Vol. 47 | No. 2 | July-December 2019 Back

Open Access

Predictive Value of Liver Stiffness Using FIB-4 Index in Mortality of Heart Failure Patients (Philippine Heart Failure Registry)

Abstract

BACKGROUND: Heart failure has an in-hospital mortality of 8.2% in the Philippines. The chronic  passive congestion caused by heart failure is known to cause liver stiffness, which is proven using  ultrasound elastography (US). However, US is not readily available in the Philippines; hence, a scoring system, the FIB-4 index, may have a prognostic value in patient with heart failure. This  study aimed to establish the utility of the FIB-4 index as an independent risk factor of mortality in  heart failure patients. 

METHODS: This was a prospective study that included heart failure patients diagnosed using the  Framingham criteria and enrolled in the Philippine Heart Failure Registry. FIB-4 index was computed  for each patient and classified as having minimal FIB-4 index (<1.45); moderate (1.46 to 3.25) or  advanced (>3.25). Regression analysis was performed to determine the association of FIB-4 index  to mortality rate.  

RESULTS: Of the 523 patients included in the study, majority were males (59.27%), newly  diagnosed with heart failure (54.50%) and had no previous hospitalization (44.9%). Paroxysmal  nocturnal dyspnea (82.41%) was the most common major criteria and dyspnea on exertion  (88.10%) was the most common minor criteria present. Most complained of dyspnea (59%) on  admission. The most common primary etiology of heart failure was hypertensive heart disease  (30%). Regression analysis showed a five-fold increased risk of mortality (p=0.0001, 95% CI  2.1–11.7) in patient with FIB-4 index value >3.25, which increased to a 14-fold increase in risk after  adjustment for covariates (p=0.0001, 95% CI 3.4–55.63), compared with patients with minimal to  moderate FIB-4 index value. 

CONCLUSION: Chronic passive congestion of the liver from heart failure leads to liver stiffness and  those patients with advanced FIB-4 index value have a 14 times higher risk of mortality compared  to those with minimal to moderate FIB-4 index value. 

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