Key result
High FIB-4 score in HFrEF linked to ~51% higher 5-year all-cause mortality.
Why the study?
HFrEF and MASLD are both associated with liver fibrosis, but the association between the FIB-4 score and adverse outcomes in HFrEF required examination.
Does a higher FIB-4 score predict increased mortality and major adverse liver outcomes in patients with HFrEF?
Cohort (n=4,523)
Yes
Does a higher FIB-4 score predict increased mortality and major adverse liver outcomes in patients with HFrEF?
Effect estimate: HR 1.51 (95% CI 1.31-1.74)
Absolute Event Rate: 43% vs 23%
The FIB-4 score serves as a strong prognostic marker in patients with HFrEF, with higher scores predicting significantly increased risks of all-cause mortality, cardiovascular mortality, and adverse liver outcomes at 5 years.
High FIB-4 score was associated with higher mortality in HFrEF; extends liver fibrosis-HF links but warrants prospective validation before clinical use.
Background Heart failure with reduced ejection fraction (HFrEF) and metabolic dysfunction-associated steatotic liver disease (MASLD) are both associated with liver fibrosis. HFrEF patients may develop liver fibrosis due to hepatic congestion, MASLD, or a combination of both. The Fibrosis-4 (FIB-4) score calculated using age, aspartate aminotransferase, alanine aminotransferase, and platelet count, serves as a screening tool for advanced liver fibrosis. This study examines the association between the FIB-4 score and all-cause mortality, cardiovascular mortality, and major adverse liver outcomes (MALO) in patients with HFrEF. Method and Results This study included 4,523 HFrEF patients from the Danish Heart Failure Registry. Based on FIB-4 score, 25.5% were low-risk, 45.7% were indeterminate-risk, and 28.8% were high-risk for advanced liver fibrosis. After five years, the cumulative incidence of all-cause mortality was 43% for the high-risk group, 36% for the indeterminate-risk group, and 23% for the low-risk group. The indeterminate-risk and high-risk group had an increased hazard ratio (HR) for all-cause mortality (HR 1.33, 95% confidence interval [CI] 1.16–1.52; HR 1.51, 95% CI 1.31-1.74) compared to the low-risk group. Similarly, HRs were elevated for cardiovascular mortality (HR 1.61, 95% CI 1.27–2.05; HR 2.14, 95% CI 1.67–2.74) and MALO (HR 1.77, 95% CI 1.01–3.31; HR 2.54, 95% CI 1.43–4.52). Conclusion A high FIB-4 score in patients with HFrEF is associated with increased mortality and MALO.Graphical abstract
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Mohamed et al. (2025) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=4,523). High FIB-4 score vs. Low FIB-4 score was evaluated on All-cause mortality (HR 1.51, 95% CI 1.31-1.74). A high FIB-4 score in patients with HFrEF was associated with increased 5-year all-cause mortality compared to a low score (43% vs 23%; HR 1.51, 95% CI 1.31-1.74).
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