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

• 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
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiaa355

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.