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The Association Between Fibrosis-4 Index and All-Cause and Cardiac Mortality in Patients With Coronary Heart Disease

Chenxi Song1,2, Zhihao Zheng1,2, Xiaohui Bian1,2

  • 1Department of Cardiology Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.

Medcomm
|June 8, 2026
PubMed

Insights

The fibrosis-4 index (FIB-4) score, a noninvasive liver fibrosis marker, is linked to increased all-cause and cardiac mortality risks in patients with diabetes/prediabetes and cardiovascular disease.

Area of Science:

  • Cardiology
  • Hepatology
  • Metabolic Diseases

Background:

  • Cardiovascular disease (CVD) and diabetes/prediabetes are significant risk factors for mortality.
  • Liver fibrosis, identified by the fibrosis-4 index (FIB-4), is increasingly recognized as a potential contributor to systemic health risks.
  • The association between FIB-4 and mortality in patients with both CVD and diabetes/prediabetes is not well-established.

Purpose of the Study:

  • To investigate the impact of the fibrosis-4 index (FIB-4) on all-cause and cardiac mortality.
  • To evaluate FIB-4's prognostic value in a high-risk population with diabetes or prediabetes and confirmed cardiovascular disease.

Main Methods:

  • Analysis of two large patient cohorts: Fuwai Hospital (N=20,133) and UK Biobank (N=5678).
  • Utilized multivariable Cox regression analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
  • Adjusted for multiple confounding factors including glucose levels, age, sex, and body mass index.

Main Results:

  • Elevated FIB-4 scores were significantly associated with increased hazards of all-cause mortality in both cohorts (Fuwai: HR 2.58; UKB: HR 1.26).
  • Elevated FIB-4 scores were also significantly associated with increased hazards of cardiac mortality in both cohorts (Fuwai: HR 2.99; UKB: HR 1.41).
  • These associations remained consistent across various subgroups, including different glucose levels, age, sex, and BMI.

Conclusions:

  • Liver fibrosis, as indicated by FIB-4, is a significant predictor of elevated all-cause and cardiac mortality.
  • FIB-4 assessment should be considered for risk stratification in patients with coronary heart disease and co-existing diabetes or prediabetes.

Keywords:
coronary heart diseasediabetes mellitusfibrosis‐4 indexmortalityprediabetesprognosis

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