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Multicenter Study
. 2022 Sep;17(6):1777-1784.
doi: 10.1007/s11739-022-02997-9. Epub 2022 May 27.

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

Tommaso Bucci #  1 , Gioacchino Galardo #  1 , Orietta Gandini  2 , Tommasa Vicario  1   3 , Carla Paganelli  3 , Sara Cerretti  4 , Chiara Bucci  4 , Francesco Pugliese  4 , Daniele Pastori  5 ; Research On Medical patients Admitted to the Emergency Department (ROMA-ED) study group
Collaborators, Affiliations
Multicenter Study

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

Tommaso Bucci et al. Intern Emerg Med. 2022 Sep.

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.

Keywords: ALT; AST; COVID-19; FIB-4; Liver fibrosis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves of survival of patients according to FIB-4 values
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curves of FIB-4 score against mortality compared to categorized AST, ALT and APRI score
See this image and copyright information in PMC

Comment in

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