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Published on: June 10, 2025
Combination of the Fibrosis 4 Index and Carbohydrate Antigen 125 to Predict Morbidity and Mortality in Acute Heart
Franco Appiani1, Raquel López-Vilella1,2,3, Víctor Donoso1,2
1Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46007 Valencia, Spain.
Insights
The fibrosis 4 (FIB-4) index combined with carbohydrate antigen 125 (CA125) identifies acute heart failure patients at higher risk for morbidity. Elevated FIB-4 and CA125 levels predict worsening heart failure episodes and hospital readmissions.
Area of Science:
- Cardiology
- Biomarkers
- Prognostic Indicators
Background:
- The fibrosis 4 (FIB-4) index, initially used for hepatic dysfunction, shows potential prognostic value in heart failure (HF).
- Carbohydrate antigen 125 (CA125) is also recognized as a biomarker in HF.
- Combining FIB-4 and CA125 may refine risk stratification in acute heart failure (AHF).
Purpose of the Study:
- To evaluate the combined prognostic utility of FIB-4 and CA125 in patients hospitalized for AHF.
- To identify subgroups of AHF patients with differential risks of morbidity and mortality based on FIB-4 and CA125 levels.
Main Methods:
- Retrospective analysis of 402 patients admitted for AHF.
- Stratification into four groups based on FIB-4 (<1.3 or high) and CA125 (≤50 U/mL or high) levels.
- Analysis of clinical, echocardiographic, therapeutic, laboratory variables, morbidity (HF-related emergency visits/readmissions), and mortality.
Main Results:
- Patients with high FIB-4 and high CA125 (Group 4) exhibited higher systemic congestion and NT-proBNP levels.
- Group 4 showed significantly increased morbidity, including more worsening HF episodes, readmissions, and emergency visits.
- FIB-4 positively correlated with worsening HF episodes; CA125 showed a trend with mortality, but no significant correlation was found between FIB-4 and CA125 or mortality.
Conclusions:
- Elevated FIB-4 and CA125 at AHF admission identify patients with poorer short- to medium-term outcomes, especially regarding worsening HF.
- The combination of FIB-4 and CA125 can aid in identifying high-risk AHF subgroups.
- Further research is warranted to fully elucidate the utility of FIB-4 in AHF management.
Background:
The implementation of the fibrosis 4 (FIB-4) index was initially associated with hepatic dysfunction; however, this index may also provide prognostic information in heart failure (HF). Thus, this study aimed to assess whether combining the FIB-4 and carbohydrate antigen 125 (CA125) indices in patients hospitalized for acute heart failure (AHF) can identify subgroups with differing risks of morbidity and mortality.
Methods:
This retrospective study included 402 patients consecutively admitted for AHF between January 2023 and December 2024, after excluding elective admissions (n = 403), inter-hospital transfers (n = 232), and low-output cases (n = 51). Patients were stratified into four groups according to the FIB-4 score (<1.3 or high) and CA125 value (≤50 U/mL or high): Group 1 (low FIB-4 + low CA125; n = 43), Group 2 (low FIB-4 + high CA125; n = 57), Group 3 (high FIB-4 + low CA125; n = 117), and Group 4 (high FIB-4 + high CA125; n = 185). Clinical, echocardiographic, therapeutic, and laboratory variables were analyzed, as well as morbidity (HF-related emergency visits and readmissions) and all-cause mortality.
Results:
Patients with both elevated FIB-4 and CA125 values had a higher prevalence of systemic/mixed congestion (p < 0.01), higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (p < 0.01), and less frequent inspiratory inferior vena cava (IVC) collapse (p < 0.01). Although no survival differences were observed (p = 0.29), morbidity was significantly higher in group 4: more worsening episodes per patient (p = 0.0001), increased HF readmissions (p = 0.004), and more emergency visits (p = 0.001). The FIB-4 index correlated positively with worsening episodes (p < 0.0001), and the CA125 value showed a trend with mortality. No significant correlation was found between FIB-4 and CA125 or between FIB-4 and mortality (p > 0.1).
Conclusions:
The FIB-4 index may be a useful indicator in AHF. Elevated values at admission for decompensation, in combination with high CA125 levels, can be used to identify a subgroup of patients with poor short- to medium-term outcomes, particularly in terms of worsening. Further studies are needed to determine the actual utility of the FIB-4 index in the context of AHF.
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