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

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

Authors :
Bucci, Tommaso
Galardo, Gioacchino
Gandini, Orietta
Vicario, Tommasa
Paganelli, Carla
Cerretti, Sara
Bucci, Chiara
Pugliese, Francesco
Pastori, Daniele
the Research On Medical patients Admitted to the Emergency Department (ROMA-ED) study group
Lubrano, Carla
Source :
Internal and Emergency Medicine. 17:1777-1784
Publication Year :
2022
Publisher :
Springer Science and Business Media LLC, 2022.

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 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 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 3.25 (p = 0.0302), APRI > 0.7 (p 51 (p = 0.0119) and ALT > 42 (p 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.

Details

ISSN :
19709366 and 18280447
Volume :
17
Database :
OpenAIRE
Journal :
Internal and Emergency Medicine
Accession number :
edsair.doi.dedup.....0a9f0fa3f3ef763625c73c8c77aec1f8
Full Text :
https://doi.org/10.1007/s11739-022-02997-9