The product of bilirubin and trigliseride is the most significant predictor of severe FIB-4 index of liver disease in cardiac patients

Abstract Background Steatotic liver disease (SLD) is a worldwide public health problem (1-3). Liver disease is frequently asymptomatic so early identification can be challenging in the primary care setting. Patients with SLD are at an increased risk for major adverse cardiovascular (CV) events and heart failure (HF) (1-3). Cardiovascular disease (CVD) and SLD share similar pathophysiological processes (1-3). The Fibrosis 4 (FIB-4) index is a liver fibrosis biomarker that can be a potential alternative to liver biopsy for diagnosing and managing liver disease (1-3). FIB-4 index can independently predict major adverse CV events in nonalcoholic fatty liver disease. Previous studies indicate that a FIB-4 value 3.25 is a biomarker of advanced liver disease. Such patients require further work-up with additional tests (e.g., vibration-controlled transient elastography (VCTE), enhanced liver fibrosis (ELF)) (1-3). Purpose We aim to calculate the FIB-4 index for cardiac patients admitted to the cardiology service. We report the FIB-4 index in 500 consecutive patients who are admitted to cardiology service with diagnosis of CVD, HF and arrhythmia over the last 1 year. Methods Patients who have been admitted to the cardiology service since March 10, 2024 until present time are included in the study. The electronic medical records of 500 consecutive patients are reviewed for demographic, clinical and laboratory variables. FIB-4 indices are calculated for all cases. The FIB-4 index is calculated using the following formula: (Age (years) X Aspartate transferase (Unit/Liter))/ (Platelet (109/L) X √Alanin transaminase (Unit/Liter)). The prevalence of increased FIB-4 (3.25) is determined. Logistic regression analysis is performed to identify the predictors of increased FIB-4 (3.25) in cardiac patients. Results Demographic and clinical variables are listed in Table 1. An increased FIB-4 index is extremely common among cardiac patients (Table 1). Male patients are younger and have a higher FIB4 index compared to female patients (Table 1). Logistic regression analysis is performed to identify the predictors of a high (3.25) FIB-4 index (Table 2). The triglyceride × bilirubin index is the most significant parameter for predicting an increased FIB-4 index in cardiac patients (Table 2). Conclusions Bilirubin and triglycerides have opposing effects on SLD and atherosclerosis through several mechanisms, including low-density lipoprotein oxidation, vascular smooth muscle cell proliferation, and endothelial dysfunction. The study indicates that the product of triglycerides × bilirubin is the most significant parameter for predicting a high FIB-4 index (3.25) in cardiac patients. Future studies are needed to elucidate the role of combined indices of triglycerides and bilirubin in the onset and outcome of SLD and CVD.