Key result
Patients with high FIB-4 and CA125 levels experienced significantly higher morbidity, including more emergency visits and readmissions, compared to those without high values.
Why the study?
Although initially associated with hepatic dysfunction, the FIB-4 index may provide prognostic information in HF. This study evaluated whether combining FIB-4 and CA125 in patients hospitalized for AHF identifies subgroups with differing risks of morbidity and mortality.
Does combining the FIB-4 and CA125 indices in patients hospitalized for acute heart failure identify subgroups with differing risks of morbidity and mortality?
Does combining the FIB-4 and CA125 indices in patients hospitalized for acute heart failure identify subgroups with differing risks of morbidity and mortality?
The combination of elevated FIB-4 and CA125 indices at admission for acute heart failure identifies a subgroup of patients at high risk for short- to medium-term clinical worsening and readmissions.
High FIB-4 plus CA125 was associated with greater morbidity in acute HF; hypothesis-generating for risk stratification and should not yet change practice.
Background: The implementation of the fibrosis 4 (FIB-4) index was initially associated with hepatic dysfunction; however, this index may also provide prognostic information in heart failure (HF). Thus, this study aimed to assess whether combining the FIB-4 and carbohydrate antigen 125 (CA125) indices in patients hospitalized for acute heart failure (AHF) can identify subgroups with differing risks of morbidity and mortality. Methods: This retrospective study included 402 patients consecutively admitted for AHF between January 2023 and December 2024, after excluding elective admissions (n = 403), inter-hospital transfers (n = 232), and low-output cases (n = 51). Patients were stratified into four groups according to the FIB-4 score (<1.3 or high) and CA125 value (≤50 U/mL or high): Group 1 (low FIB-4 + low CA125; n = 43), Group 2 (low FIB-4 + high CA125; n = 57), Group 3 (high FIB-4 + low CA125; n = 117), and Group 4 (high FIB-4 + high CA125; n = 185). Clinical, echocardiographic, therapeutic, and laboratory variables were analyzed, as well as morbidity (HF-related emergency visits and readmissions) and all-cause mortality. Results: Patients with both elevated FIB-4 and CA125 values had a higher prevalence of systemic/mixed congestion (p < 0.01), higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (p < 0.01), and less frequent inspiratory inferior vena cava (IVC) collapse (p < 0.01). Although no survival differences were observed (p = 0.29), morbidity was significantly higher in group 4: more worsening episodes per patient (p = 0.0001), increased HF readmissions (p = 0.004), and more emergency visits (p = 0.001). The FIB-4 index correlated positively with worsening episodes (p < 0.0001), and the CA125 value showed a trend with mortality. No significant correlation was found between FIB-4 and CA125 or between FIB-4 and mortality (p > 0.1). Conclusions: The FIB-4 index may be a useful indicator in AHF. Elevated values at admission for decompensation, in combination with high CA125 levels, can be used to identify a subgroup of patients with poor short- to medium-term outcomes, particularly in terms of worsening. Further studies are needed to determine the actual utility of the FIB-4 index in the context of AHF.
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Appiani et al. (2025) studied this question. Patients with high FIB-4 and CA125 levels experienced significantly higher morbidity, including more emergency visits and readmissions, compared to those without high values.
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