Association between fibrosis-4 index and 30-day all-cause mortality in critically ill patients hospitalised with acute heart failure: a retrospective cohort study from the MIMIC-IV database
- 1Department of Cardiology, Jiangdu People’s Hospital of Yangzhou, Yangzhou, China
- 2Department of Cardiology, Subei People’s Hospital of Jiangsu Province, Yangzhou, China
Abstract
Introduction: The Fibrosis-4 index (Fib-4), a non-invasive liver fibrosis biomarker, is increasingly linked to cardiovascular risk, but its role in acute heart failure (AHF) remains unclear.
Aim: We evaluated its association with 30-day all-cause mortality in critically ill patients with AHF.
Material and methods: This retrospective observational study enrolled 1535 ICU patients with AHF from the MIMIC-IV database. The primary endpoint was all-cause mortality within 30 days from the date of hospital admission. Baseline characteristics, comorbidities, laboratory data, and clinical information were extracted. Patients were divided into survival and mortality groups, and baseline differences were compared. Lasso regression identified variables influencing prognosis, which were then included in a restricted cubic splines (RCS) model. Three multivariable logistic regression models (Model 1 unadjusted; Model 2 adjusted for INR, age, BUN, and potassium; Model 3 fully adjusted for pO2 max, WBC, lymphocytes, BUN, calcium, glucose, anion gap, potassium, INR, ALP, CRRT, CK-MB, age, peripheral vascular disease, and CHA2DS2-VASc score) were constructed. Receiver operating characteristic (ROC) curve analysis assessed the predictive performance of Fib-4. Subgroup analysis evaluated potential differences across population subgroups. Sensitivity analyses using complete-case analysis and multiple imputation were performed to address missing data.
Results: The mortality group (n = 219, 14.3%) exhibited significantly higher Fib-4 values than the survival group (n = 1316). Lasso regression identified 16 variables influencing prognosis, including Fib-4. RCS analysis showed a positive correlation between Fib-4 and 30-day mortality risk (p-overall = 0.006, p-nonlinear = 0.330). After adjustment for confounders, logistic regression demonstrated that Fib-4 was an independent risk factor (Model 1: OR = 1.10, 95% CI: 1.07–1.13, p < 0.001; Model 2: OR = 1.08, 95% CI: 1.05–1.11, p < 0.001; Model 3: OR = 1.05, 95% CI: 1.02–1.09, p = 0.002). The area under the ROC curve (AUC) for Fib-4 predicting 30-day mortality was 0.665, indicating modest predictive value. The optimal cutoff was 2.25 (sensitivity 74.0%, specificity 51.4%). Quartile analysis showed a dose-response relationship (Q4 vs. Q1: OR = 2.51, 95% CI: 1.28–4.92, p = 0.007 in Model 3). Subgroup analyses revealed no significant interaction. Sensitivity analyses confirmed the robustness of the findings.
Conclusions: In critically ill patients with AHF, the Fib-4 index is independently associated with 30-day mortality but provides only modest predictive discrimination. This readily available, cost-effective marker may offer adjunctive information for early risk stratification, but its clinical utility should be interpreted with caution given the limited AUC.
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BibTeX
@article{ren2026association,
title = {{Association between fibrosis-4 index and 30-day all-cause mortality in critically ill patients hospitalised with acute heart failure: a retrospective cohort study from the MIMIC-IV database}},
author = {Xiaotian Ren and Lei Li and Fei Liu and Ye Zhu},
journal = {Postepy w kardiologii interwencyjnej = Advances in interventional cardiology},
year = {2026},
month = jul,
doi = {10.5114/aic.2026.163808},
url = {https://europepmc.org/article/PMC/PMC13721056},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Association between fibrosis-4 index and 30-day all-cause mortality in critically ill patients hospitalised with acute heart failure: a retrospective cohort study from the MIMIC-IV database
AU - Xiaotian Ren
AU - Lei Li
AU - Fei Liu
AU - Ye Zhu
PY - 2026
DA - 2026/07/30
JO - Postepy w kardiologii interwencyjnej = Advances in interventional cardiology
DO - 10.5114/aic.2026.163808
UR - https://europepmc.org/article/PMC/PMC13721056
AB - Introduction: The Fibrosis-4 index (Fib-4), a non-invasive liver fibrosis biomarker, is increasingly linked to cardiovascular risk, but its role in acute heart failure (AHF) remains unclear. Aim: We evaluated its association with 30-day all-cause mortality in critically ill patients with AHF. Material and methods: This retrospective observational study enrolled 1535 ICU patients with AHF from the MIMIC-IV database. The primary endpoint was all-cause mortality within 30 days from the date of hospital admission. Baseline characteristics, comorbidities, laboratory data, and clinical information were extracted. Patients were divided into survival and mortality groups, and baseline differences were compared. Lasso regression identified variables influencing prognosis, which were then included in a restricted cubic splines (RCS) model. Three multivariable logistic regression models (Model 1 unadjusted; Model 2 adjusted for INR, age, BUN, and potassium; Model 3 fully adjusted for pO2 max, WBC, lymphocytes, BUN, calcium, glucose, anion gap, potassium, INR, ALP, CRRT, CK-MB, age, peripheral vascular disease, and CHA2DS2-VASc score) were constructed. Receiver operating characteristic (ROC) curve analysis assessed the predictive performance of Fib-4. Subgroup analysis evaluated potential differences across population subgroups. Sensitivity analyses using complete-case analysis and multiple imputation were performed to address missing data. Results: The mortality group (n = 219, 14.3%) exhibited significantly higher Fib-4 values than the survival group (n = 1316). Lasso regression identified 16 variables influencing prognosis, including Fib-4. RCS analysis showed a positive correlation between Fib-4 and 30-day mortality risk (p-overall = 0.006, p-nonlinear = 0.330). After adjustment for confounders, logistic regression demonstrated that Fib-4 was an independent risk factor (Model 1: OR = 1.10, 95% CI: 1.07–1.13, p < 0.001; Model 2: OR = 1.08, 95% CI: 1.05–1.11, p < 0.001; Model 3: OR = 1.05, 95% CI: 1.02–1.09, p = 0.002). The area under the ROC curve (AUC) for Fib-4 predicting 30-day mortality was 0.665, indicating modest predictive value. The optimal cutoff was 2.25 (sensitivity 74.0%, specificity 51.4%). Quartile analysis showed a dose-response relationship (Q4 vs. Q1: OR = 2.51, 95% CI: 1.28–4.92, p = 0.007 in Model 3). Subgroup analyses revealed no significant interaction. Sensitivity analyses confirmed the robustness of the findings. Conclusions: In critically ill patients with AHF, the Fib-4 index is independently associated with 30-day mortality but provides only modest predictive discrimination. This readily available, cost-effective marker may offer adjunctive information for early risk stratification, but its clinical utility should be interpreted with caution given the limited AUC.
SN - 1734-9338
SN - 1897-4295
ER -