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Observational Study
. 2020 Aug 4;222(5):726-733.
doi: 10.1093/infdis/jiaa355.

Elevation of Liver Fibrosis Index FIB-4 Is Associated With Poor Clinical Outcomes in Patients With COVID-19

Luis Ibáñez-Samaniego  1   2 , Federico Bighelli  1 , Clara Usón  1 , Celia Caravaca  1 , Carlos Fernández Carrillo  2   3 , Miriam Romero  2   4 , Mónica Barreales  5 , Christie Perelló  2   3 , Antonio Madejón  2   3 , Aránzazu Caballero Marcos  1 , Agustín Albillos  2   6   7 , Inmaculada Fernández  5 , Javier García-Samaniego  2   4 , José Luis Calleja  2   3   8 , Rafael Bañares  1   2   9
Affiliations
Observational Study

Elevation of Liver Fibrosis Index FIB-4 Is Associated With Poor Clinical Outcomes in Patients With COVID-19

Luis Ibáñez-Samaniego et al. J Infect Dis. .

Abstract

Background: COVID-19 is a potentially severe disease caused by the recently described SARS-CoV-2. Whether liver fibrosis might be a relevant player in the natural history of COVID-19 is currently unknown. We aimed to evaluate the association between FIB-4 and the risk of progression to critical illness in middle-aged patients with COVID-19.

Methods: In this multicenter, retrospective study with prospective follow-up of 160 patients aged 35-65 years with COVID-19, FIB-4, clinical, and biochemical variables were collected at baseline. FIB-4 ≥2.67 defined patients with risk for advanced liver fibrosis.

Results: Risk for advanced fibrosis was estimated in 28.1% of patients. Patients with FIB-4 ≥2.67 more frequently required mechanical ventilation (37.8% vs 18.3%; P = .009). In multivariate analysis, FIB-4 ≥2.67 (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.30-8.92), cardiovascular risk factors (OR, 5.05; 95% CI, 1.90-13.39), previous respiratory diseases (OR, 4.54; 95% CI, 1.36-15.10), and C-reactive protein (OR, 1.01; 95% CI, 1.01-1.02) increased significantly the risk of ICU admission. Bootstrap confirmed FIB-4 as an independent risk factor.

Conclusions: In middle-aged patients with COVID-19, FIB-4 may have a prognostic role. The link between liver fibrosis and the natural history of COVID-19 should be evaluated in future studies.

Keywords: COVID-19; FIB-4; SARS-CoV-2; critical illness; liver fibrosis.

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Figures

Figure 1.
Figure 1.
Flow diagram of the study. Abbreviations: FIB-4, fibrosis-4 score; ICU, intensive care unit; MV, mechanical ventilation.
See this image and copyright information in PMC

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