ArticleInternal and emergency medicine2022
Fibrosis-4 (FIB-4) Index and mortality in COVID-19 patients admitted to the emergency department.
Article in Internal and emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 19 citations in OpenAlex.
- Elevated fibrosis‑4 index is associated with 30-day mortality in adult hemophagocytic lymphohistiocytosis patients.Annals of hematology · 2025Article
- Article
- FIB-4, APRI, and ALRI as Predictors of COVID-19 Outcomes: Insights from a Large-Scale Study.Diagnostics (Basel, Switzerland) · 2025Article
- Elevated non-invasive liver fibrosis scores at admission are independent risk factors for severe COVID-19: a retrospective cohort study from 2020 to 2024.Frontiers in medicine · 2025Article
- Comparison of liver fibrosis scores and fatty liver on computed tomography as risk factors for severity of COVID-19.JGH open : an open access journal of gastroenterology and hepatology · 2024Article
- Time‑dependent ROC curve analysis to determine the predictive capacity of seven clinical scales for mortality in patients with COVID‑19: Study of a hospital cohort with very high mortality.Biomedical reports · 2024Article
- The FIB-4 scores in the emergency department to predict the outcomes of COVID-19 patients in taiwan.Heliyon · 2024Article
- QTc Prolongation to Predict Mortality in Patients Admitted with COVID-19 Infection: An Observational Study.Current vascular pharmacology · 2024Observational
- Clinical characteristics and risk factors associated with diverse manifestations of COVID-19 in patients aged 85 years and older.Frontiers in public health · 2024Article
- Fib-4 score is able to predict intra-hospital mortality in 4 different SARS-COV2 waves.Internal and emergency medicine · 2023Article
- The Role of APRI, FIB-4, and SAD-60 Scores as Predictors of Mortality in COVID-19 Patients.Infectious diseases & clinical microbiology · 2023Article
- Article
- Article
- Fibrosis-4 (FIB-4) index as a predictor for mechanical ventilation and 30-day mortality across COVID-19 variants.Journal of clinical and translational science · 2023Article
- Fibrosis‑4 (FIB‑4) index and mortality in COVID‑19 patients admitted to the emergency department: a new interesting predictive index for patients with COVID-19 disease?Internal and emergency medicine · 2022Article
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Authors and funding
10 authors at 3 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
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.
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