Association between FIB-4, all-cause mortality, cardiovascular mortality, and cardiovascular disease risk among diabetic individuals: NHANES 1999–2008

Abstract

BackgroundDiabetes is prevalent worldwide and is associated with cardiovascular disease (CVD). Furthermore, due to the insulin resistance, diabetic populations are vulnerable to liver fibrosis, which increases the risk of CVD. Fibrosis-4 index (FIB-4)—a non-invasive biomarker for liver fibrosis—is crucial in predicting CVD among patients with liver diseases. However, the association between FIB-4, death, and CVD in the US diabetic population has not yet been investigated.MethodWe conducted a cross-sectional study using the data from the National Health and Nutrition Examination Survey (NHANES) 1999–2008. The mortality status was obtained from the National Death Index through December 31, 2015. Participants were divided into survivor and mortality group to compare the basic characteristics. The association between FIB-4, death, and CVD was analyzed using the restricted cubic spline method and Cox proportional hazards models. In stratified analysis, Participants were stratified based on age, sex, BMI, hypertension, or eGFR respectively.ResultsThe participants (N = 3,471) were divided into survivor (N = 1,785) and mortality groups (N = 1,632), with the mortality group exhibiting significantly higher FIB-4 values. Moreover, the risk of all-cause mortality (HR 1.24; 95% CI, 1.17–1.32) and CVD mortality (HR 1.17; 95% CI, 1.04–1.31) increased with each FIB-4 SD increase after adjusting for all covariates. However, except for myocardial infarction, FIB-4 had no significant effect on the incidence of the other three CVD subtypes (congestive heart failure, coronary heart disease, and angina pectoris). In stratified analysis, we found that the effect of FIB-4 on CVD mortality was influenced by age, and FIB-4 is a risk factor for people older than 60 years (HR 1.14; 95% CI, 1.01–1.29).ConclusionUsing data from NHANES 1999–2008, FIB-4 was found to be associated with all-cause and CVD mortality in the diabetic population, and this association was significantly affected by age. However, FIB-4 only affected the incidence of myocardial infarction. Future work should investigate the association between FIB-4 and CVD in the diabetic population.

Liver Fibrosis Scores as Predictors of Blood-Culture-Positive and Sepsis in Patients with Klebsiella pneumoniae Liver Abscess

“…A recent study revealed that diabetic patients are more likely to develop liver fibrosis. 18 Our results showed that the most common underlying disease was diabetes mellitus, accounting for 50.7% and 50.0% of the blood culture-positive and sepsis groups, respectively. Insulin regulates glucose intake in the liver.…”

Prognostic Value of Fibrosis 4 (FIB-4) Index in Sepsis Patients

“…Around 55.48% of T2DM patients also have NAFLD. The prevalence of advanced liver fibrosis is notably higher in patients with both T2DM and NAFLD (17.02%) compared to those with only T2DM (4.80%) [22,23].…”

“…Furthermore, liver fibrosis can increase the risk of cardiovascular disease (CVD). Therefore, diabetic patients with liver fibrosis may face a significantly higher risk of developing CVD [22,24].…”

Evaluation of MASLD Fibrosis, FIB-4 and APRI Score in MASLD Combined with T2DM and MACCEs Receiving SGLT2 Inhibitors Treatment

“…Liver fibrosis, caused by abnormal liver fat metabolism, may lead to abnormal accumulation of liver fat, resulting in inflammation, glucose metabolism disorder and also eventually cause CVD occurrence to increase. 14 So, can fibrosis indicators predict the occurrence of MACCEs in clinic?…”