Boeckmans Joost, Prochaska Jürgen H, Gieswinkel Alexander, Böhm Michael, Wild Philipp S, Schattenberg Jörn M
Metabolic Liver Research Center, I. Department of Medicine, University Medical Center Mainz, Mainz, Germany.
In Vitro Liver Disease Modelling Team, Department of In Vitro Toxicology and Dermato-Cosmetology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Lancet Reg Health Eur. 2024 Nov 30;48:101153. doi: 10.1016/j.lanepe.2024.101153. eCollection 2025 Jan.
The liver-heart axis potentially influences the risk of mortality in patients with heart failure. We aimed to identify the clinical utility of the fibrosis-4 (FIB-4) index in patients with heart failure for predicting mortality in the context of metabolic dysfunction-associated steatotic liver disease (MASLD).
Patients with heart failure and a subsample of healthy participants were enrolled in the MyoVasc study (NCT04064450) and followed for nine years. Participants with excessive alcohol consumption were excluded. The Fatty Liver Index (FLI) and FIB-4 index were used to classify MASLD and hepatic fibrosis, respectively. Data were adjusted for potential confounders. The primary endpoint was all-cause mortality.
2726 participants, including 172 healthy individuals, were included in the study. The participants had a mean age of 64.4 ± 11.2 years and a median FIB-4 index of 1.59 (interquartile range [1.17; 2.17]). There were 532 deaths. The FIB-4 index was predictive for all-cause mortality (hazard ratio (HR) 1.341, 95% confidence interval (CI) [1.273; 1.412], p < 0.0001). The HRs and 95% CIs for the FIB-4 index in FLI categories were 1.597 [1.256; 2.031] (p = 0.00013, FLI <30), 1.802 [1.519; 2.138] (p < 0.0001, FLI 30-60), and 1.292 [1.215; 1.374] (p < 0.0001, FLI ≥60). The interaction term for the FIB-4 index with FLI ≥60 (reference FLI <30) was HR 0.774 [0.617; 0.972] (p = 0.027), indicating a smaller impact of the FIB-4 index in FLI ≥60 than in FLI <30 (HR 1.664 [1.333; 2.077], p < 0.0001). Multivariable linear regressions revealed relevant independent relationships between the FIB-4 index and N-terminal pro-B-type natriuretic peptide, systolic dysfunction, diastolic dysfunction and left ventricular hypertrophy in participants with a FLI below 60.
In patients with heart failure, the FIB-4 index predicts all-cause mortality and relates to cardiac functional and structural changes, especially in those without MASLD.
Johannes Gutenberg-University Mainz.
肝-心轴可能影响心力衰竭患者的死亡风险。我们旨在确定纤维化-4（FIB-4）指数在心力衰竭患者中，对于预测代谢功能障碍相关脂肪性肝病（MASLD）背景下死亡率的临床实用性。
心力衰竭患者及健康参与者的一个子样本被纳入MyoVasc研究（NCT04064450），并随访9年。排除有过量饮酒的参与者。脂肪肝指数（FLI）和FIB-4指数分别用于对MASLD和肝纤维化进行分类。对数据进行潜在混杂因素调整。主要终点是全因死亡率。
2726名参与者，包括172名健康个体，被纳入研究。参与者的平均年龄为64.4±11.2岁，FIB-4指数中位数为1.59（四分位间距[1.17；2.17]）。有532例死亡。FIB-4指数可预测全因死亡率（风险比（HR）1.341，95%置信区间（CI）[1.273；1.412]，p<0.0001）。FLI各分类中FIB-4指数的HR及95%CI分别为1.597[1.256；2.031]（p=0.00013，FLI<30）、1.802[1.519；2.138]（p<0.0001，FLI 30 - 至60）和1.292[1.215；1.374]（p<0.0001，FLI≥60）。FIB-4指数与FLI≥60（参照FLI<30）的交互项为HR 0.774[0.617；0.972]（p=0.027），表明FIB-4指数在FLI≥60时的影响小于在FLI<30时（HR 1.664[1.333；2.077]，p<0.0001）。多变量线性回归显示，在FLI低于60的参与者中，FIB-4指数与N末端B型利钠肽原、收缩功能障碍、舒张功能障碍及左心室肥厚之间存在相关独立关系。
在心力衰竭患者中，FIB-4指数可预测全因死亡率，并与心脏功能和结构变化相关，尤其是在无MASLD的患者中。
美因茨约翰内斯·古腾堡大学。
