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

J Infect Dis. 2020 Aug 4;222(5):726-733. doi: 10.1093/infdis/jiaa355.


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.

Keywords: COVID-19; FIB-4; SARS-CoV-2; critical illness; liver fibrosis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus / genetics
  • Betacoronavirus / isolation & purification*
  • COVID-19
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / pathology*
  • Coronavirus Infections / virology
  • Female
  • Humans
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / virology*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / pathology*
  • Pneumonia, Viral / virology
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index