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

• Published in: The Journal of infectious diseases Vol. 222; no. 11; pp. 1794 - 1797
• Main Authors: Sterling, Richard K, Oakes, Tavis, Gal, Tamas S, Stevens, Michael P, deWit, Marjolein, Sanyal, Arun J
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.12.2020
• Subjects: Adult; Aged; Coronaviruses; COVID-19; COVID-19 - mortality; COVID-19 - pathology; COVID-19 - therapy; Diabetes mellitus; Female; Fibrosis; Hospitalization; Humans; Inflammation; Liver cirrhosis; Liver diseases; Liver Diseases - mortality; Liver Diseases - pathology; Male; Mechanical ventilation; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Respiration, Artificial; Respiratory Insufficiency - pathology; Respiratory Insufficiency - therapy; Respiratory Insufficiency - virology; Risk Factors; Ventilation; Ventilators; COVID-19; respiratory failure; FIB-4
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiaa550

Abstract 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. The FIB-4 Index, a simple tool developed to predict hepatic fibrosis, was found to independently be associated with need for mechanical ventilation and 30-day mortality in hospitalized patients with COVID-19.