Repurposing FIB-4 index as a predictor of mortality in patients with hematological malignancies and COVID-19

Abstract

Background In this study, we aimed to investigate whether FIB-4 index is useful in predicting mortality in patients with concurrent hematological malignancies and COVID-19. We also aimed to determine the optimal cut-off point for the prediction. Methods This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia. Consecutive sampling of adults with hematological malignancies and COVID-19 was performed between May 2020 and January 2021. COVID-19 screening test using the reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal samples were performed prior to hospitalization for chemotherapy. FIB-4 index is derived from [age (years) × AST (IU/L)]/[platelet count (109/L) × √ALT (U/L)]. The primary outcome of this study is mortality, defined as clinically validated death/non-survivor during a 3-months (90 days) follow-up. Results There were a total of 70 patients with hematological malignancies and COVID-19 in this study. Median FIB-4 Index was higher in non-survivors (13.1 vs 1.02, p<0.001). FIB-4 index above 3.85 has a sensitivity of 79%, specificity of 84%, PLR of 5.27, and NLR of 0.32. The AUC was 0.849 95% CI 0.735–0.962, p<0.001. This cut-off point was associated with OR of 16.70 95% CI 4.07–66.67, p<0.001. In this study, a FIB-4 >3.85 confers to 80% posterior probability of mortality and FIB-4 <3.85 to 19% probability. FIB-4 >3.85 was associated with shorter time-to-mortality (HR 9.10 95% CI 2.99–27.65, p<0.001). Multivariate analysis indicated that FIB-4 >3.85 (HR 4.09 95% CI 1.32–12.70, p = 0.015) and CRP> 71.57 mg/L (HR 3.36 95% CI 1.08–10.50, p = 0.037) were independently associated with shorter time-to-mortality. Conclusion This study indicates that a FIB-4 index >3.85 was independent predictor of mortality in patients with hematological malignancies and COVID-19 infection.

Liver Injury and Elevated FIB-4 Define a High-Risk Group in Patients with COVID-19

“…Another study on 70 patients with different hematological malignancies showed that FIB-4 > 3.85 was an independent predictor for mortality in patients with COVID-19 infection; the authors point out that the synergistic effect of SARS-CoV-2 virus on the liver and intrinsic hematopoietic abnormalities found in this subcategory of patients led to higher FIB-4 values, although admittedly their sample size was small [ 33 ]. Furthermore, a meta-analysis revealed that high FIB-4 values are associated with mortality in COVID-19 patients, thus augmenting the idea that this simple score used for detection of liver fibrosis and can be repurposed for predicting clinical outcome in COVID patients [ 32 ].…”

Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department

“…Scarce data on the COVID-19 population have been reported so far; one previous study showed that FIB-4 was associated with the need for mechanical ventilation but no data on mortality were reported [ 14 ]. Conversely, studies on mortality risk according to FIB-4 included a relatively small sample or specific subgroups of patients, such as those with liver steatosis [ 15 , 16 ] or haematological malignancies [ 17 ], and used different cut-off of FIB-4, making results of difficult comparison [ 18 ]. Given the still wide-spread diffusion of SARS-CoV-2 infection, more data allowing a better risk stratification strategy and eventually sources allocation, are warranted.…”

Effect of colchicine on mortality in patients with COVID-19 – A systematic review and meta-analysis

“…This reduces the production of IL-1β which might prevent the induction of other cytokines (IL-6 and TNF) that involve in the process of cytokine storm [ 47 ]. COVID-19 was shown to cause endotheliopathy, coagulopathy, hyper-inflammation, and cytokine storm that may potentially cause end-organ damage [ [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [55] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ]. Therefore, the anti-inflammatory and platelet inhibitory properties of colchicine that involved various steps of inflammatory response may potentially alleviate the pathology and improve outcome.…”