Association of Liver Fibrosis Scores with All-cause and Cardiovascular Mortality in Patients with Heart Failure

The aim of this study was to examine the relationship of liver fibrosis (determined via fibrosis scores) with all-cause mortality and cardiovascular mortality in HF patients. The study examined demographic and clinical data were collected from NHANES database (1999 to 2018). A total of 1356 HF patients were enrolled in our analysis. During a median follow-up time of 70 months, 455 patients died. Compared to the survivors, the death group showed significantly elevated LFSs levels. RCS analysis revealed a linear relationship between various LFSs and all-cause and cardiovascular mortality. KM curves and Cox regression models indicated that higher FIB-4 (≥ 1.637), NFS (≥ -0.064), and AST/ALT ratio (≥ 1.172) were linked to higher risk of all-cause mortality [Cox model 2: FIB-4 adjusted hazard ratio (aHR), 1.24; 95% CI, 1.04-1.48; NFS aHR, 1.19; 95% CI, 1.01-1.38; AST/ALT ratio aHR, 1.25; 95% CI, 1.07-1.47] and cardiovascular mortality in heart failure patients (FIB-4 aHR, 1.28; 95% CI, 1.07-1.67; AST/ALT ratio aHR, 1.39; 95% CI, 1.08-1.79). ROC curves indicated that FIB-4, NFS, and the AST/ALT ratio were important predicators of all-cause mortality (AUC: 0.715, 0.707, and 0.715, respectively) and cardiovascular mortality (AUC: 0.658, 0.657, and 0.659, respectively) in heart failure patients. Random survival forests showed that FIB-4, AST/ALT ratio, and NFS emerged as important factors potentially influencing mortality of HF. Consistent associations were observed in subgroup analysis. Liver fibrosis scores (FIB-4, NFS, and AST/ALT ratio) were strongly linked to all-cause and cardiovascular mortality in heart failure patients.