Related Experiment Video
Updated: Oct 19, 2025
Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Liver Fibrosis Index FIB-4 Is Associated With Mortality in COVID-19
Yijia Li1, James Regan1, Jesse Fajnzylber1
1Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
The Fibrosis-4 (FIB-4) score, a measure of liver fibrosis, is linked to higher mortality in COVID-19 patients. Higher FIB-4 scores correlate with increased risk of death and elevated viral load and inflammatory markers.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) can lead to severe outcomes, including death, particularly in individuals with risk factors.
- Elevated liver enzymes are common in COVID-19 patients, but their clinical significance is not well understood.
- The Fibrosis-4 (FIB-4) score, typically used to assess liver fibrosis, has not been widely studied in the context of COVID-19 outcomes.
Purpose of the Study:
- To investigate the association between the FIB-4 score and clinical outcomes in hospitalized COVID-19 patients.
- To determine if FIB-4 score correlates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA levels and inflammatory cytokine profiles.
- To assess the utility of FIB-4 as a potential risk stratification tool for COVID-19 mortality.
Main Methods:
- A cohort of 202 hospitalized patients with confirmed SARS-CoV-2 infection was analyzed.
- The FIB-4 score was calculated for each patient using alanine aminotransferase, aspartate aminotransferase, age, and platelet count.
- Multivariate logistic regression, Cox proportional hazards models, and Spearman correlation were used to evaluate associations with mortality, viral load, and cytokine levels.
Main Results:
- Patients who died from COVID-19 had significantly higher median FIB-4 scores (3.98) compared to survivors (1.91).
- Each one-unit increase in FIB-4 score was associated with a 1.79-fold increased odds of mortality, independent of baseline characteristics.
- FIB-4 scores were positively correlated with SARS-CoV-2 RNA levels and inflammatory markers, including interleukin-6 and interferon gamma-induced protein 10.
Conclusions:
- The FIB-4 score is a significant independent predictor of mortality in hospitalized COVID-19 patients.
- FIB-4 may serve as a simple, cost-effective biomarker for identifying high-risk individuals with COVID-19.
- The correlation of FIB-4 with viral load and inflammation suggests a potential role in the systemic impact of SARS-CoV-2 infection.
Abstract:
Coronavirus disease 2019 (COVID-19) is associated with adverse outcomes, including need for invasive mechanical ventilation and death in people with risk factors. Liver enzyme elevation is commonly seen in this group, but its clinical significance remains elusive. In this study, we calculated the Fibrosis-4 (FIB-4) score for a cohort of hospitalized patients with COVID-19 and assessed its association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, inflammatory cytokine levels, and clinical outcome. A total of 202 hospitalized participants who tested positive for SARS-CoV-2 by nasopharyngeal sampling were included in this analysis. FIB-4 was calculated for each participant using the alanine aminotransferase, aspartate aminotransferase, age, and platelet count. We evaluated the association between FIB-4 and mortality using both multivariate logistic regression and Cox proportional hazards model. Correlations between FIB-4 and SARS-CoV-2 RNA and cytokine levels were evaluated using the Spearman test. Among the 202 participants, 22 died. The median FIB-4 in participants who survived and died were 1.91 and 3.98 (P < 0.001 by Mann-Whitney U test), respectively. Each one-unit increment in FIB-4 was associated with an increased odds of death (odds ratio, 1.79; 95% confidence interval, 1.36, 2.35; P < 0.001) after adjusting for baseline characteristics including sex, body mass index, hypertension, diabetes, and history of liver diseases. During hospitalization, FIB-4 peaked and then normalized in the survival group but failed to normalize in the death group. FIB-4 was positively correlated with the level of SARS-CoV-2 viral load and monocyte-associated cytokines, especially interleukin-6 and interferon gamma-induced protein 10. Conclusion: FIB-4 is associated with mortality in COVID-19, independent of underlying conditions including liver diseases. FIB-4 may be a simple and inexpensive approach to risk-stratify individuals with COVID-19.
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow