Congenital heart diseaseCohort study
Non-invasive biomarkers of liver disease as prognostic indicators in patients with Fontan circulation
- retrospective observational cohort study
- large-volume adult congenital heart disease centre
Authors' conclusion
Higher FibroSURE, APRI, FIB-4 and MELD-XI are associated with increased hazard of death or transplant in Fontan circulation.
Study context
- Population
- Adults with Fontan circulation who had FibroSURE testing between 2008 and 2022adults with Fontan circulation, 664 FibroSURE results
- Participants
- 334 adults
- Exposure
- FibroSURE score, Aminotransferase-to-Platelet Ratio Index (APRI), FIB-4 and MELD-XI analysed against death or transplant
Main finding
As reported in the abstract
FibroSURE results above the nominal cut-off predicting cirrhosis (>0.74) · study period
FibroSURE results above cut-off (>0.74), of 664 results
83 (13%)
Observational data: associations, not effects.
Further findings
Death or transplant, in 314 patients with all four scores available
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| FibroSURE >0.74 | 5.11 (2.66–9.83) | P < 0.001 | |
| APRI >0.5 | 2.56 (1.36–4.81) | P = 0.004 | |
| FIB-4 >1.45 | 5.07 (2.67–9.64) | P < 0.001 | |
| MELD-XI >18 | 24.1 (5.51–106) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
| Outcome | fold increased hazard (95% CI) | P value |
|---|---|---|
| Death or transplant — each 0.1 increase in FibroSURE score · adjusted for age at FibroSURE and history of hepatitis C | 1.19 (1.02–1.40) | P = 0.032 |
| Death or transplant — FibroSURE >0.74 · adjusted for age at FibroSURE and history of hepatitis C | 3.26 (1.62–6.59) | P = 0.001 |
- Death or transplant, in 314 patients with all four scores available: n=314
Deaths and transplants · median follow-up of 5.6 years (IQR 2.7-9.9)
- Deaths
- 37 deaths (11%)
- Transplants
- four transplants (1%)
Original publication
Non-invasive biomarkers of liver disease as prognostic indicators in patients with Fontan circulation. Heart. Published 30 January 2026. doi:10.1136/heartjnl-2025-327308
Summarised from the published abstract; every number is checked against it