FIB-4 index predicts short-term mortality in Vietnamese acute heart failure patients

Acute heart failure (AHF) has high early mortality. The FIB-4 index indicates hepatic dysfunction in AHF, but its predictive power for short-term outcomes in developing countries is not well established. We conducted a prospective cohort study at Can Tho Central General Hospital, Vietnam, from May to December 2024 including adults aged ≥18, hospitalized with AHF and NT-proBNP levels ≥300 pg/mL. Exclusions were for those who died before blood sample collection, transferred, declined consent, or had chronic liver disease, active cancer, or end-stage renal disease. Survivors were followed up via phone for 30 days post-discharge. The primary endpoint was 30-day all-cause mortality. The final analysis included 413 patients (mean age 70, 47.7% male). In-hospital mortality was 5.1% and did not associate to FIB-4. At 30 days post-discharge, 42(17%) of 247 patients with follow-up data died (37.3% loss to follow-up). Non-survivors had higher FIB-4 scores than survivors (3.3 vs. 2.3, p = 0.006). After adjusting for age, sex, comorbidities, LVEF, and NT-proBNP, each one-point increase in FIB-4 raised the 30-day mortality risk by 9% (RR 1.09; 95%CI: 1.01–1.17). A cut-off of 3.1 identified high-risk patients, with a RR of 1.82 (95%CI: 1.03–3.22). FIB-4 demonstrated an AUC of 0.634 (95%CI: 0.535–0.733) which was comparable to NT-proBNP (AUC 0.650; 95%CI: 0.559–0.742). In this exploratory single-center study of patients with AHF, FIB-4 demonstrated an independent association with 30-day mortality, with a threshold of 3.1 identifying high-risk individuals. These findings are hypothesis-generating, and external validation is warranted before FIB-4 can be recommended for risk stratification.