Guo Ziyu, Ye Zixiang, Xu Qinfeng, Li Yike, Zheng Jingang
Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, China-Japan Friendship Hospital, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Clin Transl Sci. 2024 Dec;17(12):e70104. doi: 10.1111/cts.70104.
The aim of this study was to examine the relationship of liver fibrosis (determined via fibrosis scores) with all-cause mortality and cardiovascular mortality in HF patients. The study examined demographic and clinical data were collected from NHANES database (1999 to 2018). A total of 1356 HF patients were enrolled in our analysis. During a median follow-up time of 70 months, 455 patients died. Compared to the survivors, the death group showed significantly elevated LFSs levels. RCS analysis revealed a linear relationship between various LFSs and all-cause and cardiovascular mortality. KM curves and Cox regression models indicated that higher FIB-4 (≥ 1.637), NFS (≥ -0.064), and AST/ALT ratio (≥ 1.172) were linked to higher risk of all-cause mortality [Cox model 2: FIB-4 adjusted hazard ratio (aHR), 1.24; 95% CI, 1.04-1.48; NFS aHR, 1.19; 95% CI, 1.01-1.38; AST/ALT ratio aHR, 1.25; 95% CI, 1.07-1.47] and cardiovascular mortality in heart failure patients (FIB-4 aHR, 1.28; 95% CI, 1.07-1.67; AST/ALT ratio aHR, 1.39; 95% CI, 1.08-1.79). ROC curves indicated that FIB-4, NFS, and the AST/ALT ratio were important predicators of all-cause mortality (AUC: 0.715, 0.707, and 0.715, respectively) and cardiovascular mortality (AUC: 0.658, 0.657, and 0.659, respectively) in heart failure patients. Random survival forests showed that FIB-4, AST/ALT ratio, and NFS emerged as important factors potentially influencing mortality of HF. Consistent associations were observed in subgroup analysis. Liver fibrosis scores (FIB-4, NFS, and AST/ALT ratio) were strongly linked to all-cause and cardiovascular mortality in heart failure patients.
本研究的目的是探讨肝纤维化（通过纤维化评分确定）与心力衰竭（HF）患者全因死亡率和心血管死亡率之间的关系。该研究对从美国国家健康与营养检查调查（NHANES）数据库（1999年至2018年）收集的人口统计学和临床数据进行了分析。共有1356例HF患者纳入我们的分析。在中位随访时间70个月期间，有455例患者死亡。与幸存者相比，死亡组的肝纤维化评分（LFSs）水平显著升高。限制立方样条（RCS）分析显示，各种LFSs与全因死亡率和心血管死亡率之间存在线性关系。Kaplan-Meier（KM）曲线和Cox回归模型表明，较高的FIB-4（≥1.637）、NFS（≥ -0.064）和AST/ALT比值（≥1.172）与全因死亡风险较高相关[Cox模型2：FIB-4校正风险比（aHR），1.24；95%置信区间（CI），1.04 - 1.48；NFS aHR，1.19；95%CI，1.01 - 1.38；AST/ALT比值aHR，1.25；95%CI，1.07 - 1.47]，并且与心力衰竭患者的心血管死亡率相关（FIB-4 aHR，1.28；95%CI，1.07 - 1.67；AST/ALT比值aHR，1.39；95%CI，1.08 - 1.79）。受试者工作特征（ROC）曲线表明，FIB-4、NFS和AST/ALT比值是心力衰竭患者全因死亡率（AUC分别为：0.715、0.707和0.715）和心血管死亡率（AUC分别为：0.658、0.657和0.659）的重要预测指标。随机生存森林分析表明，FIB-4、AST/ALT比值和NFS是可能影响HF患者死亡率的重要因素。在亚组分析中观察到一致的关联。肝纤维化评分（FIB-4、NFS和AST/ALT比值）与心力衰竭患者的全因死亡率和心血管死亡率密切相关。
