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Kamiya Y, Shinoda M, Ishii N, Yamamoto S, Sekine T, Morikawa M, Ota S, Toyama‐Kousaka M, Takahashi H, Takei H, Shinkai M. Comparison of liver fibrosis scores and fatty liver on computed tomography as risk factors for severity of COVID-19. JGH Open 2024; 8:e70004. [PMID: 39130093 PMCID: PMC11310555 DOI: 10.1002/jgh3.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/20/2024] [Accepted: 07/09/2024] [Indexed: 08/13/2024]
Abstract
Background and Aim Increased liver fibrosis scores (LFS), such as fibrosis-4 index (FIB-4) or non-alcoholic fatty liver disease fibrosis score (NFS), and fatty liver are known risk factors for severe coronavirus disease 2019 (COVID-19). The purpose of this study was to identify the best scores, which predict the prognosis of COVID-19. Methods Participants comprised consecutive Japanese COVID-19 patients admitted to our hospital between February 14, 2020, and April 14, 2021. Multivariate logistic regression analysis was performed to evaluate the relationships between LFS (FIB-4, NFS, aspartate aminotransferase-to-platelet ratio index [APRI], BARD score, and hepatic steatosis index [HSI]) or fatty liver on computed tomography (CT), and severity of COVID-19. Results Of the 415 patients (mean age, 59 years), 177 patients (42.7%) needed oxygen therapy, 90 patients (21.7%) worsened to severe COVID-19, and 45 patients (10.8%) died during admission. Multivariate logistic regression analysis showed that increased FIB-4 and NFS were risk factors for death, severe COVID-19, and oxygen demand; that increased BARD was a risk factor for severe COVID-19 and oxygen demand; and that increased APRI and HSI were not risk factors for any status of COVID-19. Furthermore, increased NFS or BARD and fatty liver were independent risk factors for severe COVID-19 and oxygen demand. Conclusions This study showed that FIB-4 and NFS were the best liver fibrosis scores that predicted worse prognosis for COVID-19, and that increased NFS or BARD and fatty liver evident on CT represented independent risk factors for severe COVID-19 and oxygen demand.
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Affiliation(s)
- Yuji Kamiya
- Department of Endocrinology and MetabolismTokyo Shinagawa HospitalTokyoJapan
| | - Masahiro Shinoda
- Department of Respiratory MedicineTokyo Shinagawa HospitalTokyoJapan
| | - Naoki Ishii
- Department of GastroenterologyTokyo Shinagawa HospitalTokyoJapan
| | - Saki Yamamoto
- Department of Endocrinology and MetabolismTokyo Shinagawa HospitalTokyoJapan
| | - Tetsuo Sekine
- Department of Endocrinology and MetabolismTokyo Shinagawa HospitalTokyoJapan
| | - Miwa Morikawa
- Department of Respiratory MedicineTokyo Shinagawa HospitalTokyoJapan
| | - Shinichiro Ota
- Department of Respiratory MedicineTokyo Shinagawa HospitalTokyoJapan
| | | | | | - Hiroaki Takei
- Department of Respiratory MedicineTokyo Shinagawa HospitalTokyoJapan
| | - Masaharu Shinkai
- Department of Respiratory MedicineTokyo Shinagawa HospitalTokyoJapan
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Mendoza-Hernandez MA, Hernandez-Fuentes GA, Sanchez-Ramirez CA, Rojas-Larios F, Guzman-Esquivel J, Rodriguez-Sanchez IP, Martinez-Fierro ML, Cardenas-Rojas MI, De-Leon-Zaragoza L, Trujillo-Hernandez B, Fuentes-Murguia M, Ochoa-Díaz-López H, Sánchez-Meza K, Delgado-Enciso I. Time‑dependent ROC curve analysis to determine the predictive capacity of seven clinical scales for mortality in patients with COVID‑19: Study of a hospital cohort with very high mortality. Biomed Rep 2024; 20:100. [PMID: 38765855 PMCID: PMC11099607 DOI: 10.3892/br.2024.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024] Open
Abstract
Clinical data from hospital admissions are typically utilized to determine the prognostic capacity of Coronavirus disease 2019 (COVID-19) indices. However, as disease status and severity markers evolve over time, time-dependent receiver operating characteristic (ROC) curve analysis becomes more appropriate. The present analysis assessed predictive power for death at various time points throughout patient hospitalization. In a cohort study involving 515 hospitalized patients (General Hospital Number 1 of Mexican Social Security Institute, Colima, Mexico from February 2021 to December 2022) with COVID-19, seven severity indices [Pneumonia Severity Index (PSI) PaO2/FiO2 arterial oxygen pressure/fraction of inspired oxygen (Kirby index), the Critical Illness Risk Score (COVID-GRAM), the National Early Warning Score 2 (NEWS-2), the quick Sequential Organ Failure Assessment score (qSOFA), the Fibrosis-4 index (FIB-4) and the Viral Pneumonia Mortality Score (MuLBSTA were evaluated using time-dependent ROC curves. Clinical data were collected at admission and at 2, 4, 6 and 8 days into hospitalization. The study calculated the area under the curve (AUC), sensitivity, specificity, and predictive values for each index at these time points. Mortality was 43.9%. Throughout all time points, NEWS-2 demonstrated the highest predictive power for mortality, as indicated by its AUC values. PSI and COVID-GRAM followed, with predictive power increasing as hospitalization duration progressed. Additionally, NEWS-2 exhibited the highest sensitivity (>96% in all periods) but showed low specificity, which increased from 22.9% at admission to 58.1% by day 8. PSI displayed good predictive capacity from admission to day 6 and excellent predictive power at day 8 and its sensitivity remained >80% throughout all periods, with moderate specificity (70.6-77.3%). COVID-GRAM demonstrated good predictive capacity across all periods, with high sensitivity (84.2-87.3%) but low-to-moderate specificity (61.5-67.6%). The qSOFA index initially had poor predictive power upon admission but improved after 4 days. FIB-4 had a statistically significant predictive capacity in all periods (P=0.001), but with limited clinical value (AUC, 0.639-0.698), and with low sensitivity and specificity. MuLBSTA and IKIRBY exhibited low predictive power at admission and no power after 6 days. In conclusion, in COVID-19 patients with high mortality rates, NEWS-2 and PSI consistently exhibited predictive power for death during hospital stay, with PSI demonstrating the best balance between sensitivity and specificity.
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Affiliation(s)
- Martha A. Mendoza-Hernandez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
- COVID Unit, General Hospital Number 1, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
| | | | | | - Fabian Rojas-Larios
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Jose Guzman-Esquivel
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
| | - Iram P. Rodriguez-Sanchez
- Molecular and Structural Physiology Laboratory, School of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza 66455, Mexico
| | - Margarita L. Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico
| | - Martha I. Cardenas-Rojas
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
| | - Luis De-Leon-Zaragoza
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
| | | | - Mercedes Fuentes-Murguia
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Héctor Ochoa-Díaz-López
- Department of Health, El Colegio de La Frontera Sur, San Cristóbal de Las Casas, 29290 Chiapas, Mexico
| | - Karmina Sánchez-Meza
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Ivan Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
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Liu CY, Chou SF, Chiang PY, Sun JT, Tsai KC, Jaw FS, Chang CT, Fan CM, Wu YH, Lee PY, Hsieh CY, Chen JM, Hsieh CC. The FIB-4 scores in the emergency department to predict the outcomes of COVID-19 patients in taiwan. Heliyon 2024; 10:e25649. [PMID: 38390148 PMCID: PMC10881524 DOI: 10.1016/j.heliyon.2024.e25649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Objective We aimed to determine the reliability of using the Fibrosis-4 (FIB-4) index in COVID-19 patients without underlying liver illness. Method We employed multivariate logistic regression to identify variables that exhibited statistically significant influence on the ultimate outcome. Multilayer perceptron analysis was employed to develop a prediction model for the FIB-4 index concerning ICU admission and intubation rates. However, the scarcity of cases rendered the assessment of the mortality rate unfeasible. We plotted ROC curves to analyze the predictive strength of the FIB-4 index across various age groups. Result In univariate logistic regression, only the FIB-4 index and respiratory rate demonstrated statistical significance on all poor outcomes. The FIB-4 index for mortality prediction had an ROC and AUC of 0.863 (95% CI: 0.781-0.9444). It demonstrates predictive power across age groups, particularly for age ≥65 (AUC: 0.812, 95% CI: 0.6571-0.9673) and age <65 (AUC: 0.878, 95% CI: 0.8012-0.9558). Its sensitivity for intubation and ICU admission prediction is suboptimal. Conclusion FIB-4 index had promising power in prediction of mortality rate in all age groups.
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Affiliation(s)
- Chia-Yu Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - San-Fang Chou
- Department of Medical Research, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Ying Chiang
- Division of Hospital Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuang-Chau Tsai
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fu-Shan Jaw
- Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan
| | - Chung-Ta Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
| | - Chieh-Min Fan
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yuan-Hui Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Peng-Yu Lee
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chia-Ying Hsieh
- Department of Medical Education, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jie-Ming Chen
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-Chieh Hsieh
- Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
- Department of Emergency Medicine, Ten Chan General Hospital, Zhongli Dist, Taoyuan City, Taiwan
- International Bachelor Program in Electrical and Communication Engineering, Yuan Ze University, Taoyuan, Taiwan
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Sartorio A, Burrei G, Cristin L, Zoncapè M, Carlin M, Tadiello E, Minuz P, Dalbeni A, Romano S. QTc Prolongation to Predict Mortality in Patients Admitted with COVID-19 Infection: An Observational Study. Curr Vasc Pharmacol 2024; 22:106-121. [PMID: 38073101 DOI: 10.2174/0115701611250248231114114557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 06/14/2024]
Abstract
BACKGROUND Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes Coronavirus disease 2019 (COVID-19), characterized by pulmonary infection ranging from asymptomatic forms to respiratory insufficiency and death. Evidence of cardiac involvement in COVID-19 is increasing, and systemic inflammation or direct heart damage by SARS-CoV-2 can prolong the corrected QT interval (QTc). METHODS In this observational study, a total of 333 consecutive patients admitted to the Covid Center of Verona University Hospital from November 2020 to April 2021 were included. Patients with bundle branch block, pacemaker-controlled heart rhythm and heart rate >120 beats/min were excluded. A complete electrocardiogram (ECG) was performed at admission, and QTc values of ≥440 ms for males and ≥460 ms for females were considered prolonged. RESULTS Overall, 153 patients had prolonged QTc (45.5%). In multivariate logistic regression analysis, male sex (odds ratio (OR)=6.612, p=0.046), troponin (OR=1.04, p=0.015) and lymphocyte count (OR=3.047, p=0.019) were independently associated with QTc prolongation. Multivariate logistic regression showed that QTc was independently associated with mortality (OR=4.598, p=0.036). Age, sex, the ratio between the partial pressure of oxygen (PaO2) and the fraction of inspired oxygen (FiO2) (P/F), and fibrosis-4 index for liver fibrosis (FIB-4) were also independently associated with mortality. CONCLUSION QTc interval prolongation appears to be a frequent finding in patients with COVID-19. Moreover, prolonged QTc may be predictive of more severe forms of COVID-19 and worse outcome.
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Affiliation(s)
- Andrea Sartorio
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Giulia Burrei
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Luca Cristin
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Mirko Zoncapè
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Michele Carlin
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Enrico Tadiello
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Pietro Minuz
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Andrea Dalbeni
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
| | - Simone Romano
- Division of Internal Medicine C, Department of Medicine, University of Verona, Italy
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5
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Wu PJ, Feng IC, Lai CC, Ho CH, Kan WC, Sheu MJ, Kuo HT. The mortality of hospitalized patients with COVID-19 and non-cirrhotic chronic liver disease: a retrospective multi-center study. PeerJ 2023; 11:e16582. [PMID: 38077441 PMCID: PMC10702333 DOI: 10.7717/peerj.16582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Background Patients with chronic liver disease (CLD) have a higher risk of mortality when infected with severe acute respiratory syndrome coronavirus 2. Although the fibrosis-4 (FIB-4) index, aspartate aminotransferase-to-platelet ratio index (APRI), and albumin-bilirubin grade (ALBI) score can predict mortality in CLD, their correlation with the clinical outcomes of CLD patients with coronavirus disease 2019 (COVID-19) is unclear. This study aimed to investigate the association between the liver severity and the mortality in hospitalized patients with non-cirrhotic CLD and COVID-19. Methods This retrospective study analyzed 231 patients with non-cirrhotic CLD and COVID-19. Clinical characteristics, laboratory data, including liver status indices, and clinical outcomes were assessed to determine the correlation between liver status indices and the mortality among patients with non-cirrhotic CLD and COVID-19. Results Non-survivors had higher levels of prothrombin time-international normalized ratio (PT-INR), alanine aminotransferase, aspartate aminotransferase, and high-sensitivity C-reactive protein (hs-CRP) and lower albumin levels. Multivariable analysis showed that ALBI grade 3 (odds ratio (OR): 22.80, 95% confidence interval (CI) [1.70-305.38], p = 0.018), FIB-4 index ≥ 3.25 (OR: 10.62, 95% CI [1.12-100.31], p = 0.039), PT-INR (OR: 19.81, 95% CI [1.31-299.49], p = 0.031), hs-CRP (OR: 1.02, 95% CI [1.01-1.02], p = 0.001), albumin level (OR: 0.08, 95% CI [0.02-0.39], p = 0.002), and use of vasopressors (OR: 4.98, 95% CI [1.27-19.46], p = 0.021) were associated with the mortality. Conclusion The ALBI grade 3 and FIB-4 index ≥ 3.25, higher PT-INR, hsCRP levels and lower albumin levels could be associated with mortality in non-cirrhotic CLD patients with COVID-19. Clinicians could assess the ALBI grade, FIB-4 index, PT-INR, hs-CRP, and albumin levels of patients with non-cirrhotic CLD upon admission.
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Affiliation(s)
- Pei-Jui Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - I-Che Feng
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Hospital Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Chih Kan
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jen Sheu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Miele L, Dajko M, Savino MC, Capocchiano ND, Calvez V, Liguori A, Masciocchi C, Vetrone L, Mignini I, Schepis T, Marrone G, Biolato M, Cesario A, Patarnello S, Damiani A, Grieco A, Valentini V, Gasbarrini A. Fib-4 score is able to predict intra-hospital mortality in 4 different SARS-COV2 waves. Intern Emerg Med 2023; 18:1415-1427. [PMID: 37491564 PMCID: PMC10412472 DOI: 10.1007/s11739-023-03310-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/10/2023] [Indexed: 07/27/2023]
Abstract
Increased values of the FIB-4 index appear to be associated with poor clinical outcomes in COVID-19 patients. This study aimed to develop and validate predictive mortality models, using data upon admission of hospitalized patients in four COVID-19 waves between March 2020 and January 2022. A single-center cohort study was performed on consecutive adult patients with Covid-19 admitted at the Fondazione Policlinico Gemelli IRCCS (Rome, Italy). Artificial intelligence and big data processing were used to retrieve data. Patients and clinical characteristics of patients with available FIB-4 data derived from the Gemelli Generator Real World Data (G2 RWD) were used to develop predictive mortality models during the four waves of the COVID-19 pandemic. A logistic regression model was applied to the training and test set (75%:25%). The model's performance was assessed by receiver operating characteristic (ROC) curves. A total of 4936 patients were included. Hypertension (38.4%), cancer (12.15%) and diabetes (16.3%) were the most common comorbidities. 23.9% of patients were admitted to ICU, and 12.6% had mechanical ventilation. During the study period, 762 patients (15.4%) died. We developed a multivariable logistic regression model on patient data from all waves, which showed that the FIB-4 score > 2.53 was associated with increased mortality risk (OR = 4.53, 95% CI 2.83-7.25; p ≤ 0.001). These data may be useful in the risk stratification at the admission of hospitalized patients with COVID-19.
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Affiliation(s)
- Luca Miele
- Dipartimento di Scienze Mediche e Chirurgiche (DiSMeC), Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, 8, Largo Gemelli, 00168 Rome, Italy
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marianxhela Dajko
- Dipartimento di Scienze Mediche e Chirurgiche (DiSMeC), Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, 8, Largo Gemelli, 00168 Rome, Italy
| | - Maria Chiara Savino
- Department Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Nicola D. Capocchiano
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentino Calvez
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Liguori
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Carlotta Masciocchi
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Vetrone
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Irene Mignini
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Tommaso Schepis
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Marrone
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marco Biolato
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Alfredo Cesario
- Gemelli Digital Medicine and Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Patarnello
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Damiani
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Grieco
- Dipartimento di Scienze Mediche e Chirurgiche (DiSMeC), Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, 8, Largo Gemelli, 00168 Rome, Italy
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Department Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Dipartimento di Scienze Mediche e Chirurgiche (DiSMeC), Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, 8, Largo Gemelli, 00168 Rome, Italy
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gemelli against COVID Group
- Dipartimento di Scienze Mediche e Chirurgiche (DiSMeC), Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, 8, Largo Gemelli, 00168 Rome, Italy
- Department of Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
- Department Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Gemelli Generator Real World Data Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Gemelli Digital Medicine and Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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7
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Parajuli P, Sabo R, Alsaadawi R, Robinson A, French E, Sterling RK. Fibrosis-4 (FIB-4) index as a predictor for mechanical ventilation and 30-day mortality across COVID-19 variants. J Clin Transl Sci 2023; 7:e213. [PMID: 38028347 PMCID: PMC10643913 DOI: 10.1017/cts.2023.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Fibrosis-4 (FIB-4) index, a simple index that includes age, liver enzymes, and platelet count has been studied as a tool to identify patients at a risk of requiring mechanical ventilation due to its high negative predictive value. It is unknown if FIB-4 remains useful to predict the severity of respiratory disease requiring mechanical ventilation amongst new Coronavirus disease 2019 (COVID-19) variants and whether a relationship also exists between FIB-4 and 30-day mortality. The main objective was to determine if FIB-4 can predict mechanical ventilation requirements and 30-day mortality from COVID-19 across variants including Alpha, Delta, and Omicron. Methods This was a population-based, retrospective cohort analysis of 232,364 hospitalized patients in the National COVID-19 Cohort Collaborative between the age of 18-90 who tested positive for COVID-19 between April 27, 2020 and June 25, 2022. The primary outcome was association between FIB-4 and need for mechanical ventilation. Secondary measures included the association of FIB-4 with 30-day mortality. Results A FIB-4 > 2.67 had 1.8 times higher odds of requiring mechanical ventilation across all variants of COVID-19 (OR 1.81; 95% CI: [1.76, 1.86]). The area under the ROC curve showed high diagnostic accuracy with values ranging between 0.79 (Omicron wave) and 0.97 (delta wave). Increased FIB-4 was associated with 30-day mortality across the variates. Conclusion The FIB-4 was consistently associated with both increased utilization of mechanical ventilation and 30-day mortality among COVID-19 patients across all waves in both adjusted and unadjusted models. This provides a simple tool for risk-stratification for front-line health care professionals.
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Affiliation(s)
- Priyanka Parajuli
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy Sabo
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Rasha Alsaadawi
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Amanda Robinson
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Evan French
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard K. Sterling
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
- Division of Infectious Disease, Virginia Commonwealth University, Richmond, VA, USA
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8
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Çopur B, Sürme S, Tunçer G, Bayramlar OF. The Role of APRI, FIB-4, and SAD-60 Scores as Predictors of Mortality in COVID-19 Patients. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:144-152. [PMID: 38633008 PMCID: PMC10985813 DOI: 10.36519/idcm.2023.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/13/2023] [Indexed: 04/19/2024]
Abstract
Objective Predictors of mortality that indicate disease severity plays an important role in COVID-19 management and treatment decisions. This study aimed to investigate the association between fibrosis-4 (FIB-4) score, aspartate aminotransferase-to-platelet ratio index (APRI), and novel biomarker-based score (SAD-60) with mortality in COVID-19 patients treated in a tertiary hospital. Materials and Methods In this single-center retrospective study, patients ≥18 years of age who were admitted to our hospital for COVID-19 between December 1 and 31, 2021, were included. Patients were divided into two groups as deceased and survived. A comparative analysis was applied. Predictive abilities of the FIB-4, APRI, and SAD-60 scores for in-hospital mortality were evaluated. Results Of the 453 patients enrolled in the study, 248 (54.6%) were male, and the mean age was 52.2±14.7 years. Mortality was recorded in 39 (8.5%) of the patients. The median values of APRI (0.43 and 0.58; p=0.001), FIB-4 score (1.66 and 2.91; p<0.001), and SAD-60 (2 and 8.25; p<0.001) were higher in deceased patients than in survivors. The optimal cut-off value for predicting mortality in the receiver operating characteristic (ROC) curve analysis was 0.58 for APRI (sensitivity=56.4%, specificity=63.6%); 2.14 for FIB-4 score (sensitivity=79.5%, specificity=68.2%); 4.25 for SAD-60 (sensitivity=90%, specificity=73.8%). In Cox regression analysis with a model that included gender, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD), FIB-4 (hazard ratio [HR]=4.013, 95% confidence interval [CI]=1.643-9.803; p=0.002), and SAD-60 (HR=8.850, 95% CI=1.035-75.696; p=0.046) were independent risk factors for mortality. Conclusion SAD-60 and FIB-4 scores are easily applicable and may be used to predict mortality in COVID-19 patients.
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Affiliation(s)
- Betül Çopur
- Department of Infectious Diseases and Clinical Microbiology,
Haseki Training and Research Hospital, İstanbul, Turkey
| | - Serkan Sürme
- Department of Infectious Diseases and Clinical Microbiology,
Haseki Training and Research Hospital, İstanbul, Turkey
- Department of Medical Microbiology, Institute of Graduate
Studies, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gülşah Tunçer
- Department of Infectious Diseases and Clinical Microbiology,
Bilecik Training and Research Hospital, Bilecik, Turkey
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Masi D, Gangitano E, Criniti A, Ballesio L, Anzuini A, Marino L, Gnessi L, Angeloni A, Gandini O, Lubrano C. Obesity-Associated Hepatic Steatosis, Somatotropic Axis Impairment, and Ferritin Levels Are Strong Predictors of COVID-19 Severity. Viruses 2023; 15:v15020488. [PMID: 36851702 PMCID: PMC9968194 DOI: 10.3390/v15020488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The full spectrum of SARS-CoV-2-infected patients has not yet been defined. This study aimed to evaluate which parameters derived from CT, inflammatory, and hormonal markers could explain the clinical variability of COVID-19. We performed a retrospective study including SARS-CoV-2-infected patients hospitalized from March 2020 to May 2021 at the Umberto I Polyclinic of Rome. Patients were divided into four groups according to the degree of respiratory failure. Routine laboratory examinations, BMI, liver steatosis indices, liver CT attenuation, ferritin, and IGF-1 serum levels were assessed and correlated with severity. Analysis of variance between groups showed that patients with worse prognoses had higher BMI and ferritin levels, but lower liver density, albumin, GH, and IGF-1. ROC analysis confirmed the prognostic accuracy of IGF-1 in discriminating between patients who experienced death/severe respiratory failure and those who did not (AUC 0.688, CI: 0.587 to 0.789, p < 0.001). A multivariate analysis considering the degrees of severity of the disease as the dependent variable and ferritin, liver density, and the standard deviation score of IGF-1 as regressors showed that all three parameters were significant predictors. Ferritin, IGF-1, and liver steatosis account for the increased risk of poor prognosis in COVID-19 patients with obesity.
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Affiliation(s)
- Davide Masi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Elena Gangitano
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Criniti
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Laura Ballesio
- Department of Radiology, Anatomo–Pathology and Oncology, Sapienza University of Rome, 00185 Rome, Italy
| | - Antonella Anzuini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Luca Marino
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00185 Rome, Italy
- Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, Policlinico “Umberto I”, 00161 Rome, Italy
| | - Lucio Gnessi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
- Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, Policlinico “Umberto I”, 00161 Rome, Italy
| | - Orietta Gandini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
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Ruggeri P, Esquinas A. Fibrosis‑4 (FIB‑4) index and mortality in COVID‑19 patients admitted to the emergency department: a new interesting predictive index for patients with COVID-19 disease? Intern Emerg Med 2022; 17:2451-2452. [PMID: 35962270 PMCID: PMC9374285 DOI: 10.1007/s11739-022-03067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Paolo Ruggeri
- Pulmonology Unit, Department of Biomedical and Dental Sciences, Morphological and Functional Images (BIOMORF), University of Messina, Via Consolare Valeria 100, 98125, Messina, Italy.
| | - Antonio Esquinas
- Department of Intensive Care and Noninvasive Ventilatory Unit, Intensive Care Unit, Hospital Morales Meseguer Murcia, Murcia, Spain
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