Elevation of liver fibrosis index FIB-4 is associated with poor clinical outcomes in patients with COVID-19

J Infect Dis. 2020 Jun 21;jiaa355. doi: 10.1093/infdis/jiaa355. Online ahead of print.


Background and aims: 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: multicenter, retrospective study with prospective follow-up of 160 middle-aged (35 to 65 years) patients 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. Through multivariate logistic regression and bootstrap analysis, independent predictors of intensive care unit admission for mechanical ventilation were identified.

Results: risk for advanced fibrosis was estimated in 28.1% of patients. Patients with FIB-4 ≥2.67 required more frequently mechanical ventilation (37.8% vs 18.3%; p= 0.009). In multivariate analysis, FIB-4 ≥2.67 (OR 3.41; 95% 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 1.012; 95% CI: 1.006-1.017) 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 relevant 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.