ArticleHepatology communications2021
Liver Fibrosis Index FIB-4 Is Associated With Mortality in COVID-19.
Article in Hepatology communications, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it, 63 citations in OpenAlex.
- Liver Fibrosis Scores and Hospitalization, Mechanical Ventilation, Severity, and Death in Patients with COVID-19: A Systematic Review and Dose-Response Meta-Analysis.Canadian journal of gastroenterology & hepatology · 2022Pooled it
- Fibrosis-4 index and mortality in coronavirus disease 2019: a meta-analysis.European journal of gastroenterology & hepatology · 2021Pooled it
- Prognostic Value of Fibrosis-4 Index, Hepatic Biomarkers, and Plasma Acute-Phase Reactants in Critical Patients Undergoing Percutaneous Endoscopic Gastrostomy: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Exacerbated Hepatic Stress and Systemic Metabolic Disruption Driven by SARS-CoV-2 P.1 Variant in K18-hACE2 Mice.Immunity, inflammation and disease · 2026Article
- Association Between High FIB-4 Score and the Risk of Malignancy Development and Mortality: A Retrospective Longitudinal Case-Control Study.Digestive diseases and sciences · 2025Article
- FIB-4, APRI, and ALRI as Predictors of COVID-19 Outcomes: Insights from a Large-Scale Study.Diagnostics (Basel, Switzerland) · 2025Article
- FIB-4 Index Can Predict Mortality in Hospitalized Patients with COVID-19 Infection, Independent of CT Severity Score.Archives of Iranian medicine · 2025Article
- Prognostic Value of the Pretransplant Fibrosis-4 Index on Non-Relapse and Overall Mortality following Unrelated Single-Unit Cord Blood Transplantation in Adults.Acta haematologica · 2025Article
- Article
- An Increase in Aspartate Aminotransferase Can Predict Worsening Disease Severity in Japanese Patients with COVID-19.Clinics and practice · 2024Article
- Prognostic impact of FAN score in patients receiving nivolumab plus ipilimumab for metastatic renal cell carcinoma.Scientific reports · 2024Article
- Prognostic Value of Fibrosis 4 (FIB-4) Index in Sepsis Patients.Journal of personalized medicine · 2024Article
- The FIB-4 scores in the emergency department to predict the outcomes of COVID-19 patients in taiwan.Heliyon · 2024Article
- Observational
- QTc Prolongation to Predict Mortality in Patients Admitted with COVID-19 Infection: An Observational Study.Current vascular pharmacology · 2024Observational
- Correlation Between Coronavirus Disease 2019 Severity and Noninvasive Assessment of Liver Fibrosis in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2023Article
- Metabolic-associated fatty liver disease and liver fibrosis scores as COVID-19 outcome predictors: a machine-learning application.Internal and emergency medicine · 2023Article
- 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
- Differential Effects of COVID-19 Hospitalization on the Trajectory of Liver Disease Progression.Gastro hep advances · 2023Article
Corrections and comments
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Authors and funding
16 authors at 2 institutions in 1 country.
Funding
Abstract
Coronavirus disease 2019 (COVID-19) is associated with adverse outcomes, including need for invasive mechanical ventilation and death in people with risk factors. Liver enzyme elevation is commonly seen in this group, but its clinical significance remains elusive. In this study, we calculated the Fibrosis-4 (FIB-4) score for a cohort of hospitalized patients with COVID-19 and assessed its association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, inflammatory cytokine levels, and clinical outcome. A total of 202 hospitalized participants who tested positive for SARS-CoV-2 by nasopharyngeal sampling were included in this analysis. FIB-4 was calculated for each participant using the alanine aminotransferase, aspartate aminotransferase, age, and platelet count. We evaluated the association between FIB-4 and mortality using both multivariate logistic regression and Cox proportional hazards model. Correlations between FIB-4 and SARS-CoV-2 RNA and cytokine levels were evaluated using the Spearman test. Among the 202 participants, 22 died. The median FIB-4 in participants who survived and died were 1.91 and 3.98 (P < 0.001 by Mann-Whitney U test), respectively. Each one-unit increment in FIB-4 was associated with an increased odds of death (odds ratio, 1.79; 95% confidence interval, 1.36, 2.35; P < 0.001) after adjusting for baseline characteristics including sex, body mass index, hypertension, diabetes, and history of liver diseases. During hospitalization, FIB-4 peaked and then normalized in the survival group but failed to normalize in the death group. FIB-4 was positively correlated with the level of SARS-CoV-2 viral load and monocyte-associated cytokines, especially interleukin-6 and interferon gamma-induced protein 10. Conclusion: FIB-4 is associated with mortality in COVID-19, independent of underlying conditions including liver diseases. FIB-4 may be a simple and inexpensive approach to risk-stratify individuals with COVID-19.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.