Liver fibrosis-4 score predicts mortality in critically ill patients with coronavirus disease 2019

• Published in: Online journal of anaesthesia Vol. 22; no. 2; pp. 149 - 156
• Main Authors: Abosamak, Mohammed, Szergyuk, Ivan, Santos De Oliveira, Maria, Lippi, Giuseppe, Al-Jabbary, Ahmed, Al-Najjar, Amal, Albadi, Marzooq, Henry, Brandon
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer - Medknow Publications 01.07.2021; Wolters Kluwer Medknow Publications
• Subjects: coronavirus disease 2019; fibrosis-4; intensive care unit; liver fibrosis; mortality; mortality; liver fibrosis; intensive care unit; Coronavirus disease 2019; fibrosis-4
• ISSN: 2589-7934; 0973-0311; 0973-0311
• DOI: 10.4103/TheIAForum.TheIAForum_49_21

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.