Usefulness of fibrosis-4 (FIB-4) score and metabolic alterations in the prediction of SARS-CoV-2 severity

Abstract

Despite vaccination programs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains a public health problem. Identifying key prognostic determinants of severity of the disease may help better focus health resources. The negative prognostic role for metabolic and hepatic alterations is established; however, the interplay among different metabolic comorbidities and their interconnections with the liver have never been explored.The objective of this study is to evaluate the impact of liver alterations in addition to metabolic comorbidities as a predictor of SARS-CoV-2 severity. 382 SARS-CoV-2 patients were enrolled. Severe SARS-CoV-2 was diagnosed according to international consensus. Transaminases > 2 times the upper limit of normality (2ULN), hepatic steatosis (by ultrasound and/or computed tomography in 133 patients), and FIB-4 defined liver alterations. All data were collected on admission. The results are severe SARS-CoV-2 infection in 156 (41%) patients (mean age 65 ± 17; 60%males). Prevalence of obesity was 25%; diabetes, 17%; hypertension, 44%; dyslipidaemia, 29%; with 13% of the cohort with ≥ 3 metabolic alterations. Seventy patients (18%) had transaminases > 2ULN, 82 (62%) steatosis; 199 (54%) had FIB-4 < 1.45 and 45 (12%) > 3.25. At multivariable analysis, ≥ 3 metabolic comorbidities (OR 4.1, CI 95% 1.8–9.1) and transaminases > 2ULN (OR 2.6, CI 95% 1.3–6.7) were independently associated with severe SARS-CoV-2. FIB-4 < 1.45 was a protective factor (OR 0.42, CI 95% 0.23–0.76). Hepatic steatosis had no impact on disease course. The presence of metabolic alterations is associated with severe SARS-CoV-2 infection, and the higher the number of coexisting comorbidities, the higher the risk of severe disease. Normal FIB-4 values are inversely associated with advanced SARS-CoV-2 regardless of metabolic comorbidities, speculating on use of these values to stratify the risk of severe infection.

The FIB-4 scores in the emergency department to predict the outcomes of COVID-19 patients in taiwan

“…We found that the liver fibrosis index, as measured using the FIB-4 index, was significantly associated with the risk of poor prognosis, including ICU admission, mechanical ventilation, and mortality, in COVID-19 patients without underlying liver diseases. Our results are consistent with those of previous studies that demonstrated the predictive value of liver function tests, such as ALT and AST levels, for COVID-19 infection [ [11] , [12] , [13] , [14] ]. The liver is a target organ of the SARS-CoV-2 virus and is often affected by the inflammatory response to the infection.…”

COVID-19 and MAFLD/NAFLD: An updated review

“…Intermediate and high FIB-4 scores had a combined 3-fold increase in severe COVID-19 risk (adjusted OR = 2.95, p < 0.005). Similarly, in a study in Italy (45), the FIB-4 score < 1.45 was associated with lower disease severity (adjusted OR = 0.3, p = 0.01) and mortality (adjusted OR = 0.4, p = 0.04). Contrary to the previous results, do Amaral e Castro and colleagues (46) did not find an association between HS and worse COVID-19 outcomes, although HS was more common among patients with worse outcomes.…”

Fib-4 score is able to predict intra-hospital mortality in 4 different SARS-COV2 waves

“…Park et al [ 7 ] found a cut-off of 4.95 to be a good predictor of mortality. Lombardi et al [ 30 ] recently confirmed the prognostic role of FIB-4 in 382 patients. They showed that a FIB4 < 1.45 is a protective factor against severe SARS-CoV-2 infection and that in patients with at least one metabolic comorbidity, FIB-4 > 1.45 is associated with poorer outcomes.…”