Pozzobon Fernanda Manhães, Luiz Ronir Raggio, Parente Júlia Gomes, Guarilha Taísa Melo, Fontes Maria Paula Raymundo Cunha, Chindamo Maria Chiara, de Mello Perez Renata
Department of Internal Medicine, Barra D'Or Hospital, Rede D'Or São Luiz, Rio de Janeiro.
Health Assistance Division, Fluminense Federal University (UFF), Niterói.
Eur J Gastroenterol Hepatol. 2025 Aug 1;37(8):955-960. doi: 10.1097/MEG.0000000000002966. Epub 2025 Mar 13.
Fibrosis-4 (FIB-4) score and D-dimer (DD) have emerged as prognostic markers in coronavirus disease 2019 (COVID-19). However, precise cutoff points remain undefined, and their combined use has been scarcely studied. We aimed to analyze FIB-4 and DD performance, individually and combined, to predict outcomes among COVID-19 patients.
From March to December 2020, hospitalized COVID-19 patients were evaluated based on clinical and laboratory tests from their first day of hospitalization. Primary outcome was inhospital mortality, and secondary outcomes included hospital stay length, ICU admission and duration, need for hemodialysis, ventilatory support, and extent of lung involvement. Optimal FIB-4 and DD cutoff points to predict mortality were established to maximize sensitivity and specificity. A sequential diagnostic strategy using both markers was subsequently evaluated.
Among 518 patients (61 ± 16 years, 64% men), the inhospital mortality rate was 18%. FIB-4 outperformed DD in predicting mortality (area under the receiver operating characteristic curve: 0.76 vs. 0.65, P = 0.003) and was chosen as the first step in sequential analysis. Mortality was higher in patients with FIB-4 ≥1.76 vs. FIB-4 <1.76 (26 vs. 5%, P < 0.001) and DD ≥2000 ng/ml vs. DD <2000 ng/ml (38 vs. 16%, P < 0.001). Using FIB-4 as a screening test (cutoff = 1.76, 90% sensitivity) followed by DD (cutoff = 2000 ng/ml; 90% specificity) identified a subgroup with higher mortality when compared with FIB-4 alone (48 vs. 26%, P < 0.001), missing the identification of only 2% of deaths.
Sequential use of FIB-4 and DD represents a comprehensive strategy to identify high-risk COVID-19 patients at hospital admission, potentially minimizing unnecessary DD tests in those deemed low-risk by FIB-4.
纤维化-4（FIB-4）评分和D-二聚体（DD）已成为2019冠状病毒病（COVID-19）的预后标志物。然而，确切的临界值仍未明确，且它们的联合应用很少被研究。我们旨在分析FIB-4和DD单独及联合使用时预测COVID-19患者预后的性能。
2020年3月至12月，对住院的COVID-19患者从住院首日起进行临床和实验室检查评估。主要结局是住院死亡率，次要结局包括住院时间、入住重症监护病房（ICU）情况及时间、血液透析需求、通气支持需求和肺部受累程度。确定预测死亡率的最佳FIB-4和DD临界值，以最大化敏感性和特异性。随后评估使用这两种标志物的序贯诊断策略。
在518例患者（61±16岁，64%为男性）中，住院死亡率为18%。FIB-4在预测死亡率方面优于DD（受试者操作特征曲线下面积：0.76对0.65，P = 0.003），并被选为序贯分析的第一步。FIB-4≥1.76的患者死亡率高于FIB-4<1.76的患者（26%对5%，P<0.001），DD≥2000 ng/ml的患者死亡率高于DD<2000 ng/ml的患者（38%对16%，P<0.001）。以FIB-4作为筛查试验（临界值 = 1.76，敏感性90%），随后以DD（临界值 = 2000 ng/ml；特异性90%）进行检测，与单独使用FIB-4相比，识别出一个死亡率更高的亚组（48%对26%，P<0.001），仅漏诊2%的死亡病例。
序贯使用FIB-4和DD是一种在入院时识别高危COVID-19患者的综合策略，可能会减少对那些被FIB-4判定为低风险患者进行不必要的DD检测。
