Prognostic value of fibrosis-5 index combined with C-reactive protein in patients with acute decompensated heart failure

Abstract

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 [10⁹/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.

Keywords: Acute decompensated heart failure; C-reactive protein; Fibrosis-5 index; Major adverse cardiac and cerebral events.