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Association Between Noninvasive Liver Fibrosis Scores and Heart Failure in a General Population
Xiao Liu1,2, Hong-Jin Zhang3,4, Chang-Chang Fang5
1Jiujiang Clinical Precision Medicine Research Center Jiujiang China.
Insights
Noninvasive liver fibrosis scores like FIB-4, NFS, and APRI are linked to a higher prevalence of heart failure in the general US population. These scores help identify individuals at risk for advanced liver fibrosis and subsequent cardiovascular events.
Area of Science:
- Hepatology
- Cardiology
- Public Health
Background:
- The link between nonalcoholic fatty liver disease and cardiovascular disease is known, but the association between noninvasive liver fibrosis scores and cardiovascular events needs clarification.
- This study investigates the relationship between liver fibrosis, assessed by noninvasive scores, and heart failure prevalence.
Purpose of the Study:
- To explore the association between noninvasive liver fibrosis scores and the prevalence of heart failure in the general US population.
- To assess the prevalence of advanced liver fibrosis risk using FIB-4, NFS, and APRI scores.
Main Methods:
- Utilized data from the National Health and Nutrition Examination Survey (2011-2018) including 19,695 participants.
- Assessed advanced hepatic fibrosis risk using Fibrosis-4 (FIB-4), nonalcoholic fatty liver disease fibrosis score (NFS), and aspartate aminotransferase to platelet ratio index (APRI).
- Employed weighted logistic regression to analyze the association between liver fibrosis scores and heart failure prevalence, including subgroup analysis for sex differences.
Main Results:
- The national prevalence of advanced liver fibrosis risk ranged from 0.35% (APRI) to 8.06% (NFS).
- Significant associations were found between advanced liver fibrosis risk and heart failure prevalence across all three scores (FIB-4 OR 1.15, NFS OR 1.42, APRI OR 1.44).
- Categorical analysis also showed significant links, with higher odds of heart failure for individuals with elevated scores (FIB-4 OR 2.18, NFS OR 2.53). The association between APRI and heart failure was stronger in females.
Conclusions:
- Noninvasive liver fibrosis scores indicate varying prevalence of advanced liver fibrosis risk in the US general population.
- FIB-4, NFS, and APRI scores are independently associated with an elevated prevalence of heart failure.
- The findings highlight the potential of noninvasive liver fibrosis scores in identifying individuals at risk for heart failure, particularly in specific subgroups like females.
Background:
The association between nonalcoholic fatty liver disease and cardiovascular disease is firmly established, yet the association between noninvasive liver fibrosis scores and cardiovascular events remains a topic of uncertainty. Our study aimed to explore the association between liver fibrosis and heart failure.
Methods And Results:
The data set was from the National Health and Nutrition Examination Survey 2011 to 2018. Advanced hepatic fibrosis risk was assessed through 3 noninvasive liver fibrosis scores: Fibrosis-4 score (FIB-4), the nonalcoholic fatty liver disease fibrosis score (NFS), and the aspartate aminotransferase to platelet ratio index (APRI). We included 19 695 eligible participants. The national prevalence of advanced liver fibrosis risk in the United States was 4.20%, 8.06%, and 0.35% as determined by FIB-4, NFS, and APRI scores, respectively. Weighted logistic regression analysis revealed significant associations between advanced liver fibrosis risk and the prevalence of heart failure (continuous variables, FIB-4: odds ratio [OR], 1.15 [95% CI, 1.07-1.23]; NFS: OR, 1.42 [95% CI, 1.23-1.64]; APRI: OR, 1.44 [95% CI, 1.15-1.81]). When the scores were assessed as categorical variables, the results were still significant (FIB-4 ≥2.67 versus FIB-4 <1.3: OR, 2.18 [95% CI, 1.47-3.24]; NFS ≥0.675 versus NFS <-1.455: OR, 2.53 [95% CI, 1.37-4.68]). Subgroup analysis found that the association between APRI and heart failure was stronger in female patients.
Conclusions:
In the general US population, the prevalence of advanced liver fibrosis risk varied between 0.35% and 8.06% as indicated by noninvasive liver fibrosis scores. FIB-4, NFS, and APRI scores were linked to an elevated prevalence of heart failure.
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