Background: Simple tests of routine data are needed in those with coronavirus 2 (SARS-CoV-2) 2019, or COVID-19 to help identify those you may need mechanical ventilation (MV). Objective: To determine if FIB-4 is associated need for MV in a multi-ethnic, national cohort of patients with COVID-19 and if so, to determine the optimal FIB-4 cutoff. Patients and Methods: This was a retrospective national cohort study of adults seen in an ambulatory or emergency department setting diagnosed with COVID-19 identified using the TriNetX platform. Measures included demographics, comorbid diseases, and routine laboratory tests. Results: A total of 4901 patients with COVID-19 were included: mean age was 56, 48% female, 42% obese, 38% White, 40% Black, cardiac disease 15%, diabetes mellitus (DM) 39%, liver disease 20%, and respiratory disease 50%. Need for MV was 6%. The optimal cutoff FIB-4 for need for mechanical ventilation was 3.04 (AUC 0.735) which had a sensitivity, specificity, positive and negative predictive values of 42%, 77%, 11%, and 95%, respectively with 93% accuracy. When stratified by race, increased FIB-4 remained associated with need for mechanical ventilation in both Whites and Blacks. Conclusions: FIB-4 can be used by front line providers to identify which patients may require MV.