J Infect Dis. 2020 Aug 28:jiaa550. doi: 10.1093/infdis/jiaa550. Online ahead of print.
The fibrosis-4 index (FIB-4), developed to predict fibrosis in liver disease, was used to identify patients with COVID-19 who will require ventilator support as well as associated with 30-day mortality. Multivariate analysis found obesity (OR 4.5), diabetes (OR 2.55), and FIB-4 ≥ 2.67 (OR 3.09) independently associated with need for mechanical ventilation. When controlling for ventilator use, gender, and comorbid conditions, FIB-4 ≥ 2.67 was also associated with increased 30-day mortality (OR 8.4; 95% CI 2.23-31.7). While it may not be measuring hepatic fibrosis, its components suggest that increases in FIB-4 may be reflecting systemic inflammation associated with poor outcomes.