State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Cardiology, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Science, Beijing, China.
Liver Int. 2021 Jun;41(6):1294-1304. doi: 10.1111/liv.14780. Epub 2021 Jan 10.
BACKGROUND & AIMS: Liver fibrosis score (LFS) has been used for predicting the cardiovascular outcomes (CVOs) in diverse populations. However, the association of LFS with CVOs in patients with previous myocardial infarction (MI) remains undetermined. We aimed to examine the prognostic value of LFS in patients with prior MI in a prospective cohort.
A total of 3718 patients with previous MI were consecutively enrolled from March 2009 to January 2019. Five LFSs including the fibrosis-4 (FIB-4) score, non-alcohol fatty liver disease fibrosis score (NFS), Forns score, HUI score and BARD score were used. The CVOs covered major adverse cardiac event (MACEs), cardiovascular mortality and all-cause mortality. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).
During a mean follow-up of 47.4 ± 24.8 months, 431 (11.6%) MACEs occurred. Kaplan-Meier analysis demonstrated that higher LFSs resulted in a significantly higher probability of CVOs. Compared to the lowest score group, multivariable-adjusted HRs (95% CIs) of the highest group of FIB-4, NFS, Forns score, HUI score and BARD score were 1.75 (1.32-2.33), 2.37 (1.70-3.33), 2.44 (1.61-3.73), 1.58 (1.16-2.14) and 1.27 (1.03-1.57) respectively. These LFSs were also independent predictors of cardiovascular mortality and all-cause mortality. Similar results were observed across subgroups analysis. The addition of LFSs to a prediction model significantly increased the C-statistic for CVOs.
The present study firstly demonstrated that LFS could be used as a risk stratification tool for predicting CVOs in patients with previous MI, which should be evaluated further.
肝纤维化评分（LFS）已被用于预测不同人群的心血管结局（CVO）。然而，LFS 与既往心肌梗死（MI）患者 CVO 的相关性尚不确定。本研究旨在前瞻性队列中研究 LFS 在既往 MI 患者中的预后价值。
2009 年 3 月至 2019 年 1 月，连续纳入 3718 例既往 MI 患者。使用 5 种 LFS，包括纤维化 4 评分（FIB-4）、非酒精性脂肪性肝病纤维化评分（NFS）、Forns 评分、HUI 评分和 BARD 评分。CVO 包括主要不良心脏事件（MACE）、心血管死亡率和全因死亡率。Cox 比例风险模型计算风险比（HR）及其 95%置信区间（CI）。
平均随访 47.4±24.8 个月期间，发生 431 例（11.6%）MACE。Kaplan-Meier 分析表明，较高的 LFS 导致 CVO 的概率显著增加。与最低评分组相比，FIB-4、NFS、Forns 评分、HUI 评分和 BARD 评分的最高组的多变量调整 HR（95%CI）分别为 1.75（1.32-2.33）、2.37（1.70-3.33）、2.44（1.61-3.73）、1.58（1.16-2.14）和 1.27（1.03-1.57）。这些 LFS 也是心血管死亡率和全因死亡率的独立预测因子。亚组分析也观察到类似结果。LFS 的加入显著提高了 CVO 的预测模型的 C 统计量。
本研究首次证明 LFS 可作为预测既往 MI 患者 CVO 的风险分层工具，尚需进一步评估。
