Background: Emerging evidence suggests that liver dysfunction in the course of coronavirus disease 2019 (COVID-19) illness is a critical prognostic factor for mortality in COVID-19 patients, and the Fibrosis-4 (FIB-4) score, developed to reflect level of hepatic fibrosis, has been associated with adverse outcomes in hospitalized COVID-19 patients. This study aimed to investigate intensive care unit (ICU) admitted patients, a high-risk subpopulation, research on which is lacking. Materials and Methods: This retrospective cohort study examined FIB-4 scores and clinical endpoints including death, acute cardiac injury (ACI), acute kidney injury, and need for mechanical ventilation in critically ill COVID-19 patients, without prior hepatic disease, throughout ICU stay. Results: Of 60 patients enrolled, 35% had ICU admission FIB-4 >2.67. Among nonsurvivors, FIB-4 was significantly higher at admission (median 3.19 vs. 1.44; P < 0.001) and only a minority normalized 2.67 was associated with a median survival time of 18 days from ICU admission versus 40 days with FIB-4