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FIB-4 score as a predictor of COVID-19-related severity in hospitalized patients
Ana Lucena Valera1, Rocío Aller de la Fuente2, Yolanda Sánchez Torrijos3
1Digestive Diseases, Hospital Universitario Virgen del Rocío, España.
Insights
Elevated Fibrosis-4 (FIB-4) index before and during COVID-19 infection indicates higher mortality risk. Liver injury markers improved post-infection, showing reversibility of liver damage.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Liver fibrosis, a precursor to cirrhosis, can influence systemic disease outcomes.
- COVID-19 has been associated with various organ injuries, including the liver.
- The prognostic role of pre-existing liver fibrosis in COVID-19 patients remains under investigation.
Purpose of the Study:
- To investigate the impact of liver fibrosis, assessed by the Fibrosis-4 (FIB-4) index, on the prognosis and liver injury associated with COVID-19.
- To determine if baseline and admission FIB-4 scores predict mortality in COVID-19 patients.
Main Methods:
- A retrospective multicenter study included 575 patients hospitalized with COVID-19.
- Fibrosis-4 (FIB-4) index was calculated at baseline (within 6 months pre-infection) and at admission.
- Multivariate analysis was used to assess the association between FIB-4 and mortality, adjusting for other factors.
Main Results:
- Elevated baseline FIB-4 was significantly associated with increased mortality (OR 1.61).
- FIB-4 levels increased from baseline to admission and were also independently associated with mortality (OR 1.14).
- Liver injury markers (AST, ALT) were elevated during infection but significantly reduced six months post-resolution, indicating reversible liver damage.
Conclusions:
- Increased FIB-4, both at baseline and on admission, is linked to higher severity and mortality in COVID-19.
- Liver damage indicated by elevated transaminases and FIB-4 levels is generally reversible after COVID-19 infection resolution.
Aim:
to determine the impact of liver fibrosis on the prognosis of COVID and liver injury associated with the infection.
Methods:
retrospective multicenter study including 575 patients requiring admission for COVID-19 between January and June 2020. Fibrosis index-4 (FIB-4) was calculated within six months prior to infection and at six months post-infection.
Results:
baseline FIB-4 was elevated in patients who died (1.91 ± 0.95 vs 1.43 ± 0.85; p < 0.001). In addition, 17.1 % (32/187) of patients with baseline FIB-4 < 1.45 died vs 52.9 % (9/17) with FIB-4 > 3.25 (p < 0.001). In the adjusted multivariate analysis, baseline FIB-4 (OR 1.61 [95 % CI: 1.19-2.18]; p = 0.002) was independently associated with mortality. Parameters associated with liver injury, including aspartate aminotransferase (AST) (28 ± 10 vs 45 ± 56 IU/l; p < 0.001) and alanine aminotransferase (ALT) (20 ± 12 vs 38 ± 48 IU/l; p < 0.001) were significantly higher at admission compared to baseline. Furthermore, FIB-4 increased from baseline to the time of admission (1.53 ± 0.88 vs 2.55 ± 1.91; p < 0.001), and up to 6.9 % (10/145) of patients with FIB-4 < 1.45 on admission died vs 47.5 % if FIB-4 > 3.25 (58/122) (p < 0.001). In the adjusted multivariate analysis, FIB-4 on admission (OR 1.14 [95 % CI: 1.03-1.27]; p = 0.015) was independently associated with mortality. In addition, AST (42 ± 38 vs 22 ± 17 IU/l; p < 0.001) and ALT (40 ± 50 vs 20 ± 19 IU/l; p < 0.001) were significantly reduced at six months after the resolution of infection. Accordingly, FIB-4 decreased significantly (2.12 ± 1.25 vs 1.32 ± 0.57; p < 0.001) six months after the infection.
Conclusion:
increased FIB-4, either at baseline or at the time of admission, was associated with severity and mortality related to respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the liver damage expressed by elevated transaminases and FIB-4 levels was reversible in most of patients.
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