Association between noninvasive hepatic fibrosis indices and heart failure mortality

Heart failure (HF) is a chronic progressive clinical condition characterized by structural or functional impairment of the ventricles. The prevalence of HF is increasing, and it continues to be a significant cause of morbidity and mortality. Liver involvement during fibrosis in HF patients is associated with adverse clinical outcomes. Our study aimed to evaluate the relationship between noninvasive liver fibrosis indices and HF mortality. Our study was a retrospective analysis of patients with HF admitted to our hospital between 2017 and 2023. Patients were followed up until 2024 and divided into 2 groups according to mortality. The patients’ liver fibrosis indices were calculated, and Cox regression analysis was performed to identify the independent predictors of mortality. Their ability to predict mortality was assessed using receiver operating characteristic Curve analysis, and the areas under the curve were compared. Our study included 2029 patients with HF. The mean follow-up period was 1655 days. The mortality rate was 9.5% (N = 193). The aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio was not a predictor of HF mortality, whereas APRI and FIB-4 index were independent predictors of HF mortality. According to receiver operating characteristic curve analysis, the FIB-4 score was superior to the APRI in predicting mortality. The APRI had a specificity of 93.4% at a cutoff value of 1.0. The FIB-4 Score had a sensitivity of 89.6% at a cutoff value of 1.0. Our study found that AST/ALT ratio did not predict HF mortality. However, our study found that the FIB-4 score was associated with mortality in all types of HF, and the APRI was associated with mortality in HFrEF and HFmrEF. These parameters can be calculated easily and practically from routine examinations and can be used in HF follow-up and prognosis estimation.