ArticleThe Lancet regional health. Europe2025
Clinical utility of the Fibrosis-4 index for predicting mortality in patients with heart failure with or without metabolic dysfunction-associated steatotic liver disease: a prospective cohort study.
Article in The Lancet regional health. Europe, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04064450 (MyoVasc - An Epidemiological Cohort Study to Investigate the Development and Progression of Heart Failure and the Interaction With Vascular Disease), which is not on this map. Cited by 18 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
MyoVasc - An Epidemiological Cohort Study to Investigate the Development and Progression of Heart Failure and the Interaction With Vascular Disease
Who cites it
18 citing papers in PubMed.
- Hepatic fibrosis severity assessed by FIB-4 index is independently associated with reduced kidney function in patients with metabolic dysfunction-associated steatotic liver disease: a nationwide multicenter study from Türkiye.Hepatology international · 2026Article
- Prognostic Value of Fibrosis-4 Index, Hepatic Biomarkers, and Plasma Acute-Phase Reactants in Critical Patients Undergoing Percutaneous Endoscopic Gastrostomy: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- FIB-4 Index as a Non-Invasive Biomarker of Congestion and Prognosis in Heart Failure.Journal of clinical medicine · 2026Review
- Article
- Effect of coded steatotic liver disease on outcomes of percutaneous coronary intervention in non-diabetic adults: insights from a multicenter real-world cohort.BMC cardiovascular disorders · 2026Observational
- Risk-associated and clinically informative biomarkers for cardiovascular risk stratification in metabolic dysfunction-Associated steatotic liver disease.American journal of preventive cardiology · 2026Article
- Noninvasive strategies for metabolic dysfunction-associated steatotic liver disease assessment and referral in Japan.World journal of gastroenterology · 2026Review
- I-FABP, citrulline and non-invasive liver dysfunction indices in patients with depression - cross-sectional study results.BMC gastroenterology · 2026Article
- Association between the Fibrosis-4 index and mortality risk in acute pancreatitis.Frontiers in medicine · 2026Article
- Dual target, dual benefit: real-world effects of SGLT2 inhibitors and GLP-1 receptor agonists on the FIB-4 score in people with type 2 diabetes mellitus.Hormones (Athens, Greece) · 2025Review
- Time-updated FIB-4 index predicts coronary artery calcification progression in individuals with metabolic dysfunction-associated steatotic liver disease.Scientific reports · 2025Article
- Anthropometric and Metabolic Determinants of Multi-Organ Stress in Adults with Obesity: Application of the CaRaMeL-O Score.Healthcare (Basel, Switzerland) · 2025Article
- Association Between High FIB-4 Score and the Risk of Malignancy Development and Mortality: A Retrospective Longitudinal Case-Control Study.Digestive diseases and sciences · 2025Article
- The Relationship Between FIB-4 Score and Dynapenia in Older Adults.Diagnostics (Basel, Switzerland) · 2025Article
- Fibrosis 4 Index Predicts Haemocompatibility-Related Adverse Events in Patients Using Left Ventricular Assist Devices.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Article
- Novel subtypes of metabolic associated steatotic liver disease linked to clinical outcomes: implications for precision medicine.Journal of translational medicine · 2025Article
- The importance of patient engagement in the multimodal treatment of MASLD.Communications medicine · 2025Review
- Temporal comorbidity patterns preceding MASLD-related major adverse liver outcomes: a nationwide population-based case-control study in Sweden.BMJ public health · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: The liver-heart axis potentially influences the risk of mortality in patients with heart failure. We aimed to identify the clinical utility of the fibrosis-4 (FIB-4) index in patients with heart failure for predicting mortality in the context of metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: Patients with heart failure and a subsample of healthy participants were enrolled in the MyoVasc study (NCT04064450) and followed for nine years. Participants with excessive alcohol consumption were excluded. The Fatty Liver Index (FLI) and FIB-4 index were used to classify MASLD and hepatic fibrosis, respectively. Data were adjusted for potential confounders. The primary endpoint was all-cause mortality. Findings: 2726 participants, including 172 healthy individuals, were included in the study. The participants had a mean age of 64.4 ± 11.2 years and a median FIB-4 index of 1.59 (interquartile range [1.17; 2.17]). There were 532 deaths. The FIB-4 index was predictive for all-cause mortality (hazard ratio (HR) 1.341, 95% confidence interval (CI) [1.273; 1.412], p < 0.0001). The HRs and 95% CIs for the FIB-4 index in FLI categories were 1.597 [1.256; 2.031] (p = 0.00013, FLI <30), 1.802 [1.519; 2.138] (p < 0.0001, FLI 30-60), and 1.292 [1.215; 1.374] (p < 0.0001, FLI ≥60). The interaction term for the FIB-4 index with FLI ≥60 (reference FLI <30) was HR 0.774 [0.617; 0.972] (p = 0.027), indicating a smaller impact of the FIB-4 index in FLI ≥60 than in FLI <30 (HR 1.664 [1.333; 2.077], p < 0.0001). Multivariable linear regressions revealed relevant independent relationships between the FIB-4 index and N-terminal pro-B-type natriuretic peptide, systolic dysfunction, diastolic dysfunction and left ventricular hypertrophy in participants with a FLI below 60. Interpretation: In patients with heart failure, the FIB-4 index predicts all-cause mortality and relates to cardiac functional and structural changes, especially in those without MASLD. Funding: Johannes Gutenberg-University Mainz.
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