Elevation of Liver Fibrosis Index FIB-4 Is Associated With Poor Clinical Outcomes in Patients With COVID-19

Abstract Background COVID-19 is a potentially severe disease caused by the recently described SARS-CoV-2. Whether liver fibrosis might be a relevant player in the natural history of COVID-19 is currently unknown. We aimed to evaluate the association between FIB-4 and the risk of progression to criti...

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Published in:	The Journal of infectious diseases Vol. 222; no. 5; pp. 726 - 733
Main Authors:	Ibáñez-Samaniego, Luis, Bighelli, Federico, Usón, Clara, Caravaca, Celia, Fernández Carrillo, Carlos, Romero, Miriam, Barreales, Mónica, Perelló, Christie, Madejón, Antonio, Marcos, Aránzazu Caballero, Albillos, Agustín, Fernández, Inmaculada, García-Samaniego, Javier, Calleja, José Luis, Bañares, Rafael
Format:	Journal Article
Language:	English
Published:	US Oxford University Press 04-08-2020
Subjects:	Adult Aged Betacoronavirus - genetics Betacoronavirus - isolation & purification C-reactive protein Cardiovascular diseases Clinical outcomes Coronavirus Infections - diagnosis Coronavirus Infections - pathology Coronavirus Infections - virology Coronaviruses COVID-19 Female Fibrosis Humans Liver Liver Cirrhosis - diagnosis Liver Cirrhosis - pathology Liver Cirrhosis - virology Major and Brief Reports Male Mechanical ventilation Middle age Middle Aged Multivariate analysis Pandemics Pneumonia, Viral - diagnosis Pneumonia, Viral - pathology Pneumonia, Viral - virology Prospective Studies Respiratory diseases Retrospective Studies Risk Factors SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Severity of Illness Index COVID-19 liver fibrosis SARS-CoV-2 FIB-4 critical illness
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Summary:	Abstract Background COVID-19 is a potentially severe disease caused by the recently described SARS-CoV-2. Whether liver fibrosis might be a relevant player in the natural history of COVID-19 is currently unknown. We aimed to evaluate the association between FIB-4 and the risk of progression to critical illness in middle-aged patients with COVID-19. Methods In this multicenter, retrospective study with prospective follow-up of 160 patients aged 35–65 years with COVID-19, FIB-4, clinical, and biochemical variables were collected at baseline. FIB-4 ≥2.67 defined patients with risk for advanced liver fibrosis. Results Risk for advanced fibrosis was estimated in 28.1% of patients. Patients with FIB-4 ≥2.67 more frequently required mechanical ventilation (37.8% vs 18.3%; P = .009). In multivariate analysis, FIB-4 ≥2.67 (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.30–8.92), cardiovascular risk factors (OR, 5.05; 95% CI, 1.90–13.39), previous respiratory diseases (OR, 4.54; 95% CI, 1.36–15.10), and C-reactive protein (OR, 1.01; 95% CI, 1.01–1.02) increased significantly the risk of ICU admission. Bootstrap confirmed FIB-4 as an independent risk factor. Conclusions In middle-aged patients with COVID-19, FIB-4 may have a prognostic role. The link between liver fibrosis and the natural history of COVID-19 should be evaluated in future studies. Patients with COVID-19 who present with FIB-4 ≥ 2.67 at diagnosis of the infection are at higher likelihood of requiring mechanical ventilation irrespective of previous history of cardiovascular risk factors, respiratory diseases, or baseline inflammatory response.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2 J. L. C. and R. B. share senior authorship.
ISSN:	0022-1899 1537-6613
DOI:	10.1093/infdis/jiaa355