纤维化-5 指数联合 C 反应蛋白对急性失代偿性心力衰竭患者的预后价值。
Prognostic value of fibrosis-5 index combined with C-reactive protein in patients with acute decompensated heart failure.
机构信息
Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, 210008, Jiangsu, China.
Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, China.
出版信息
BMC Cardiovasc Disord. 2023 Oct 4;23(1):492. doi: 10.1186/s12872-023-03530-2.
BACKGROUND
Fibrosis-5 (FIB-5) index is a marker of liver fibrosis and has been shown to have a good prognostic value for patients with acute heart failure (AHF), and C-reactive protein (CRP) has inflammatory properties and predicts adverse prognosis in patients with HF. However, the long-term prognostic value of FIB-5 index combined with CRP in patients with acute decompensated HF (ADHF) is yet unclear.
METHODS
This retrospective study included 1153 patients with ADHF hospitalized from January 2018 to May 2022.The FIB-5 index was calculated as (albumin [g/L]×0.3 + PLT count [10/L]×0.05)-(ALP [U/L]×0.014 + AST to ALT ratio×6 + 14). Patients were stratified into the following four groups according to the median value of FIB-5 index (=-2.11) and CRP (= 4.5): Group 1 had a high FIB-5 index (FIB-5 index >-2.11) and a low CRP (CRP ≤ 4.5); Group 2 had both low FIB-5 index and low CRP; Group 3 had both high FIB-5 index and high CRP; Group 4 had a low FIB-5 index (FIB-5 index ≤-2.11) and a high CRP (CRP > 4.5). The endpoint was major adverse cardiac and cerebral events (MACCEs). Multivariate Cox analysis was used to evaluate the association of the combination with the development of MACCEs. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analysis were used to compare the accuracy of the combination with a single prognostic factor for predicting the risk of MACCEs.
RESULTS
During the mean follow-up period of 584 ± 12 days, 488 (42.3%) patients had MACCEs. Kaplan-Meier analysis revealed that the incidence of MACCEs was different in the four groups (P < 0.001). After adjusting for the confounding factors, the hazard ratio (HR) for MACCEs in Group 4 (low FIB-5 index + high CRP) was the highest (Model 1, HR = 2.04, 95%CI 1.58-2.65, P < 0.001; Model 2, HR = 1.67, 95%CI 1.28-2.18, P < 0.001; Model 3, HR = 1.66, 95%CI: 1.27-2.17, P < 0.001). Additionally, the combination of FIB-5 index and CRP enabled more accurate prediction of MACCEs than FIB-5 index alone (NRI, 0.314,95%CI 0.199-0.429; P < 0.001; IDI, 0.023; 95% CI 0.015-0.032; P < 0.001).
CONCLUSIONS
In patients with ADHF, the combination of the FIB-5 index and CRP may be useful in risk stratification in the future.
背景
纤维化-5 （FIB-5）指数是肝纤维化的标志物，已被证明对急性心力衰竭（AHF）患者具有良好的预后价值，C 反应蛋白（CRP）具有炎症特性，并预测心力衰竭患者的不良预后。然而，FIB-5 指数联合 CRP 对急性失代偿性心力衰竭（ADHF）患者的长期预后价值尚不清楚。
方法
本回顾性研究纳入了 2018 年 1 月至 2022 年 5 月期间因 ADHF 住院的 1153 例患者。FIB-5 指数的计算方法为（白蛋白[g/L]×0.3+血小板计数[10/L]×0.05）-（ALP[U/L]×0.014+AST 与 ALT 比值×6+14）。根据 FIB-5 指数（=-2.11）和 CRP（=4.5）的中位数，患者被分为以下四组：第 1 组 FIB-5 指数高（FIB-5 指数>-2.11）且 CRP 低（CRP≤4.5）；第 2 组 FIB-5 指数和 CRP 均低；第 3 组 FIB-5 指数和 CRP 均高；第 4 组 FIB-5 指数低（FIB-5 指数≤-2.11）且 CRP 高（CRP>4.5）。终点为主要不良心脑事件（MACCEs）。多变量 Cox 分析用于评估组合与 MACCEs 发展的相关性。净重新分类改善（NRI）和综合判别改善（IDI）分析用于比较组合与单一预后因素预测 MACCEs 风险的准确性。
结果
在平均随访 584±12 天期间，488 例（42.3%）患者发生 MACCEs。Kaplan-Meier 分析显示，四组患者 MACCEs 的发生率不同（P<0.001）。在调整混杂因素后，第 4 组（低 FIB-5 指数+高 CRP）发生 MACCEs 的风险比（HR）最高（模型 1，HR=2.04，95%CI 1.58-2.65，P<0.001；模型 2，HR=1.67，95%CI 1.28-2.18，P<0.001；模型 3，HR=1.66，95%CI：1.27-2.17，P<0.001）。此外，FIB-5 指数和 CRP 的组合比 FIB-5 指数单独预测 MACCEs 更准确（NRI，0.314，95%CI 0.199-0.429；P<0.001；IDI，0.023；95%CI 0.015-0.032；P<0.001）。
结论
在 ADHF 患者中，FIB-5 指数和 CRP 的组合可能有助于未来的风险分层。
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