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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
Correspondence Address:
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  | Check |
DOI: 10.4103/TheIAForum.TheIAForum_49_21
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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.
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