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

J Infect Dis. 2020 Nov 9;222(11):1794-1797. doi: 10.1093/infdis/jiaa550.


The Fibrosis-4 Index (FIB-4), developed to predict fibrosis in liver disease, was used to identify patients with coronavirus disease 2019 who will require ventilator support as well as those associated with 30-day mortality. Multivariate analysis found obesity (odds ratio [OR], 4.5), diabetes mellitus (OR, 2.55), and FIB-4 ≥2.67 (OR, 3.09) independently associated with need for mechanical ventilation. When controlling for ventilator use, sex, and comorbid conditions, FIB-4 ≥2.67 was also associated with increased 30-day mortality (OR, 8.4 [95% confidence interval, 2.23-31.7]). Although it may not be measuring hepatic fibrosis, its components suggest that increases in FIB-4 may be reflecting systemic inflammation associated with poor outcomes.

Keywords: COVID-19; FIB-4; respiratory failure.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • COVID-19 / mortality
  • COVID-19 / pathology*
  • COVID-19 / therapy*
  • Female
  • Hospitalization
  • Humans
  • Liver Diseases / mortality
  • Liver Diseases / pathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Respiration, Artificial*
  • Respiratory Insufficiency / pathology
  • Respiratory Insufficiency / therapy
  • Respiratory Insufficiency / virology
  • Risk Factors