Liver fibrosis‑4 score predicts mortality in critically ill patients with coronavirus disease 2019

Background: Emerging evidence suggests that liver dysfunction in the course of coronavirus disease 2019 (COVID‑19) illness is a critical prognostic factor for mortality in COVID‑19 patients, and the Fibrosis‑4 (FIB‑4) score, developed to reflect level of hepatic fibrosis, has been associated with adverse outcomes in hospitalized COVID‑19 patients. This study aimed to investigate intensive care unit (ICU) admitted patients, a high‑risk subpopulation, research on which is lacking. Materials and Methods: This retrospective cohort study examined FIB‑4 scores and clinical endpoints including death, acute cardiac injury (ACI), acute kidney injury, and need for mechanical ventilation in critically ill COVID‑19 patients, without prior hepatic disease, throughout ICU stay. Results: Of 60 patients enrolled, 35% had ICU admission FIB‑4 >2.67. Among nonsurvivors FIB‑4 was significantly higher at admission (median 3.19 vs. 1.44; P < 0.001) and only a minority normalized <1.45 (36.0%). Each one‑unit increment in admission FIB‑4 was associated with 67.4% increased odds of death (95% confidence interval [CI], 9.8%–162.6%; P = 0.017). FIB‑4 >2.67 was associated with a median survival time of 18 days from ICU admission versus 40 days with FIB‑4 <2.67 (P = 0.016). Admission FIB‑4 was also higher in patients developing ACI (median 4.99 vs. 1.76; P < 0.001). FIB‑4 correlated with age (r = 0.449; P < 0.001), and aspartate transaminase with alanine transaminase (r = 0.674; P < 0.001) and lactate dehydrogenase (r = 0.618; P < 0.001). Conclusion: High ICU admission FIB‑4 is associated with mortality in critically ill COVID‑19 patients, with failure to normalize at time of death, however, the high score is likely a result of generalized cytotoxicity rather than advanced hepatic fibrosis.