Novel LiverRisk score is associated with adverse outcome in heart failure: insights from the BIOSTAT-CHF study

Abstract Background/Introduction Heart failure and Metabolic-Associated Steatotic Liver Disease (MASLD) are known to interact, likely through co-existent haemodynamic disturbances, and systemic inflammation. However, their relative contributions are not known. LiverRisk is a novel blood-based score to estimate liver fibrosis, that is superior at quantifying levels of liver fibrosis in an asymptomatic general population when compared to traditional liver fibrosis scores such as FIB-4. FIB-4 has been demonstrated to predict cardiac outcomes in MASLD patients. However, the prognostic value of LiverRisk is not known well in patients with heart failure. Purpose In this study, we evaluate the prognostic value of LiverRisk on outcomes in Heart Failure patients. Methods We assessed outcomes from 1,102 patients with heart failure from the BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) study with the available information on age, sex, glucose, cholesterol, AST, ALT, GGT and platelet count which were used to calculate LiverRisk score. Clinical outcome assessed was All-cause mortality (ACM). Kaplan-Meier curves were plotted to visual time-to-outcome and Cox proportional hazards was used to assess Hazard Ratios (HR) with 95% Confidence Interval (95% CI). We adjusted for inflammatory markers, IL-6 and TNF Receptor Superfamily 4 (TNFRSF4) to assess the inflammation-independent effect of fibrosis on outcomes. Results Higher LiverRisk scores were strongly associated with poorer clinical outcomes compared to the Low-risk Group, most strikingly in patients with LiverRisk scores ≥15 (Figure, Table). Even after adjustment for inflammation, LiverRisk demonstrated a strong association with outcomes Very High (≥15): HR 4.41, 95% CI 2.36-8.21; High (10-15): HR 3.00, 95% CI 1.94-4.64; Intermediate (6-10): HR 1.79, 95% CI 1.21-2.63 (Table). After adjustment for LiverRisk scores, TNFRSF4 showed a significant association with outcomes (HR 1.57, 95% CI 1.34-1.84). Conclusions Our findings indicate that the LiverRisk score is strongly associated with poorer clinical outcomes in patients with heart failure. Adjustment for inflammatory markers shows that liver fibrosis has a strong independent association with outcomes in heart failure patients.FigureKaplan-Meier curves TableHRs of LiverRisk categories