Fibrosis-4 index reflects right-sided filling pressure in patients with heart failure

Maeda, Daichi; Sakane, Kazushi; Ito, Takahide; Kanzaki, Yumiko; Sohmiya, Koichi; Hoshiga, Masaaki

doi:10.1007/s00380-019-01505-y

Cited by 22 publications

(38 citation statements)

References 27 publications

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“…The latest report by Maeda et al . 20 showed that FIB‐4 index could non‐invasively reflect right‐sided filling pressure and that event‐free rates were lower among patients with a high than a low FIB‐4 index in Kaplan–Meier analysis. However, HF patients in this report were not classified into new categories of HF such as HFrEF, HFmrEF and HFpEF.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of liver stiffness assessed by fibrosis‐4 index in patients with heart failure

et al. 2021

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Background Heart failure (HF)-related congestive hepatopathy is a well-recognized problem in management of HF. The fibrosis-4 (FIB4) index calculated by [age × aspartate aminotransferase (IU/L)/platelet count (10 9 /L) × square root of alanine aminotransferase (IU/L)] is useful for evaluating liver stiffness. We aimed to investigate the impact of the FIB4 index on prognosis in patients with HF. Methods and results Consecutive HF patients referred for hospitalization at Kumamoto University Hospital, Japan, were registered between 2006 and 2015. We observed cardiovascular outcomes in each type of HF [HF with reduced left ventricular ejection fraction (LVEF) (HFrEF), HF with mid-range LVEF (HFmrEF) and with preserved LVEF (HFpEF)] according to their FIB4 index; Group 1 (FIB4 index <1.3), Group 2 (FIB4 index: 1.3-2.67), and Group 3 (FIB4 index >2.67). This study enrolled 83 HFrEF patients, 117 HFmrEF patients, and 504 HFpEF patients. In HFpEF patients, the Kaplan-Meier curve revealed that Group 3 had a significantly higher rate of total cardiovascular events compared with the other two groups. By contrast, the occurrences of total cardiovascular events were not different among three groups in HFrEF and HFmrEF patients. Multivariate Cox proportional hazard analysis with significant factors in univariate analysis identified that the FIB4 index as an independent and significant predictor for future total cardiovascular events in HFpEF patients (hazard ratio: 1.09, 95% confidence interval: 1.03-1.15, P = 0.001). Conclusions The FIB4 index was a significant predictor for total cardiovascular events in HFpEF.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of liver stiffness assessed by fibrosis‐4 index in patients with heart failure

et al. 2021

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“…The FIB4 index value at discharge was reported to be associated with long-term mortality in patients with compensated HF after admission for worsening HF, which might be caused by the liver fibrosis. 11,12) Meanwhile, the FIB4 index during the acute phase of AHF was affected by the hemodynamics, such as congestive liver and/or liver hypoperfusion. It might not be able to evaluate the fibrosis and/or liver damage itself accurately.…”

Section: Importance Of the Fib4 Index In Ahfmentioning

confidence: 99%

“…7,8) High FIB4 index values are also recognized as a good predictor of adverse clinical outcomes in patients with non-hepatic disease. 9,10) Although the FIB4 index value at discharge was reported to be associated with long-term mortality in patients with compensated HF after admission for worsening HF, 11,12) the FIB4 index during the acute phase of AHF has not been reported.…”

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confidence: 99%

Clinical Significance of the Fibrosis-4 Index in Patients with Acute Heart Failure Requiring Intensive Care

et al. 2021

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The Fibrosis-4 (FIB4) index could indicate the liver fibrosis in patients with chronic hepatic diseases. It was calculated using the following formula: (age × aspartate aminotransferase [U/L]) / (platelet count [10 3 /μL] × alanine aminotransferase [U/L]). However, the clinical impact of the FIB4 index in the acute phase of acute heart failure (AHF) has not been sufficiently investigated.A total 1,468 AHF patients were analyzed. The median FIB4 index was 2.71 [1.85-4.22]. The patients were divided into three groups according to the quartiles of their FIB4 index (low-FIB4 [Q1, !1.847], middle-FIB4 [Q2/Q3, 1.848-4.216], and high-FIB4 [Q4, "4.216] groups). A Kaplan-Meier curve analysis showed that the prognosis, such as all-cause mortality and HF events within 365 days, was significantly poorer in the high-FIB4 group than in the middle-FIB4 and low-FIB4 groups. A multivariate Cox regression model identified high FIB4 index as an independent predictor of 365-day all-cause death (hazard ratio (HR): 1.660, 95% CI: 1.136-2.427) and HF events (HR: 1.505, 95% CI: 1.145-1.978). The multivariate logistic regression analysis showed that the high plasma volume status (PVS) (Q4, odds ratio [OR]: 2.099, 95% CI: 1.429-3.082), low systolic blood pressure (SBP) (< 100 mmHg, OR: 3.825, 95% CI: 2.504-5.840), and low left ventricular ejection fraction (< 40%, OR: 1.321, 95% CI: 1.002-1.741) were associated with a high FIB4 index.A high FIB4 index can predict adverse outcomes in AHF patients, which indicate that congestive liver and liver hypoperfusion occur due to low cardiac output in the acute phase of AHF.

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“…8 FIB-4 has also been shown to be a good prognostic marker of death or rehospitalization due to heart failure in patients with heart failure. [9][10][11] On the other hand, the fibrosis-5 (FIB-5) index, which is calculated using albumin, alkaline phosphatase (ALP), AST to ALT ratio, and PLT count, was recently proposed as a simple liver fibrosis marker. 12 The predictive value of FIB-5 for liver fibrosis was first validated in patients with HCV infection.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of the liver fibrosis marker fibrosis‐5 index in patients with acute heart failure

et al. 2022

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Aims Recently, liver fibrosis markers, such as the fibrosis-4 index (FIB-4), have been shown to be associated with prognosis in patients with heart failure. The fibrosis-5 (FIB-5) index, which assesses albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, is a simple liver fibrosis marker that was reported to be superior to FIB-4 for differentiation of liver fibrosis. This study aimed to compare the prognostic value of FIB-4 and FIB-5 in patients with heart failure. Methods and resultsThe FIB-4 and FIB-5 scores were calculated at discharge in 906 patients hospitalized with heart failure. The patients were stratified into three groups based on their FIB-5 scores: low (n = 303), middle (n = 301), and high (n = 302) FIB-5 groups. The primary endpoint was a composite of cardiac death or rehospitalization for heart failure. The low FIB-5 group was older and had larger inferior vena cava diameters and higher brain natriuretic peptide levels than the other two groups. The primary endpoint occurred in 156 (51.5%), 110 (36.5%), and 54 patients (17.9%) in the low, middle, and high FIB-5 groups, respectively (P < 0.001). On Cox proportional hazard analysis, the low FIB-5 was independently associated with the primary endpoint after adjustment for confounding factors. The association was consistent in both patients with preserved and reduced left ventricular ejection fraction (LVEF), and there was no significant interaction between LVEF phenotypes in terms of the prognostic impact of FIB-5 (P for interaction = 0.311). FIB-5 was superior to FIB-4 as a prognostic indicator of the primary endpoint (continuous net reclassification improvement, 0.530; 95% confidence interval [CI], 0.399-0.662; P < 0.001; integrated discrimination improvement, 0.072; 95% CI, 0.057-0.088; P < 0.001). Conclusions The FIB-5 is a useful risk stratification marker with better prognostic value than FIB-4 in patients hospitalized with heart failure.

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Fibrosis-4 index reflects right-sided filling pressure in patients with heart failure

Cited by 22 publications

References 27 publications

Prognostic significance of liver stiffness assessed by fibrosis‐4 index in patients with heart failure

Prognostic significance of liver stiffness assessed by fibrosis‐4 index in patients with heart failure

Clinical Significance of the Fibrosis-4 Index in Patients with Acute Heart Failure Requiring Intensive Care

Prognostic value of the liver fibrosis marker fibrosis‐5 index in patients with acute heart failure

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