Liver fibrosis score predicts mortality in heart failure patients with preserved ejection fraction

Abstract

AimsHeart failure with preserved ejection fraction (HFpEF) has several pathophysiological aspects, including stiffness and/or congestion of multiple organs. Poor prognosis is expected in heart failure patients with liver stiffness, which has recently been assessed by non‐alcoholic fatty liver disease fibrosis score (NFS; based on aspartate aminotransferase to alanine aminotransferase ratio, platelet counts, and albumin). We aimed to investigate the impact of NFS on prognosis of HFpEF patients, with consideration for the peripheral collagen markers such as procollagen type III peptide (PIIIP), type IV collagen 7S, and hyaluronic acid.Methods and resultsWe performed a prospective observational study. Consecutive 492 hospitalized HFpEF patients were divided into four groups based on their NFS: first–fourth quartiles (n = 123). The fourth quartile group had the highest levels of PIIIP, type IV collagen 7S, hyaluronic acid, and B‐type natriuretic peptide (P<0.001 each). In addition, there were significant positive correlations between PIIIP, type IV collagen 7S, hyaluronic acid, B‐type natriuretic peptide, and NFS (P < 0.001 each). In the follow‐up period (mean 1107 days), 93 deaths occurred. All‐cause mortality increased in all four quartiles (8.1%, 12.2%, 23.6%, and 31.7%, P < 0.001). In the multivariable Cox proportional hazard analysis, NFS was an independent predictor of all‐cause mortality in the HFpEF patients.ConclusionsNFS, a novel indicator of liver fibrosis, correlates with circulating systemic markers of fibrosis and congestion and is associated with higher all‐cause mortality in HFpEF patients. NFS can be calculated simply and may be a useful tool to assess liver stiffness and prognosis in HFpEF patients.

Association between liver fibrosis and cognition in a nationally representative sample of older adults

“…Our findings build on this work by demonstrating the impact of liver fibrosis on cognition in a population-based, unselected sample using a liver fibrosis score that can be calculated from routine laboratory tests and that has been validated across a wide variety of underlying liver conditions. Conceptually, our findings are consistent with a growing understanding that liver fibrosis has implications for human biology and disease, irrespective of the underlying etiology, as has been observed for cerebrovascular disease and heart disease, for example [24,25,31]. Clinically, our approach takes into account Figure 1 Flow diagram of the study population for analysis of the association between liver fibrosis and cognitive measures in older adults.…”

“…We used the FIB-4 score because we previously observed that the prevalence of liver fibrosis by this score in NHANES correlates with other population-based prevalence estimates [23]. Our approach of examining liver fibrosis without consideration of the underlying etiology is consistent with other efforts to understand the role of liver fibrosis in human biology and disease [24][25][26]. The primary analysis treated the FIB-4 score as a continuous variable.…”

Accuracy of Noninvasive Scoring Systems in Assessing Risk of Death and Liver-Related Endpoints in Patients With Nonalcoholic Fatty Liver Disease

“…Our results differ somewhat to previous studies. [11][12][13][14][15][30][31][32] For example, compared with the paper by Angulo et al, 11 we found lower hazard ratios for both mortality and liver-related events and lower AUROCs for predicting the studied outcomes. This could be because differences in cohort characteristics.…”

Association of NAFLD Fibrosis Score with Subclinical Myocardial Remodeling in Patients with Type 2 Diabetes: A Cross-Sectional Study in China

“…Second, diagnosis of NAFLD was not included in the present study, precluding further analysis by stratifying the presence of NAFLD. However, NFS was previously shown to be associated with CVD and mortality in different population, regardless of the presence of NAFLD or not [8,15]. Third, liver biopsy was not taken in the evaluation of brosis.…”

“…Evidence has indicated that NFS is associated with coronary atherosclerosis and predicts cardiovascular events and mortality in subjects with NAFLD [12][13][14]. Further study revealed that NFS was also associated with cardiovascular mortality in different populations, including patients with heart failure or coronary artery disease and even in the general population, regardless of the presence of NAFLD [8,[13][14][15][16]. However, the relationship between NFS and CVD in type 2 diabetic subjects was rarely studied [10,17].…”