Heart failure & cardiomyopathies
Prognostic value of Fibrosis-4 Index and preoperative dynamic changes in heart transplantation
Main finding · All-cause mortalityResult — go to the resultHazard ratio 1.04 95% CI 1.02–1.07Authors' conclusion
Preoperative FIB-4 is a robust and independent predictor of post-transplant mortality, with greater predictive importance than traditional surgical risk factors. Dynamic improvement in FIB-4 before transplantation is associated with better survival. Integrating FIB-4 into routine preoperative assessment may refine risk stratification and guide pre-transplant management.
Study context
- Population
- Adult patients who underwent orthotopic HTx between January 2015 and December 2024, with follow-up through June 2025adult patients who underwent orthotopic HTx
- Participants
- 791 patients
- Exposure
- Patients stratified by preoperative FIB-4 into low (<1.30), intermediate (1.30-2.67), and high (>2.67) risk groups
- Highn = 153
- Outcome
- All-cause mortality
- Follow-up
- Median 28.8 months
Main finding
As reported in the abstract
Hazard ratio
1.04
95% CI 1.02–1.07
P < 0.001
Per unit increase in preoperative FIB-4, as printed
- Patients who died
- 218 patients (27.6%)
- Non-linear association of preoperative FIB-4 with mortality, inflection point
- 2.03
Observational data: associations, not effects.
Further findings
Mortality among high-risk patients, by preoperative improvement in FIB-4 category (subgroup)
| Comparison | Adjusted HR (95% CI) | P value | |
|---|---|---|---|
| Preoperative improvement in FIB-4 categoryAmong high-risk patients (n = 153); comparator not stated · adjusted | 0.49 (0.29–0.82) | P = 0.007 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
FIB-4 improvement with preoperative glutathione use
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| Preoperative use of glutathioneIndependently associated | 1.50 (1.01–2.22) | P = 0.04 | |
| 0.512Odds ratio (log scale) |
Variable importance in Random Survival Forest (RSF) model
- FIB-4 was the most important prognostic variable (Variable Importance)
- 0.068
- Outperforming traditional donor and surgical factors
Sensitivity analyses
- FIB-4's prognostic value independent of age
- interaction P = .745
- Superior to its individual components (aspartate aminotransferase, alanine aminotransferase, and platelet count)
Correlation of FIB-4 with invasive haemodynamic parameters, tricuspid regurgitation severity, MELD/MELD-XI scores
- No significant association
Original publication
Summarised from the published abstract; every number is checked against it