In:
Internal and Emergency Medicine, Springer Science and Business Media LLC, Vol. 17, No. 6 ( 2022-09), p. 1777-1784
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.
Type of Medium:
Online Resource
ISSN:
1828-0447
,
1970-9366
DOI:
10.1007/s11739-022-02997-9
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2022
detail.hit.zdb_id:
2378342-4
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