The Association between the Fibrosis-4 Index and COVID-19: A Systematic Review and Meta-Analysis

Objective. The prognosis value of fibrosis-4 score (FIB-4) in COVID-19 is controversial. Hence, we conducted a systematic review and meta-analysis to investigate the association between the FIB-4 index and COVID-19 disease progression. Methods. We performed meta-analysis using the PubMed, Embase, and Cochrane databases. A fixed-or random-effects model was used for evaluating heterogeneity. Results. Thirteen studies were included. The meta-analysis of unadjusted results showed that compared to lower FIB-4 index, patients with higher FIB-4 index had increased odds of mortality (OR=5.1, 95%CI 3.67-7.09; P < 0.001), ICU admission (OR=2.32, 95%CI: 1.65-3.25, P < 0.00001) and need for mechani-cal ventilator support (OR=3.51, 95%CI: 2.1-5.85, P < 0.001). In addition, the meta-analysis of adjusted results showed patients with higher FIB-4 index was associated with increased risk of mortality (OR=3.01, 95%CI: 2.21-4.09, P < 0.001) and need for mechanical ventilator support (OR=3.76, 95%CI: 2.08-6.82, P < 0.001) compared to patients with lower FIB-4 index. Conclusion. This meta-analysis indicated that high FIB-4 index score was associated with the severity and mortality in COVID-19 infected patients.