Association between liver fibrosis scores and the risk of mortality among patients with coronary artery disease

Abstract

Background and aims

Fatty liver diseases are highly prevalent in patients with coronary artery disease (CAD) and might progress to irreversible liver fibrosis. Whether baseline liver fibrosis (LF) scores are associated with long-term mortality among patients with CAD requires investigation.

Methods

The analysis was conducted based on a prospective cohort study among 3263 patients with CAD in China. Cox models were used to assess the association of baseline levels of LF scores, including non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis 4 score (FIB-4), aspartate aminotransferase to platelet ratio index (APRI), gamma-glutamyltransferase to platelet ratio (GPR), and Forns score, with the risk of all-cause and cardiovascular mortality among CAD patients.

Results

During a median follow-up period of 7.56 (inter-quartile range: 6.86–8.31) years, 538 deaths were identified, 319 of those were due to cardiovascular diseases. Compared with patients with lowest score levels, multivariable-adjusted HRs (95% CI) for those with highest levels of NFS, FIB-4, APRI, GPR and Forns score were 2.89 (2.14–3.91), 2.84 (2.14–3.76), 1.77 (1.33–2.36), 1.47 (1.19–1.83) and 3.10 (1.88–5.11) for all-cause mortality, 3.02 (2.05–4.45), 3.34 (2.29–4.86), 1.99 (1.40–2.83), 1.80 (1.36–2.39) and 2.43 (1.28–4.61) for cardiovascular mortality, respectively. These associations were consistent when we excluded those who died within the first year of follow-up or stratified patients by different sex, age, BMI, diabetes status, metabolic syndrome status, CAD type and hsCRP level.

Conclusions

Higher LF scores are associated with increased risks of all-cause and cardiovascular mortality among CAD patients. LF scores might play a potential role in CAD prognosis prediction.