Liver fibrosis-4 score predicts mortality in critically ill patients with coronavirus disease 2019
Mohammed Fawzi Abosamak1, Ivan Szergyuk2, Maria Helena Santos De Oliveira3, Giuseppe Lippi4, Ahmed Suliman Al-Jabbary5, Amal H Al-Najjar6, Marzooq A Albadi7, Brandon M Henry8
1 Department of Anesthesia and Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt; Department of Intensive Care, Security Forces Hospital, Riyadh, KSA
2 Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
3 Department of Statistics, Federal University of Parana, Curitiba, Brazil
4 Department of Neuroscience, Biomedicine and Movement, Section of Clinical Biochemistry, University of Verona, Verona, Italy
5 Department of Intensive Care, Security Forces Hospital, Riyadh, KSA
6 Drug and Poison Information Center, Security Forces Hospital, Riyadh, KSA
7 Department of Rheumatology, Security Forces Hospital, Riyadh, KSA
8 Cardiac Intensive Care Unit, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
Dr. Mohammed Fawzi Abosamak
Department of Anesthesia and Intensive Care, Faculty of Medicine, Tanta University, Tanta, Post Code 31511
Source of Support: None, Conflict of Interest: None
Background: Emerging evidence suggests that liver dysfunction in the course of coronavirus disease 2019 (COVID-19) illness is a critical prognostic factor for mortality in COVID-19 patients, and the Fibrosis-4 (FIB-4) score, developed to reflect level of hepatic fibrosis, has been associated with adverse outcomes in hospitalized COVID-19 patients. This study aimed to investigate intensive care unit (ICU) admitted patients, a high-risk subpopulation, research on which is lacking.
Materials and Methods: This retrospective cohort study examined FIB-4 scores and clinical endpoints including death, acute cardiac injury (ACI), acute kidney injury, and need for mechanical ventilation in critically ill COVID-19 patients, without prior hepatic disease, throughout ICU stay.
Results: Of 60 patients enrolled, 35% had ICU admission FIB-4 >2.67. Among nonsurvivors, FIB-4 was significantly higher at admission (median 3.19 vs. 1.44; P < 0.001) and only a minority normalized <1.45 (36.0%). Each one-unit increment in admission FIB-4 was associated with 67.4% increased odds of death (95% confidence interval [CI], 9.8%–162.6%; P = 0.017). FIB-4 >2.67 was associated with a median survival time of 18 days from ICU admission versus 40 days with FIB-4 <2.67 (P = 0.016). Admission FIB-4 was also higher in patients developing ACI (median 4.99 vs. 1.76; P < 0.001). FIB-4 correlated with age (r = 0.449; P < 0.001), and aspartate transaminase with alanine transaminase (r = 0.674; P < 0.001) and lactate dehydrogenase (r = 0.618; P < 0.001).
Conclusion: High ICU admission FIB-4 is associated with mortality in critically ill COVID-19 patients, with failure to normalize at time of death, however, the high score is likely a result of generalized cytotoxicity rather than advanced hepatic fibrosis.