Prognostic value of the FIB-4 and FIB-5 indices in patients hospitalised for acute heart failure. Analysis of the RICA-2 registry.

BACKGROUND

Acute heart failure (AHF) is a leading cause of hospitalization in elderly patients with multiple comorbidities. Hepatic congestion reflects hemodynamic severity and prognosis, but its clinical assessment is limited. The noninvasive serum indices FIB-4 and FIB-5, originally developed in hepatology to estimate liver fibrosis, may provide prognostic information in AHF.

METHODS

We conducted a prospective analysis of patients hospitalized for AHF included in the RICA-2 registry (December 2022-May 2025). FIB-4 and FIB-5 indices were calculated from routine clinical and laboratory variables. Associations with baseline characteristics, echocardiographic parameters, and short-term mortality (in-hospital or 30-day) were evaluated using univariate, multivariate, and penalized regression models, as well as survival analyses and ROC curves.

RESULTS

A total of 401 patients with FIB-4 and 326 with FIB-5 were included (median age 83 years; high comorbidity burden). Median values were 2.12 for FIB-4 and -1.23 for FIB-5. High-risk subgroups showed worse renal function, elevated NT-proBNP, and right ventricular dysfunction. In penalized regression, FIB-4 was associated with higher pulmonary artery systolic pressure, lower TAPSE, and higher NT-proBNP; FIB-5 showed no consistent predictors. In-hospital and thirty-day mortality was higher in the high-risk FIB-5 subgroup (HR 7.3; P = .03 log-rank). Both indices demonstrated moderate prognostic discrimination (AUC ≈ 0.7).

CONCLUSIONS

In elderly patients hospitalized for AHF, FIB-4 and FIB-5 are simple and inexpensive prognostic tools. FIB-5 identified patients at higher short-term mortality risk, whereas FIB-4 correlated with markers of congestion and right ventricular dysfunction. These indices may complement risk stratification but require validation in larger cohorts.