Association between Fibrosis-4 Index Levels and the Risk of Renal Dysfunction and Adverse Prognosis in Patients with Acute Heart Failure

doi:10.3969/j.issn.1009-0126.2025.12.027

Abstract：Objective To explore the association between Fibrosis-4 Index (FIB-4) levels and the risk of renal dysfunction and adverse prognosis in patients with acute heart failure (AHF). Methods A total of 265 AHF patients admitted to the Department of Cardiology of Hanzhong City People's Hospital from May 2021 to May 2023 were selected. According to the estimated glomerular filtration rate (eGFR), they were divided into a renal dysfunction group (n=63, eGFR < 60 mL/(min·1.73 m²)) and a non-renal dysfunction group (n=202, eGFR ≥ 60 mL/(min·1.73 m²)). The FIB-4 levels between the two groups were compared, and Pearson correlation analysis was performed. Finally, 243 AHF patients were followed up for 12 months and divided into an adverse prognosis group (n=98) and a favorable prognosis group (n=145) based on their outcomes. The clinical data and laboratory indicators of the two groups were compared, and a multivariate logistic regression model was used to screen factors associated with adverse prognosis in AHF patients. A restricted cubic spline plot was used to fit the relationship between FIB-4 levels and prognosis in AHF patients. Results The FIB-4 level in the renal dysfunction group was significantly higher than that in the non-renal dysfunction group (2.85±0.35 vs 2.21±0.27, P<0.05). FIB-4 levels were negatively correlated with renal dysfunction in AHF patients (r=-0.685, P<0.01). The adverse prognosis group had significantly higher levels of renal dysfunction, N-terminal pro-B-type natriuretic peptide (NT-proBNP), cystatin C, and FIB-4, and lower left ventricular ejection fraction (LVEF) compared to the favorable prognosis group (P<0.01). Renal dysfunction (OR=3.554, 95% CI: 1.273–9.919, P<0.05), NT-proBNP (OR=1.004, 95% CI: 1.002–1.006, P<0.01), cystatin C (OR=10.050, 95% CI: 4.440–22.752, P<0.01), and FIB-4 (OR=21.648, 95% CI: 6.457–72.573, P<0.01) were risk factors for adverse prognosis in AHF patients, while LVEF was a protective factor (OR=0.803, 95% CI: 0.721–0.894, P<0.01). There was a significant nonlinear relationship between FIB-4 levels and prognosis in AHF patients (x=27.470, P<0.01). Conclusion FIB-4 levels are associated with renal dysfunction and adverse prognosis in patients with AHF.