as clinically validated death/non-survivor during a 3-months (90 days) follow-up. Results There were a total of 70 patients with hematological malignancies and COVID-19 in this study. Median FIB-4 Index was higher in non-survivors (13.1 vs 1.02, p<0.001). FIB-4 index above 3.85 has a sensitivity of 79%, specificity of 84%, PLR of 5.27, and NLR of 0.32. The AUC was 0.849 95% CI 0.735–0.962, p<0.001. This cut-off point was associated with OR of 16.70 95% CI 4.07–66.67, p<0.001. In this study, a FIB-4 >3.85 confers to 80% posterior probability of mortality and FIB-4 <3.85 to 19% probability. FIB-4 >3.85 was associated with shorter time-to-mortality (HR 9.10 95% CI 2.99–27.65, p<0.001). Multivariate analysis indicated that FIB-4 >3.85 (HR 4.09 95% CI 1.32–12.70, p = 0.015) and CRP> 71.57 mg/L (HR 3.36 95% CI 1.08–10.50, p = 0.037) were independently associated with shorter time-to-mortality. Conclusion This study indicates that a FIB-4 index >3.85 was independent predictor of mortality in patients with hematological malignancies and COVID-19 infection.

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Fibrosis-4 index as a predictor for mortality in hospitalised patients with COVID-19: a retrospective multicentre cohort study

Cited by 29 publications

References 33 publications

High Fibrosis-4 Index Is Related with Worse Clinical Outcome in Patients with Coronavirus Disease 2019 and Diabetes Mellitus: A Multicenter Observational Study

High Fibrosis-4 Index Is Related with Worse Clinical Outcome in Patients with Coronavirus Disease 2019 and Diabetes Mellitus: A Multicenter Observational Study

Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients

Repurposing FIB-4 index as a predictor of mortality in patients with hematological malignancies and COVID-19

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