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Published on: February 10, 2015
Comparison of liver function test- and inflammation-based prognostic scores for coronavirus disease 2019: a single
Evangelos Cholongitas1, Triada Bali1, Vasiliki E Georgakopoulou2,3
1First Department of Internal Medicine.
Insights
The Fibrosis-4 (FIB-4) score independently predicts mortality in COVID-19 patients. The C-Reactive Protein to albumin ratio (CAR) is linked to outcomes in COVID-19 patients with nonalcoholic fatty liver disease (NAFLD).
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Several liver and inflammation-based scores exist to predict COVID-19 patient outcomes.
- Direct comparative studies of these predictive scores are lacking.
Purpose of the Study:
- To compare the predictive abilities of liver- and inflammation-based scores for COVID-19 patient mortality.
- To evaluate the Fibrosis-4 (FIB-4) score and C-Reactive Protein to albumin ratio (CAR) in predicting COVID-19 clinical course.
Main Methods:
- Retrospective analysis of 1038 hospitalized COVID-19 patients.
- Assessment of clinical and laboratory data, including FIB-4 and CAR scores on admission.
Main Results:
- FIB-4 independently predicted mortality in COVID-19 patients (HR 1.11, P=0.004) with good discriminative ability (AUC 0.76).
- Higher FIB-4 scores (>2.67) correlated with worse survival.
- CAR was an independent risk factor for mortality (HR 1.014, P=0.021), need for high-flow nasal cannula (HR 1.016, P=0.007), and acute kidney injury (HR 1.017, P=0.002).
- In COVID-19 patients with possible nonalcoholic fatty liver disease (NAFLD), higher CAR scores (>12) were associated with worse survival (P=0.024).
Conclusions:
- FIB-4 demonstrated superior predictive performance for mortality compared to other scores in COVID-19 patients.
- CAR was the sole score independently associated with the clinical course in COVID-19 patients with possible NAFLD.
Background:
Although several liver- and inflammation-based scores to predict the clinical course of patients with coronavirus disease 2019 (COVID-19) have been evaluated, no direct comparison regarding their predictive ability has been performed.
Methods:
1038 patients (608 males, age 63.5 ± 17 years) hospitalized with documented COVID-19 infection to the non-ICU ward, were included retrospectively. Clinical and laboratory characteristics on admission including evaluation of Fibrosis-4 (FIB-4) score and C-Reactive Protein (CRP) to albumin ratio (CAR) were recorded.
Results:
One hundred and twenty-four patients (11.9%) died during hospitalization after 8 (3-72) days. In multivariate analysis, FIB-4 (hazard ratio, 1.11; 95% confidence interval (CI), 1.034-1.19; P = 0.004), was independently associated with mortality, with very good discriminative ability (area under the receiver operating characteristic curve curve, 0.76). The patients with FIB-4 >2.67 (n = 377), compared to those with ≤2.67 (n = 661), had worse survival (log-rank 32.6; P < 0.001). Twenty-four (6.8%) of 352 patients with possible nonalcoholic fatty liver disease (NAFLD) (defined as Hepatic Steatosis Index >36) died during hospitalization. In multivariate analysis, CAR was an independent risk factor (1) for mortality (hazard ratio, 1.014; 95% CI, 1.002-1.025; P = 0.021), (2) the need for high-flow nasal cannula with or without intubation (hazard ratio, 1.016; 95% CI, 1.004-1.027; P = 0.007) and (3) development of acute kidney injury (hazard ratio, 1.017; 95% CI, 1.006-1.028; P = 0.002). In addition, the patients with possible NAFLD and CAR >12 (n = 154), compared to those with CAR ≤12 (n = 198), had worse survival (log-rank 5.1; P = 0.024).
Conclusions:
FIB-4 was an independent factor for mortality with better performance compared to other liver function test- and inflammation-based scores in patients with COVID-19, while CAR was the only score independently associated with the clinical course in COVID-19 patients with possible NAFLD.
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