Study On Correlation Between Prognosis Of Patients With HFrEF And Liver Fibrosis

BackgroundHeart failure refers to a series of pathophysiological changes caused by abnormal structure or function of the heart resulting in impaired ventricular systolic or diastolic ability,with dyspnea,edema,fatigue as the clinical manifestation.Heart failure is the end-stage manifestation of cardiovascular disease and the leading cause of death.Heart failure causes peripheral circulation congestion and insufficient organ perfusion,which often involves multiple organs,including brain,liver and kidney.Heart failure can cause acute ischemic hepatitis or chronic congestive liver disease when it affects the liver,then eventually lead to a series of changes in liver function and structure.Previous studies have shown that laboratory abnormalities in liver function may predict the prognosis of patients with heart failure.In the liver structural changes initially manifested as liver fibrosis,different degrees of fibrosis is important to judge the degree of progression of heart failure.Patients with heart failure have a limited chance of viable liver biopsies.Non-invasive liver fibrosis measurement can be used to evaluate the liver fiber elasticity of patients.FIB-4 index and APRI score have been reported to evaluate liver fibrosis or stiffness in patients with nonalcoholic fatty liver disease.At present,there are few domestic related studies.The purpose of this study was to evaluate liver fibrosis in patients with heart failure with reduced ejection fraction by using FIB-4 index and APRI score.Whether the prognosis of reduced heart failure is related to the degree of liver fibrosis.ObjectiveTo assess the correlation between prognosis of patients with HFrEF and noninvasive liver fibrosis assessment such as FIB-4 index,APRI score,etc.MethodsClinical data of 180 patients with HFrEF admitted in the First Affiliated Hospital of Zhengzhou University from January 2019 to April 2019 were retrospectively analyzed.The main endpoint events were all-cause death,heart failure re-hospitalization,reduced activity tolerance and other symptoms of heart failure Patients were divided into non-endpoint event groups and endpoint event groups acrossing to the results of 6 months follow-up.Age,sex,left ventricular ejection fraction(LVEF),Aspartate transaminase(AST),alanine aminotransfease(ALT),platelet(PLT)and other related indexes were collected.And the FIB-4 index and APRI score were calculated at admission.Then we make the analysis of the differences and correlations between the endpoint event group and the non-terminal event group.MACE includs cardiac death and nonlethal myocardial infarction.ResultsA total of 78 patients with end events in 6 months and 102 patients in control group were collected in 180 patients with reduced blood fraction type heart failure.The diffence of the patient's basic data including age,sex,left ventricular ejection fraction(LVEF),Aspartate transaminase(AST),platelet(PLT),white blood cell(WBC),red blood cells(RBC),Low Density Lipoprotein Chesterol(LDL-C),fasting blood-glucose,Estimated glomerularfiltrationrate(eGFR)and other related indexes don't have the statistical significance.Patients in the endpoint event group had lower systolic and diastolic blood pressure than patients in the non-focus event group(P<0.05).patients in the endpoint event group were higher in alanine aminotransferase(ALT)than patients in the non-focused time group(P<0.05).erythrocyte(RBC)systolic and diastolic blood pressure were correlated with patient prognosis in univariate correlation analysis.In the FIB-4 index and APRI scores,two model scores reflecting the extent of liver fibrosis,the difference of FIB-4 index is significant between the two groups(Z=2.477 p=0.013),the difference of APRI score isn't significant between the two groups(Z=0.759 p=0.448).Logistic regression was used to analyzed the differences in all the indexes between the non-endpoint event groups and endpoint event groups.Univariate analysis Logistic regression showed that FIB-4 index was statistically significant between the end point event and non-end point event groups(Z=0.196,P=0.024),APRI score was not statistically significant between the end point event and non-end point event groups(Z=0.005,P=0.445)The ROC curve was plotted with FIB-4 index in all patients.The area under the curve was 0.608,P<0.05.By calculating the Youden index,the best specificity and sensitivity were obtained at FIB-4 index=1.812.The sensitivity was 55%and the specificity was 67%.when fib-4 index>1.812,the patient with heart failure with reduced ejection fraction(HFrEF)has a high end points rate and poor prognosis within six month.ConclusionThis study found that decreased red blood cell count,systolic blood pressure,and diastolic blood pressure were independent risk factors affecting the prognosis of patients with chronic heart failure.Erythrocyte count,systolic blood pressure,diastolic blood pressure lower patients with poor prognosis for chronic heart failure patients FIB-4 index can be used to evaluate the ejection fraction of patients with heart failure prognosis evaluation indicators.FIB-4 index>1.812,the incidence of 6-month endpoint events was significantly increased.higher the FIB-4 index,the worse the prognosis of patients with heart failure with reduced ejection fraction.