Hepatic injury biomarkers in COVID-19

Introduction and Objectives

: C-reactive protein (CRP) and D-dimer have been shown to be predictors of severity in patients with COVID-19. The FIB-4 and APRI scoring systems are tools calculated using routine laboratory parameters that allow non-invasive evaluation of liver fibrosis. Some studies have demonstrated that the parameters comprising these scores predict mortality in COVID-19. The objective of this study was to determine the role of various liver injury biomarkers in stratifying the severity of hospitalized patients with COVID-19.

Materials and Patients

Analytical and retrospective study. Patients with COVID-19 were included, while those with liver disease were excluded. A receiver operating characteristic (ROC) analysis with 95% confidence intervals (CI) was performed to determine the predictive performance of FIB-4, APRI, D-dimer, and CRP in terms of the need for invasive mechanical ventilation (IMV) and mortality.

Results

A total of 448 hospitalized patients with COVID-19 were included in the study. 68.2% were male, with a mean age of 56.27 ± 14.7 years. 35.1% had systemic arterial hypertension, 29.2% had diabetes mellitus, 6% had cancer, 5% had chronic obstructive pulmonary disease, and 3.3% had chronic kidney disease. 21.4% required nasal cannula support, 29.4% required mask with reservoir, 35.5% required high-flow oxygen therapy, and 13.1% required IMV. 48% had severe disease, and 28.1% died. ROC analysis with 95% CI revealed that the best predictor of the need for IMV was the FIB-4 index, with an AUC of 0.637 (95% CI 0.545 - 0.732, p= 0.003), followed by APRI with an AUC of 0.596 (95% CI 0.504-0.687, p=0.04). The best predictor of mortality was FIB-4 with an AUC of 0.689 (95% CI 0.620 - 0.785, p= <0.001), followed by D-dimer with an AUC of 0.608 (95% CI 0.528 - 0.688, p= 0.041).

Conclusions

The application of the FIB-4 index with a cutoff point of ≥1.9 predicts IMV and mortality in SARS-CoV-2 infection and is superior to the standard severity biomarkers (CRP and D-dimer).

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

None

Figure 1: ROC curves.

Table 1 Mortality and invasive mechanical ventilation markers in SARS-CoV-2: Analysis of ROC curves

Mortality
Marker	AUC	CI 95%	Cut-off point	Sensitivity	Specificity	P value
FIB-4	0.689	0.620-0.785	1.905	0.610	0.384	<0.001
APRI	0.569	0.493-0.645	0.605	0.429	0.308	0.066
CPR	0.572	0.493-0.651	184.50	0.494	0.312	0.055
D Dímer	0.608	0.528-0.688	747.50	0.455	0.236	0.041
Invasive mechanical ventilation
FIB-4	0.637	0.545-0.732	2.225	0.545	0.324	0.003
APRI	0.596	0.504-0.687	0.505	0.545	0.412	0.41
CPR	0.541	0.439-0.644	168.70	0.455	0.399	0.52
D Dímer	0.631	0.536-0.726	488.50	0.568	0.378	0.005