Year 2024 / Volume 116 / Number 9
Original
FIB-4 score as a predictor of COVID-19-related severity in hospitalized patients

465-471

DOI: 10.17235/reed.2024.9811/2023

Ana Lucena Valera, Rocío Aller de la Fuente, Yolanda Sánchez Torrijos, Manuel Romero Gómez, Javier Ampuero Herrojo,

Abstract
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.
Lay Summary
The prevalence of abnormal liver function tests in COVID-19 patients has been reported to range from 15% to 70%. In this setting, liver fibrosis could be a relevant factor in the natural history of COVID-19. FIB-4 is a simple four-variable tool (including AST, ALT, age, and platelet) for estimating liver fibrosis. In our study, we observed that patients with increased FIB-4 had a higher severity and mortality related to SARS-CoV-2 infection. The early identification of high-risk patients could improve patient care and prognosis of SARS-CoV-2 infection.
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References
1. Gato S, Lucena-Valera A, Muñoz-Hernández R, et al. Impact of COVID-19 on liver disease: From the experimental to the clinic perspective. World J Virol. 2021;10(6):301-311.
2. Bloom PP, Meyerowitz EA, Reinus Z, et al. Liver Biochemistries in Hospitalized Patients With COVID-19. Hepatology. 202173(3):890-900.
3. Hundt MA, Deng Y, Ciarleglio MM, et al. Abnormal Liver Tests in COVID-19: A Retrospective Observational Cohort Study of 1,827 Patients in a Major U.S. Hospital Network. Hepatology. 2020;72(4):1169-1176.
4. Ampuero J, Romero Gómez M. COVID-19 and the liver: the chicken or the egg dilemma. Rev Esp Enferm Dig. 2021;113(7):555.
5. Ampuero J, Lucena A, Hernández-Guerra M, et al. Primary biliary cholangitis and SARS-CoV-2 infection: incidence, susceptibility and outcomes. Gut. 2021; 7:gutjnl-2021-325700.
6. Sterling RK, Lissen E, Clumeck N, el at. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317-25.
7. Vilar-Gomez E, Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers. Journal of Hepatology. 2018;68(2):305-15.
8. Crisan D, Avram L, Grapa C, et al. Liver Injury and Elevated FIB-4 Define a High-Risk Group in Patients with COVID-19. J Clin Med. 2021 28;11(1):153.
9. Li Y, Regan J, Fajnzylber J, Coxen K, et al. Liver Fibrosis Index FIB-4 Is Associated With Mortality in COVID-19. Hepatol Commun. 2021;5(3):434-445.
10. Pranata R, Yonas E, Huang I, et al. Fibrosis-4 index and mortality in coronavirus disease 2019: a meta-analysis. Eur J Gastroenterol Hepatol. 2021; 1;33(S1):368-374.
11. Ibáñez-Samaniego L, Bighelli F, Usón C, et al. Elevation of Liver Fibrosis Index FIB-4 Is Associated With Poor Clinical Outcomes in Patients With COVID-19. J Infect Dis. 2020; 222(5):726-733.
12. APASL COVID Task Force, APASL COVID Liver Injury Spectrum Study (APCOLIS Study-NCT 04345640), Sarin SK, et al. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Hepatol Int; 2020;14(5):690-700.
13. Wang Y, Hu M, Yang H. Cirrhosis is an independent predictor for COVID-19 mortality: A meta-analysis of confounding cofactors-controlled data. J Hepatol. 2023;78(1):28-31
14. Bertolini A, van de Peppel IP, Bodewes F, et al. Abnormal Liver Function Tests in Patients With COVID-19: Relevance and Potential Pathogenesis. Hepatology. 2020;72(5):1864-1872.
15. Levin AT, Hanage WP, Owusu-Boaitey N, et al. Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications. Eur J Epidemiol. 2020;35(12):1123-1138.
16. Chen LY, Chu HK, Bai T, et al. Liver damage at admission is an independent prognostic factor for COVID-19. J Dig Dis 2020;21:512-518.
17. Ampuero J, Sánchez-Torrijos Y, García Lozano MR, et al. Impact of liver injury on the severity of COVID-19: Systematic Review with Meta-analysis. Rev Esp Enferm Dig. 2020; 113(2):125-135.
18. Fu L, Wang B, Yuan T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect. 2020;80(6):656-665.
19. Canillas L, Broquetas T, Carrión JA, et al. Follow-up evaluation of patients with liver test abnormalities detected during SARS-CoV2 infection. J Viral Hepat. 2022;29(9):823-834.
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Lucena Valera A, Aller de la Fuente R, Sánchez Torrijos Y, Romero Gómez M, Ampuero Herrojo J. FIB-4 score as a predictor of COVID-19-related severity in hospitalized patients. 9811/2023


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Publication history

Received: 30/06/2023

Accepted: 26/04/2024

Online First: 20/05/2024

Published: 09/09/2024

Article revision time: 285 days

Article Online First time: 325 days

Article editing time: 437 days


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