Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department.

Tytuł:: Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department.
Autorzy:: Bucci T; Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
Galardo G; Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
Gandini O; Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Vicario T; Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.; Emergency Department, Policlinico Tor Vergata Hospital, Rome, Italy.
Paganelli C; Emergency Department, Policlinico Tor Vergata Hospital, Rome, Italy.
Cerretti S; Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Bucci C; Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Pugliese F; Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Pastori D; Emergency Medicine Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy. .
Corporate Authors:: Research On Medical patients Admitted to the Emergency Department (ROMA-ED) study group
Źródło:: Internal and emergency medicine [Intern Emerg Med] 2022 Sep; Vol. 17 (6), pp. 1777-1784. Date of Electronic Publication: 2022 May 27.
Typ publikacji:: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: Milan : Springer
Original Publication: Rome, Italy : CEPI-AIM Group, 2006-
MeSH Terms:: COVID-19*/blood
COVID-19*/complications
COVID-19*/mortality
Liver Cirrhosis*/mortality
Liver Cirrhosis*/virology
Severity of Illness Index*
Aspartate Aminotransferases/blood ; Biomarkers/blood ; Cohort Studies ; Emergency Service, Hospital ; Humans ; Oxygen/blood ; Platelet Count ; ROC Curve ; Retrospective Studies
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Contributed Indexing:: Investigator: E Fante; F Urso; E Baldini; L Zinnamosca; M Alessandroni; G Loiudice; C Boccardo; E Petrillo; G Della Grotta; L Magrini; M Colzi; C Gianni; F Biamonte; A Concistrè; A Ponzio; C Franchi; C Marinelli; T Pecci; F Fabi; G Roma; A Massi; A Diaczenko; E Bresciani; E Bresciani; M Suppa; A Servello; A Rosa; A Coppola; AM Mazzocchitti; M Palladino; G Bertazzoni; S Minisola; L Petramala; L Marino; A Marletta; M De Cataldis; D Corbi; R Ansalone; A D'Ercole; S Fontana; P Rapisarda; P Piccari; G Marcelli; M Cascio; V Di Manno; M Ruggiero; G Cardillo Piccolino; P Sinacori; S Rossi; D Di Vanna; M Barbera; MC Cedrone; V Di Biagio; E Galati; G Iacopelli; A Leonardi; D Rigamonti; M Colantonio; A Leonardi; E Pellegrino; MA Colafati; M Milocco; R Berardi; D Menichelli; G Franchino; A Criniti; C Lubrano; M Santulli; A Angeloni; E Lorusso; S Giglio
Keywords: ALT; AST; COVID-19; FIB-4; Liver fibrosis
Substance Nomenclature:: 0 (Biomarkers)
EC 2.6.1.1 (Aspartate Aminotransferases)
S88TT14065 (Oxygen)
Entry Date(s):: Date Created: 20220527 Date Completed: 20220913 Latest Revision: 20221206
Update Code:: 20240104
PubMed Central ID:: PMC9140323
DOI:: 10.1007/s11739-022-02997-9
PMID:: 35624344
: Czasopismo naukowe

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Liver damage worsens the prognosis of coronavirus 19 disease (COVID-19). However, the best strategy to stratify mortality risk according to liver damage has not been established. The aim of this study is to test the predictive value of the validated Fibrosis-4 (FIB-4) Index and compared it to liver transaminases and to the AST-to-Platelet ratio index (APRI). Multicenter cohort study including 992 consecutive COVID-19 patients admitted to the Emergency Department. FIB-4 > 3.25 and APRI > 0.7 were used to define liver damage. Multivariable Cox regression and ROC curve analysis for mortality were performed. Secondary endpoints were (1) need for high-flow oxygen and (2) mechanical ventilation. 240 (24.2%) patients had a FIB-4 > 3.25. FIB-4 > 3.25 associated with an increased mortality (n = 119, log-rank test p < 0.001 and adjusted hazard ratio (HR) 1.72 (95% confidence interval [95%CI] 1.14-2.59, p = 0.010). ROC analysis for mortality showed that FIB-4 (AUC 0.734, 95% CI 0.705-0.761) had a higher predictive value than AST (p = 0.0018) and ALT (p < 0.0001). FIB-4 > 3.25 was also superior to APRI > 0.7 (AUC 0.58, 95% CI 0.553-0.615, p = 0.0008). Using an optimized cut-off > 2.76 (AUC 0.689, 95% CI 0.659-0.718, p < 0.0001), FIB-4 was superior to FIB-4 > 3.25 (p = 0.0302), APRI > 0.7 (p < 0.0001), AST > 51 (p = 0.0119) and ALT > 42 (p < 0.0001). FIB-4 was also associated with high-flow oxygen use (n = 255, HR 1.69, 95% CI 1.25-2.28, p = 0.001) and mechanical ventilation (n = 39, HR 2.07, 95% CI 1.03-4.19, p = 0.043). FIB-4 score predicts mortality better than liver transaminases and APRI score. FIB-4 score may be an easy tool to identify COVID-19 patients at worse prognosis in the emergency department.
(© 2022. The Author(s).)

Comment in: Intern Emerg Med. 2022 Nov;17(8):2451-2452. (PMID: 35962270)

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