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Meta-Analysis
. 2021 Dec 1;33(1S Suppl 1):e368-e374.
doi: 10.1097/MEG.0000000000002091.

Fibrosis-4 index and mortality in coronavirus disease 2019: a meta-analysis

Raymond Pranata  1 , Emir Yonas  2 , Ian Huang  3 , Michael Anthonius Lim  1 , Sally Aman Nasution  4 , Raden Ayu Tuty Kuswardhani  5
Affiliations
Meta-Analysis

Fibrosis-4 index and mortality in coronavirus disease 2019: a meta-analysis

Raymond Pranata et al. Eur J Gastroenterol Hepatol. .

Abstract

Background/aims: In this meta-analysis, we aimed to evaluate the prognostic value of fibrosis-4 index (FIB-4) in COVID-19.

Methods: We performed a comprehensive literature search of PubMed, Embase, and Scopus databases on 26 November 2020. FIB-4 was calculated by [age (years) × AST (IU/L)]/[platelet count (109/L) × √ALT (U/L)]. A value above cutoff point was considered high and a value below cutoff point was considered low. The main outcome was mortality, the association between high FIB-4 and mortality was reported in odds ratio (OR). Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic OR (DOR), area under the curve (AUC) were generated.

Results: There were 963 patients from five studies included in this systematic review and meta-analysis. Meta-analysis showed that high FIB-4 was associated with increased mortality [OR 3.96 (2.16-7.27), P < 0.001; I2: 41.3%]. High FIB-4 was associated mortality with a sensitivity of 0.56 (0.40-0.70), specificity of 0.80 (0.72-0.86), PLR 2.8 (1.8-4.2), NLR 0.55 (0.39-0.78), DOR 5 (2-10), and AUC of 0.77 (0.73-0.81). Fagan's nomogram indicated that for a pre-test probability (mortality) of 30%, a high FIB-4 was associated with 54% post-test probability and a low FIB-4 was associated with 19%, respectively. The funnel-plot analysis was asymmetrical, trim-and-fill analysis by imputation of a study on the left side using linear estimator resulted in an OR of 3.48 (1.97-6.14). Egger's test showed no indication of small-study effects (P = 0.881).

Conclusion: High FIB-4 was associated with mortality in patients with COVID-19.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
Fig. 2.
Fig. 2.
Fibrosis-4 Index (FIB-4) and mortality in COVID-19.
Fig. 3.
Fig. 3.
SROC with prediction & confidence contours for high FIB-4 and mortality.
Fig. 4.
Fig. 4.
Fagan’s nomogram for high FIB-4 and mortality
Fig. 5.
Fig. 5.
Publication bias. Funnel-plot (a) and trim-and-fill analysis (b).
See this image and copyright information in PMC

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