The Fibrosis-4 Index Is Associated With Need for Mechanical Ventilation and 30-Day Mortality in Patients Admitted With Coronavirus Disease 2019

Sterling, Richard K.; Oakes, Tavis; Gal, Tamas S.; Stevens, Michael P.; deWit, Marjolein; Sanyal, Arun J.

doi:10.1093/infdis/jiaa550

Cited by 33 publications

(43 citation statements)

References 13 publications

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“…Furthermore, elevation of this FIB-4 (equal or higher than 2.67) was associated with poor clinical outcomes in middle-aged patients with COVID-19, including required mechanical ventilation and ICU admission [ 22 ]. Moreover, FIB-4 was also related with increased risk of mortality in hospitalized patients with COVID-19 as well as with lower survival [ 23 , 24 ]. In addition, FIB-4 positively correlated to SARS-CoV-2 viral load and the levels of inflammatory cytokines [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients

Ramos-López

San-Cristóbal

Martínez-Urbistondo

et al. 2021

JCM

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Objective: to screen putative associations between liver markers and proinflammatory-related features concerning infectious morbidity and fatal outcomes in COVID-19 patients. Methods: a total of 2094 COVID-19 positive patients from the COVID-DATA-SAFE-LIFES cohort (HM hospitals consortium) were classified according to median values of hepatic, inflammatory, and clinical indicators. Logistic regression models were fitted and ROC cures were generated to explain disease severity and mortality. Results: intensive care unit (ICU) assistance plus death outcomes were associated with liver dysfunction, hyperinflammation, respiratory insufficiency, and higher associated comorbidities. Four models including age, sex, neutrophils, D-dimer, oxygen saturation lower than 92%, C-reactive protein (CRP), Charlson Comorbidity Index (CCI), FIB-4 and interactions with CRP, neutrophils, and CCI explained ICU plus death variance in more than 28%. The predictive values of ROC curves were: FIB-4 (0.7339), AST/ALT ratio (0.7107), CRP (0.7003), CCI index (0.6778), neutrophils (0.6772), and platelets (0.5618) concerning ICU plus death outcomes. Conclusions: the results of this research revealed that liver and proinflammatory features are important determinants of COVID-19 morbidity and fatal outcomes, which could improve the current understanding of the COVID-19 physiopathology as well as to facilitate the clinical management and therapy decision-making of this disease under a personalized medicine scope.

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Section: Discussionmentioning

confidence: 99%

Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients

Ramos-López

San-Cristóbal

Martínez-Urbistondo

et al. 2021

JCM

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“…Compared to NAFLD patients with low FIB-4 scores or individuals without NAFLD, NAFLD patients with intermediate or high FIB-4 scores are more likely to be older and obese; to have diabetes, higher liver enzymes, and higher C-reactive protein; and to exhibit lower levels of lymphocytes, platelets, triglycerides, and high-density lipoprotein cholesterol (7,8). Moreover, among COVID-19 patients, the need for mechanical ventilation is independently associated with obesity (OR 4.5), diabetes mellitus (OR 2.55), and FIB-4 of ≥2.67 (OR 3.09), and FIB-4 of ≥2.67 is also associated with increased 30day mortality (OR 8.4; 95% CI 2.23 to 31.7) (68).…”

Section: Accepted Articlementioning

confidence: 99%

“…(7,8) Moreover, among patients with COVID-19, the need for mechanical ventilation is independently associated with obesity (OR 4.5), diabetes mellitus (OR 2.55) and FIB-4 ≥ 2.67 (OR 3.09), and FIB-4 ≥ 2.67 is also associated with increased 30-day mortality (OR, 8.4; 95% CI, 2.23 to 31.7). (68) The association between NAFLD/NASH and a severe course of COVID-19 suggests the possibility that a genetic risk score for NAFLD, based on the weighted effect of risk variants in PNPLA3 (patatin-like phospholipase domain containing 3)-TM6SF2 (transmembrane 6 superfamily member 2)-MBOAT7 (membrane-bound O-acyltransferase domain-containing protein 7)-GCKR (glucokinase regulator) on hepatic fat in the general population, (69) may affect COVID-19 risk. (70) In an analysis of 1,460 individuals, of whom 526 were positive and 934 were negative for SARS-CoV-2, the genetic risk score for NAFLD was not associated with an increased risk of COVID-19.…”

Section: Fatty Liver and Covid-progressionmentioning

confidence: 99%

Impact of COVID‐19 in Liver Disease Progression

Martı́nez

Franco

2021

Hepatol Commun

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease 19 , which has infected millions of people worldwide in only a few months.A minority, but significant number, of infected individuals require hospitalization and intensive care. From the start of this new virus pandemic, it was apparent that obese and/or diabetic individuals had a bad prognosis for COVID-19 progression, strongly suggesting an association between liver disease and severe COVID-19. Since chronic liver disease (CLD) is associated with immune dysregulation and inflammation, it is unsurprising that CLD patients may carry a greater risk of adverse outcomes following SARS-CoV-2 infection. Initial COVID-19 data have also indicated that healthy infected individuals display abnormal liver function tests, suggesting a possible direct implication of SARS-CoV-2 in liver damage. Here we show that COVID-19 affects the liver metabolism and increases the morbidity and mortality of individuals with underlying CLD.

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“…A recent publication from Europe indicates that an elevation of FIB‐4 is associated with poor clinical outcomes in patients with COVID‐19, ( 7 ) and another study from the United States has shown that a FIB‐4 score ≥ 2.67 is associated with both 30‐day mortality and the need for ventilation. ( 8 ) However, neither study showed temporal trends of FIB‐4 changes, and it is difficult to distinguish whether elevations of FIB‐4 are related to underlying liver fibrosis versus direct cytopathic effects from COVID‐19.…”

mentioning

confidence: 95%

Liver Fibrosis Index FIB‐4 Is Associated With Mortality in COVID‐19

Regan

Fajnzylber

et al. 2020

Hepatol. Commun.

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Coronavirus disease 2019 (COVID‐19) is associated with adverse outcomes, including need for invasive mechanical ventilation and death in people with risk factors. Liver enzyme elevation is commonly seen in this group, but its clinical significance remains elusive. In this study, we calculated the Fibrosis‐4 (FIB‐4) score for a cohort of hospitalized patients with COVID‐19 and assessed its association with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA, inflammatory cytokine levels, and clinical outcome. A total of 202 hospitalized participants who tested positive for SARS‐CoV‐2 by nasopharyngeal sampling were included in this analysis. FIB‐4 was calculated for each participant using the alanine aminotransferase, aspartate aminotransferase, age, and platelet count. We evaluated the association between FIB‐4 and mortality using both multivariate logistic regression and Cox proportional hazards model. Correlations between FIB‐4 and SARS‐CoV‐2 RNA and cytokine levels were evaluated using the Spearman test. Among the 202 participants, 22 died. The median FIB‐4 in participants who survived and died were 1.91 and 3.98 ( P < 0.001 by Mann‐Whitney U test), respectively. Each one‐unit increment in FIB‐4 was associated with an increased odds of death (odds ratio, 1.79; 95% confidence interval, 1.36, 2.35; P < 0.001) after adjusting for baseline characteristics including sex, body mass index, hypertension, diabetes, and history of liver diseases. During hospitalization, FIB‐4 peaked and then normalized in the survival group but failed to normalize in the death group. FIB‐4 was positively correlated with the level of SARS‐CoV‐2 viral load and monocyte‐associated cytokines, especially interleukin‐6 and interferon gamma–induced protein 10. Conclusion: FIB‐4 is associated with mortality in COVID‐19, independent of underlying conditions including liver diseases. FIB‐4 may be a simple and inexpensive approach to risk‐stratify individuals with COVID‐19.

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The Fibrosis-4 Index Is Associated With Need for Mechanical Ventilation and 30-Day Mortality in Patients Admitted With Coronavirus Disease 2019

Cited by 33 publications

References 13 publications

Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients

Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients

Impact of COVID‐19 in Liver Disease Progression

Liver Fibrosis Index FIB‐4 Is Associated With Mortality in COVID‐19

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