Liver fibrosis score predicts mortality in heart failure patients with preserved ejection fraction.
Liver fibrosis score predicts mortality in heart failure patients with preserved ejection fraction.
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DOI：
10.1002/ehf2.12222
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发表时间：
2018-04
影响因子：
3.8
通讯作者：
Takeishi Y
中科院分区：
文献类型：
--
作者：
Yoshihisa A;Sato Y;Yokokawa T;Sato T;Suzuki S;Oikawa M;Kobayashi A;Yamaki T;Kunii H;Nakazato K;Saitoh SI;Takeishi Y
射血分数保留性心力衰竭（HFpEF）具有几个病理生理学方面，包括多个器官的僵硬和/或充血。预期伴有肝硬化的心力衰竭患者预后不良，最近通过非酒精性脂肪肝疾病纤维化评分（NFS;基于天冬氨酸转氨酶/丙氨酸转氨酶比值、血小板计数和白蛋白）进行了评估。我们的目的是研究NFS对HFpEF患者预后的影响，同时考虑外周胶原标志物，如III型前胶原肽（PIIIP）、IV型胶原7S和透明质酸。我们进行了一项前瞻性观察研究。将492例住院HFpEF患者根据NFS分为4组：第1 ~第4四分位数组（n = 123）。第四个四分位数组的PIIIP、IV型胶原7S、透明质酸和B-型利钠肽水平最高（均P<0.001）。此外，PIIIP、IV型胶原7S、透明质酸、B型利钠肽和NFS之间存在显著正相关（均P < 0.001）。在随访期间（平均1107天），发生了93例死亡。所有四个四分位数的全因死亡率均增加（8.1%、12.2%、23.6%和31.7%，P < 0.001）。在多变量考克斯比例风险分析中，NFS是HFpEF患者全因死亡率的独立预测因子。NFS是一种新的肝纤维化指标，与纤维化和充血的循环系统标志物相关，并与HFpEF患者的全因死亡率较高相关。NFS可以简单地计算，并可能是一个有用的工具，以评估HFpEF患者的肝硬度和预后。
Heart failure with preserved ejection fraction (HFpEF) has several pathophysiological aspects, including stiffness and/or congestion of multiple organs. Poor prognosis is expected in heart failure patients with liver stiffness, which has recently been assessed by non‐alcoholic fatty liver disease fibrosis score (NFS; based on aspartate aminotransferase to alanine aminotransferase ratio, platelet counts, and albumin). We aimed to investigate the impact of NFS on prognosis of HFpEF patients, with consideration for the peripheral collagen markers such as procollagen type III peptide (PIIIP), type IV collagen 7S, and hyaluronic acid. We performed a prospective observational study. Consecutive 492 hospitalized HFpEF patients were divided into four groups based on their NFS: first–fourth quartiles (n = 123). The fourth quartile group had the highest levels of PIIIP, type IV collagen 7S, hyaluronic acid, and B‐type natriuretic peptide (P<0.001 each). In addition, there were significant positive correlations between PIIIP, type IV collagen 7S, hyaluronic acid, B‐type natriuretic peptide, and NFS (P < 0.001 each). In the follow‐up period (mean 1107 days), 93 deaths occurred. All‐cause mortality increased in all four quartiles (8.1%, 12.2%, 23.6%, and 31.7%, P < 0.001). In the multivariable Cox proportional hazard analysis, NFS was an independent predictor of all‐cause mortality in the HFpEF patients. NFS, a novel indicator of liver fibrosis, correlates with circulating systemic markers of fibrosis and congestion and is associated with higher all‐cause mortality in HFpEF patients. NFS can be calculated simply and may be a useful tool to assess liver stiffness and prognosis in HFpEF patients.
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