Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital.
Division of Gastroenterology and Hepatology, Nippon Medical School.
Int Heart J. 2021 Jul 30;62(4):858-865. doi: 10.1536/ihj.20-793. Epub 2021 Jul 17.
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/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.
纤维化 4 指数（FIB4）可用于评估慢性肝脏疾病患者的肝纤维化程度。其计算公式为：（年龄×天门冬氨酸氨基转移酶[U/L]）/（血小板计数[10/μL]×√丙氨酸氨基转移酶[U/L]）。然而，FIB4 指数在急性心力衰竭（AHF）急性期的临床意义尚未得到充分研究。本研究共分析了 1468 例 AHF 患者。FIB4 指数的中位数为 2.71[1.85-4.22]。根据 FIB4 指数的四分位数（低 FIB4[Q1，≤1.847]、中 FIB4[Q2/Q3，1.848-4.216]和高 FIB4[Q4，≥4.216]组）将患者分为三组。Kaplan-Meier 曲线分析显示，高 FIB4 组的全因死亡率和 365 天内心力衰竭事件发生率明显低于中 FIB4 组和低 FIB4 组。多变量 Cox 回归模型确定高 FIB4 指数是 365 天全因死亡（危险比[HR]：1.660，95%可信区间：1.136-2.427）和心力衰竭事件（HR：1.505，95%可信区间：1.145-1.978）的独立预测因子。多变量逻辑回归分析显示，高血浆容量状态（PVS）（Q4，比值比[OR]：2.099，95%可信区间：1.429-3.082）、低收缩压（SBP）（<100mmHg，OR：3.825，95%可信区间：2.504-5.840）和低左心室射血分数（<40%，OR：1.321，95%可信区间：1.002-1.741）与高 FIB4 指数相关。高 FIB4 指数可预测 AHF 患者的不良预后，提示 AHF 急性期由于心输出量降低导致充血性肝和肝灌注不足。
