The fibrosis‐4 score is associated with long‐term mortality in different phenotypes of acute heart failure

Abstract

Background Fibrosis‐4 score (FIB4) was a non‐invasive surrogate to estimate the amount of liver scarring in chronic hepatitis. Considering the presence of increased central venous pressure and congestive hepatopathy in patients with decompensated heart failure, we therefore investigated the prognostic values of FIB4 in acute heart failure (AHF) patients. Method Patients hospitalised primarily for HF were drawn from an intramural registry. FIB4 was calculated according to age, aspartate aminotransferase, alanine aminotransferase and platelet count. All‐cause mortality up to 5 years after discharge was obtained by linking to the national death registry. Results Among a total of 1854 participants, 940 patients died during a mean follow‐up of 28.3 ± 21.8 months. FIB4 score was related to mortality and the composite of cardiovascular death or HF rehospitalisation, independent of age, sex, left ventricular ejection fraction, left atrial dimension, sodium and haemoglobin levels, estimated glomerular filtration rate, comorbidities, and medications [hazard ratio and 95% confidence interval of mortality: 1.009 (1.002–1.015), and the composite of cardiovascular death or HF hospitalisation: 1.020 (1.010–1.031)]. The prognostic value of FIB4 was predominantly in the subjects with heart failure and preserved or mildly reduced ejection fraction (HFpEF and HFmrEF), or coronary artery disease (CAD) than the counterparts [interaction p‐value <0.001, and 0.004, respectively]. Conclusions FIB4 was an independent predictor of survival in AHF patients, irrespective of the phenotypes of HF. The higher predictive value of mortality of FIB4 was observed in the subjects with HFpEF, HFmrEF or CAD.

Liver stiffness as a cornerstone in heart disease risk assessment

“…53 The predictive role of the FIB-4 index for mortality in acute HF was investigated in 1854 patients and seemed to be limited to patients with HFpEF (HR per SD: 1.069, 95% CI: 1.047-1.092) and HFmrEF (HR per SD: 1.036, 95% CI: 1.002-1.072), and not of use in HFrEF (HR per SD: 1.005, 95% CI: 0.997-1.012). 54 Yet, if MASLD-related fibrosis apart from fluid overload potently contributes to the exacerbation of acute HF remains to be clarified, especially considering that VCTE-determined liver stiffness was found to decrease along with N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels during hospitalization in patients with acute decompensated HF. 55 This has been substantiated in a study including 877 patients hospitalized for acute HF that separated the cohort based on the reduction of FIB-4 index during hospitalization (low (<1.0%, n = 293), middle (1.0%-27.4%, n = 292), and high (>27.4%, n = 292) reduction of FIB-index).…”

“…Therefore, the determination of liver stiffness using NITs in acute HF could predict short‐term prognosis 53,54,56,57 and can help inform about adequate venous decongestion prior to discharge 58,59 …”

“…The authors showed that patients from the low (HR: 2.16, 95% CI: 1.41-3.32, p < .001) and middle (HR: 1.70, 95% CI: 1.10-2.63) group were at an increased risk to die from all causes or to get rehospitalized because of HF within 180 days compared with patients from the high reduction in FIB-4 index group. 56 Therefore, the determination of liver stiffness using NITs in acute HF could predict short-term prognosis 53,54,56,57 and can help inform about adequate venous decongestion prior to discharge. 58,59 3 | C ARDIAC ARRHY THMIA S Most evidence linking MASLD to cardiac arrhythmias is present for atrial fibrillation (AF), although associations exist as well for ventricular arrhythmias and cardiac conduction defects.…”

“…Elderly patients with MASLD admitted for acute HF showed to be especially at risk for mortality when having MASLD‐fibrosis (determined using ultrasonography, FIB‐4 index, and aspartate aminotransferase (AST) to platelet ratio index (APRI)), suggesting a role to also measure liver stiffness in the context of acute HF 53 . The predictive role of the FIB‐4 index for mortality in acute HF was investigated in 1854 patients and seemed to be limited to patients with HFpEF (HR per SD: 1.069, 95% CI: 1.047–1.092) and HFmrEF (HR per SD: 1.036, 95% CI: 1.002–1.072), and not of use in HFrEF (HR per SD: 1.005, 95% CI: 0.997–1.012) 54 …”

Hepatocyte-specific CCAAT/enhancer binding protein α restricts liver fibrosis progression

“…Growing clinical evidence revealed that liver fibrosis is a main determinant of outcomes or all-cause mortality in liver disease ( 1 – 6 ). Metabolic dysfunction–associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), could progress to metabolic dysfunction–associated steatohepatitis (MASH), previously known as nonalcoholic steatohepatitis (NASH), accompanied with liver fibrosis occurrence ( 7 ).…”